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Sample records for repeat antenatal corticosteroids

  1. Effects of Antenatal Corticosteroids in Preterm Delivery

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    Kuo-Gon Wang

    2004-12-01

    Full Text Available Antenatal corticosteroid administration is one of the most effective methods to improve perinatal outcomes. It reduces the incidence of respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia and necrotizing enterocolitis in preterm neonates. Antenatal corticosteroids are also effective in treating maternal hemolysis, elevated liver enzymes and low platelet count syndrome. However, complications in neonates and mothers may occur when antenatal corticosteroids are given, including infection, sepsis and maternal pulmonary edema. The National Institutes of Health Consensus Development Conference recommends treatment regimens of either two 12 mg doses of betamethasone given intramuscularly 24 hours apart or four 6 mg doses of dexamethasone given intramuscularly 12 hours apart between 24 and 34 weeks of gestation in pregnancies at risk for preterm delivery. The benefits are most apparent when the corticosteroids are administered between 24 hours and 7 days before delivery. In principle, antenatal steroid therapy should not be routinely repeated in patients with preterm labor. For preterm premature rupture of membranes at less than 30–32 weeks of gestation, antenatal corticosteroids are also suggested as long as there is no evidence of infection.

  2. Glycemic management after antenatal corticosteroid therapy

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    Sanjay Kalra

    2014-01-01

    Full Text Available Antenatal corticosteroids (ACS are recommended for use in antenatal mothers at risk of preterm delivery before 34 weeks. One common side-effect of these drugs is their propensity to cause hyperglycemia. A PubMed search was made using terms ′steroid,′ ′dexamethasone,′ ′betamethasone′ with diabetes/glucose. Relevant articles were extracted. In addition, important cross-reference articles were reviewed. This review, based upon this literature search, discusses the available evidence on effects on glycemic status as well as management strategies in women with pre-existing diabetes, gestational diabetes mellitus, as well as normoglycemic women after ACS use in pregnancy.

  3. Uso antenatal do corticosteroide e hemorragia peri-intraventricular Antenatal corticosteroids and intraventricular hemorrhage

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    Luis Eduardo de F. Vinagre

    2010-09-01

    Full Text Available OBJETIVO: Realizar uma revisão bibliográfica sobre o uso antenatal do corticosteroide na prevenção da hemorragia peri-intraventricular. FONTES DE DADOS: Levantamento bibliográfico por meio do Pubmed e SciELO abrangendo os últimos 20 anos. Foram utilizadas as palavras chaves no idioma inglês: "cerebral hemorrhage", "steroids" e "newborn, infant". SÍNTESES DE DADOS: A hemorragia peri-intraventricular é uma importante patologia nos prematuros, sobretudo nos menores de 34 semanas, devido a suas graves sequelas neurológicas. Uma vez ocorrido o sangramento, não há tratamento específico. Desta forma, a prevenção torna-se o maior objetivo das pesquisas. O resultado da meta-análise de estudos randomizados demonstrou que o corticosteroide antenatal reduz a mortalidade e a incidência da doença de membrana hialina e da hemorragia peri-intraventricular. O efeito protetor na redução do risco da hemorragia peri-intraventricular não está completamente esclarecido. Além de acelerar a maturidade pulmonar, o corticosteroide antenatal estimula a maturação da microvasculatura da matriz germinativa, promove o espessamento da membrana basal, acelera a formação proteica nas junções firmes e estabiliza o fluxo sanguíneo cerebral. Também melhora as condições de nascimento dos fetos pré-termo. CONCLUSÕES: O uso antenatal do corticosteroide associado à implementação de melhores práticas de atendimento ao prematuro tem sido responsável pela evidente redução dos índices dessa doença. Apesar de comprovada eficácia e segurança, não é amplamente utilizado. Medidas devem ser tomadas para estimular seu uso como prática rotineira no atendimento de gestantes com risco de parto prematuro.OBJECTIVE: To conduct a literature review on the use of antenatal corticosteroids for the prevention of peri-intraventricular hemorrhage. DATA SOURCE: Bibliography search in Pubmed and SciELO databases covering the past 20 years using the following

  4. Risk of preterm delivery: a single course of antenatal corticosteroids.

    Science.gov (United States)

    2010-08-01

    For women at risk of delivery before 34 weeks of gestation, administration of betamethasone or dexamethasone for 24 or 36 hours reduces neonatal morbidity and mortality. In a double-blind randomised trial involving 1858 pregnant women, who received either a single course of corticosteroids or multiple courses every 14 days, no statistically significant difference in the rates of mortality and respiratory morbidity were observed during the 28 first days of life. Newborns had decreased height, weight and head circumference in the group treated every 14 days. No difference in outcome was noted at 2 years among 1047 infants whose mothers had received a single course of betamethasone or weekly treatment up to 32 weeks of gestation. Similarly, no difference in outcome was observed among 556 children whose mothers had received an initial course of betamethasone followed by regular injections of either betamethasone or placebo. However, 6 children (2.9%) exposed to repeated maternal treatment developed cerebral palsy, versus only one of the children (0.5%) exposed to a single course, indicating that repeat courses of antenatal corticosteroids might have a detrimental effect. In practice, it seems prudent to only use a single course of corticosteroids in this setting.

  5. [Antenatal corticosteroid therapy and late preterm infant morbidity and mortality].

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    Gázquez Serrano, I M; Arroyos Plana, A; Díaz Morales, O; Herráiz Perea, C; Holgueras Bragado, A

    2014-12-01

    Late preterm infants (34-36 weeks gestation) have a morbidity rate significantly higher than those born at term. However, few interventions have been undertaken to reduce this increased morbidity and mortality. Antenatal corticosteroid administration could be an effective preventive measure. The aim of this study was to describe the morbidity associated with late prematurity in our institution, and determine if there are differences between those who received antenatal corticosteroids. A prospective observational study was conducted on late preterm infants born in a tertiary hospital from October 2011 until September 2012. Two groups were formed according to whether or not they had received antenatal steroids. The rates of morbidity and mortality for each of the groups were analysed and compared. There was a total of 4127 live newborns during the study period, of whom 3795 were term and 332 were preterm (the overall prematurity rate was 8.04%). There were 247 late preterm deliveries, representing 6% of live born infants, and 74.4% of all premature infants. Of late preterm infants, 63.2% were admitted to the Neonatal Unit and 29.6% had received antenatal steroids. The incidence of admission to the Neonatal Unit and Neonatal Intensive Care, transient tachypnea, need for respiratory support in the form of continuous positive pressure airway and oxygen therapy, incidence of hypoglycemia, feeding difficulty, and jaundice requiring phototherapy were significantly higher (P<.05) in the late preterm group that did not receive antenatal steroids. Our finding suggests that the administration of antenatal corticosteroids to patients at risk of 34-36 weeks delivery could significantly reduce the cost and acute morbidity associated with late preterm birth. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  6. Consumers attitudes and beliefs towards the receipt of antenatal corticosteroids and use of clinical practice guidelines

    National Research Council Canada - National Science Library

    McGoldrick, E L; Crawford, T; Brown, J A; Groom, K M; Crowther, C A

    2016-01-01

    ...) demonstrating scepticism towards their purpose and applicability to their needs. There is no information pertaining to consumers' views and attitudes on the receipt of antenatal corticosteroids (ACS...

  7. Does the time of delivery after antenatal corticosteroids matter?

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    Patrícia Campos

    2016-01-01

    Full Text Available Introduction: Preterm delivery is associated with an increased risk of newborn morbidity and mortality. Respiratory distress syndrome (RDS is the most common comorbidity. It has been proven that this syndrome can be prevented with the administration of antenatal corticosteroids to women at risk of preterm delivery, before 35 weeks of gestational age.Aim: To evaluate the risk factors, severity, co-morbidities, and mortality of RDS in newborns of less than 35 weeks of gestational age, with specific emphasis on the association between the elapsed time since the administration of the last dose of a full cycle of corticosteroids and the frequency and severity of RDS.Methods: This descriptive retrospective study includes all newborns of less than 35 weeks of gestational age, who were born at our center between January 1, 2012 and December 31, 2014 and admitted to Neonatal Intensive Care Unit (NICU. Newborns with major malformations, chromosomopathies, hydrops, congenital TORCH infection or outborns were excluded. RDS was diagnosed according to the criteria of the Update on the European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants (2013 and classified with a grade of I to III, in accord with radiographic results.Results: A total of 234 newborns were studied, of which 35.5% had RDS. Antenatal corticosteroids were used for 90.1% of all newborns. When adjusted to the severity of RDS, birth weight, gestational age, and vasopressor support were all predictive factors of newborn mortality. A ROC curve identified a cut-off of at most 10.5 hours between the last dose of a full cycle of corticosteroids and the delivery as higher risk of onset of RDS and another cut-off of at most 6.5 hours as higher risk of onset of moderate to severe RDS (sensitivity of 80.0% and 83.3%, respectively.Conclusion: The last dose of a full antenatal corticosteroids cycle must be given at least 10.5 hours prior to delivery to

  8. Pituitary-adrenal response in preterm very low birth weight infants after treatment with antenatal corticosteroids

    National Research Council Canada - National Science Library

    Ng, P C; Wong, G W; Lam, C W; Lee, C H; Wong, M Y; Fok, T F; Wong, W; Chan, D C

    1997-01-01

    Antenatal corticosteroids have been widely used for the prevention of respiratory distress syndrome in preterm neonates, yet little is known about their effects on the hypothalamic-pituitary-adrenal...

  9. Do antenatal corticosteroids in term elective cesarean sections reduce neonatal respiratory morbidity?

    National Research Council Canada - National Science Library

    Petour Gazitúa, Felipe; Pérez Velásquez, Javiera

    2015-01-01

    .... To find the best evidence available to determine whether the use of antenatal corticosteroids reduces the incidence of respiratory distress syndrome in term babies born by elective caesarean section...

  10. Use of antenatal corticosteroids for preterm birth in Latin America: providers knowledge, attitudes and practices

    National Research Council Canada - National Science Library

    Aleman, Alicia; Cafferata, Maria L; Gibbons, Luz; Althabe, Fernando; Ortiz, Jose; Sandoval, Xochitl; Padilla-Raygoza, Nicolás; Belizán, José M

    2013-01-01

    Antenatal corticosteroids administered to women at risk of preterm birth is an intervention which has been proved to reduce the risk of respiratory distress syndrome, intraventricular hemorrhage, and neonatal mortality...

  11. Mid-Childhood Bone Mass After Exposure to Repeat Doses of Antenatal Glucocorticoids: A Randomized Trial.

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    McKinlay, Christopher J D; Cutfield, Wayne S; Battin, Malcolm R; Dalziel, Stuart R; Crowther, Caroline A; Harding, Jane E

    2017-05-01

    Treatment of women at risk for preterm birth with repeat doses of glucocorticoids reduces neonatal morbidity, but could have adverse effects on skeletal development. We assessed whether exposure to repeat antenatal betamethasone alters bone mass in children whose mothers participated in the Australasian Collaborative Trial of Repeat Doses of Corticosteroids. Women were randomized to a single dose of betamethasone or placebo, ≥7 days after an initial course of glucocorticoids, repeated each week that they remained at risk for preterm birth at children underwent whole-body dual-energy radiograph absorptiometry at 6 to 8 years' corrected age. Of 212 eligible childhood survivors, 185 were studied (87%; 91 repeat betamethasone group; 94 placebo [single course] group). Children exposed to repeat antenatal betamethasone and those exposed to placebo had similar whole-body bone mineral content (median repeat betamethasone: 553 g, interquartile range: 442-712 g; placebo: 567 g, interquartile range: 447-750 g; geometric mean ratio: 0.99; 95% confidence interval: 0.94-1.03, P = .55) and bone area (median repeat betamethasone 832 cm(2), interquartile range: 693-963 cm(2); placebo: 822 cm(2), interquartile range: 710-1020 cm(2); geometric mean ratio: 0.99, 95% confidence interval: 0.92-1.07, P = .75). Exposure to repeat doses of antenatal betamethasone compared with a single course of glucocorticoids does not alter bone mass in mid-childhood. Copyright © 2017 by the American Academy of Pediatrics.

  12. Antenatal corticosteroid therapy : short-term effects on fetal behaviour and haemodynamics

    NARCIS (Netherlands)

    Mulder, E. J. H.; de Heus, R.; Visser, G. H. A.

    2009-01-01

    Antenatal corticosteroid therapy to enhance fetal lung maturity in threatened preterm delivery has a number of non-pulmonary side-effects, both beneficial and undesirable. This review focuses on the short-term (transient) effects of betamethasone and dexamethasone on aspects of fetal circulation and

  13. Prescribing patterns of antenatal corticosteroids in women with threatened preterm labor

    NARCIS (Netherlands)

    Wilms, F.F.; Baaren, G.J. van; Vis, J.Y.; Oudijk, M.A.; Kwee, A.; Porath, M.M.; Scheepers, H.C.; Spaanderman, M.E.; Bloemenkamp, K.W.; Bolte, A.C.; Bax, C.J.; Cornette, J.M.; Duvekot, J.J.; Bijvank, B.W. Nij; Eyck, J. van; Franssen, M.T.; Sollie, K.M.; Vandenbussche, F.P.H.A.; Woiski, M.D.; Post, J.A. van der; Bossuyt, P.M.; Opmeer, B.C.; Mol, B.W.

    2015-01-01

    OBJECTIVE: To assess the impact of cervical length (CL) measurement and fetal fibronectin testing (fFN) on the clinicians' decision to prescribe antenatal corticosteroids (ACS) to women with symptoms of preterm labor. STUDY DESIGN: This is a secondary analysis of a prospective cohort study including

  14. Prescribing patterns of antenatal corticosteroids in women with threatened preterm labor

    NARCIS (Netherlands)

    Wilms, Femke F; van Baaren, Gert-Jan; Vis, Jolande Y; Oudijk, Martijn A; Kwee, Anneke; Porath, Martina M; Scheepers, Hubertina C J; Spaanderman, Marc E A; Bloemenkamp, Kitty W M; Bolte, Antoinette C; Bax, Caroline J; Cornette, Jérôme M J; Duvekot, Johannes J; Nij Bijvank, Bas W A; van Eyck, Jim; Franssen, Maureen T M; Sollie, Krystyna M; Vandenbussche, Frank P H A; Woiski, Mallory D; van der Post, Joris A M; Bossuyt, Patrick M M; Opmeer, Brent C; Mol, Ben W J

    OBJECTIVE: To assess the impact of cervical length (CL) measurement and fetal fibronectin testing (fFN) on the clinicians' decision to prescribe antenatal corticosteroids (ACS) to women with symptoms of preterm labor. STUDY DESIGN: This is a secondary analysis of a prospective cohort study including

  15. Prescribing patterns of antenatal corticosteroids in women with threatened preterm labor

    NARCIS (Netherlands)

    Wilms, Femke F.; van Baaren, Gert-Jan; Vis, Jolande Y.; Oudijk, Martijn A.; Kwee, Anneke; Porath, Martina M.; Scheepers, Hubertina C. J.; Spaanderman, Marc E. A.; Bloemenkamp, Kitty W. M.; Bolte, Antoinette C.; Box, Caroline J.; Cornette, Jerome M. J.; Duvekot, Johannes J.; Bijvank, Bas W. A. Nij; van Eyck, Jim; Franssen, Maureen T. M.; Sollie, Krystyna M.; Vandenbussche, Frank P. H. A.; Woiski, Mallory D.; van der Post, Joris A. M.; Bossuyt, Patrick M. M.; Opmeer, Brent C.; Mol, Ben W. J.

    Objective: To assess the impact of cervical length (CL) measurement and fetal fibronectin testing (fFN) on the clinicians' decision to prescribe antenatal corticosteroids (ACS) to women with symptoms of preterm labor. Study design: This is a secondary analysis of a prospective cohort study including

  16. Antenatal and postnatal corticosteroid and resuscitation induced lung injury in preterm sheep

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    Kallapur Suhas G

    2009-12-01

    Full Text Available Abstract Background Initiation of ventilation using high tidal volumes in preterm lambs causes lung injury and inflammation. Antenatal corticosteroids mature the lungs of preterm infants and postnatal corticosteroids are used to treat bronchopulmonary dysplasia. Objective To test if antenatal or postnatal corticosteroids would decrease resuscitation induced lung injury. Methods 129 d gestational age lambs (n = 5-8/gp; term = 150 d were operatively delivered and ventilated after exposure to either 1 no medication, 2 antenatal maternal IM Betamethasone 0.5 mg/kg 24 h prior to delivery, 3 0.5 mg/kg Dexamethasone IV at delivery or 4 Cortisol 2 mg/kg IV at delivery. Lambs then were ventilated with no PEEP and escalating tidal volumes (VT to 15 mL/kg for 15 min and then given surfactant. The lambs were ventilated with VT 8 mL/kg and PEEP 5 cmH20 for 2 h 45 min. Results High VT ventilation caused a deterioration of lung physiology, lung inflammation and injury. Antenatal betamethasone improved ventilation, decreased inflammatory cytokine mRNA expression and alveolar protein leak, but did not prevent neutrophil influx. Postnatal dexamethasone decreased pro-inflammatory cytokine expression, but had no beneficial effect on ventilation, and postnatal cortisol had no effect. Ventilation increased liver serum amyloid mRNA expression, which was unaffected by corticosteroids. Conclusions Antenatal betamethasone decreased lung injury without decreasing lung inflammatory cells or systemic acute phase responses. Postnatal dexamethasone or cortisol, at the doses tested, did not have important effects on lung function or injury, suggesting that corticosteroids given at birth will not decrease resuscitation mediated injury.

  17. Antenatal Corticosteroids: A Risk Factor for the Development of Chronic Disease

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    Elizabeth Asztalos

    2012-01-01

    Full Text Available Preterm birth remains a major health issue worldwide. Since the 1990s, women at risk for preterm birth received a single course of exogenous antenatal corticosteroids (ACSs to facilitate fetal lung maturity. More recently, repeated or multiple courses of ACS have been supported to provide continued fetal maturity support for women with continued risk of preterm birth. However, exogenous ACS reduces birth weight which, in turn, is associated with adverse adult outcomes such as coronary heart disease, stroke, hypertension, and type 2 diabetes. The long-term effects of ACS exposure on HPA axis activity and neurological function are well documented in animal studies, and it appears that ACS, regardless of dose exposure, is capable of affecting fetal HPA axis development causing permanent changes in the HPA axis that persists through life and is manifested by chronic illness and behavioral changes. The challenge in human studies is to demonstrate whether an intervention such as ACS administration in pregnancy contributes to developmental programming and how this is manifested in later life.

  18. Association between gestational age at birth, antenatal corticosteroids, and outcomes at 5 years: multiple courses of antenatal corticosteroids for preterm birth study at 5 years of age (MACS-5)

    National Research Council Canada - National Science Library

    Asztalos, Elizabeth; Willan, Andrew; Murphy, Kellie; Matthews, Stephen; Ohlsson, Arne; Saigal, Saroj; Armson, Anthony; Kelly, Edmond; Delisle, Marie-France; Gafni, Amiram; Lee, Shoo; Sananes, Renee; Rovet, Joanne; Guselle, Patricia; Amankwah, Kofi

    2014-01-01

    The Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study (MACS) showed no benefit in the reduction of major neonatal mortality/morbidity or neurodevelopment at 2 and 5 years of age...

  19. Two-year follow-up of a randomised trial with repeated antenatal betamethasone.

    Science.gov (United States)

    Peltoniemi, O M; Kari, M A; Lano, A; Yliherva, A; Puosi, R; Lehtonen, L; Tammela, O; Hallman, M

    2009-11-01

    Weekly repeated antenatal corticosteroid treatment improves respiratory outcome but decreases fetal growth and may impair neurodevelopmental outcome. We have previously reported that a single repeat betamethasone (BM) dose neither decreased fetal growth nor improved the outcome of preterm infants during the first hospitalisation. To study prospectively whether a single repeat dose of BM influences neurodevelopment and growth within 2 years. Women with imminent delivery before 34.0 gestational weeks were eligible if they remained undelivered for >7 days after a single course of antenatal BM. After stratification, a single repeat dose of BM (12 mg) or placebo was given. The children underwent neurological and psychometric examinations and a speech evaluation at a corrected age of 2 years. Prospective, blinded evaluation following the randomised multicentre trial. 259 (82%) surviving infants completed the 2-year follow-up, 120 in the BM group and 139 in the placebo group. The rate of survival without severe neurodevelopmental impairment was similar in both groups (BM 98%, placebo 99%). The risk of cerebral palsy (BM 2%, placebo 1%), growth or re-hospitalisation rates (BM 60%, placebo 50%) did not differ between the groups. A single repeat dose of antenatal BM tended not to influence physical growth or neurodevelopment at 2 years of age.

  20. Antenatal corticosteroids trial in preterm births to increase neonatal survival in developing countries: study protocol

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    Althabe Fernando

    2012-09-01

    Full Text Available Abstract Background Preterm birth is a major cause of neonatal mortality, responsible for 28% of neonatal deaths overall. The administration of antenatal corticosteroids to women at high risk of preterm birth is a powerful perinatal intervention to reduce neonatal mortality in resource rich environments. The effect of antenatal steroids to reduce mortality and morbidity among preterm infants in hospital settings in developed countries with high utilization is well established, yet they are not routinely used in developing countries. The impact of increasing antenatal steroid use in hospital or community settings with low utilization rates and high infant mortality among premature infants due to lack of specialized services has not been well researched. There is currently no clear evidence about the safety of antenatal corticosteroid use for community-level births. Methods We hypothesize that a multi country, two-arm, parallel cluster randomized controlled trial to evaluate whether a multifaceted intervention to increase the use of antenatal corticosteroids, including components to improve the identification of pregnancies at high risk of preterm birth and providing and facilitating the appropriate use of steroids, will reduce neonatal mortality at 28 days of life in preterm newborns, compared with the standard delivery of care in selected populations of six countries. 102 clusters in Argentina, Guatemala, Kenya, India, Pakistan, and Zambia will be randomized, and around 60,000 women and newborns will be enrolled. Kits containing vials of dexamethasone, syringes, gloves, and instructions for administration will be distributed. Improving the identification of women at high risk of preterm birth will be done by (1 diffusing recommendations for antenatal corticosteroids use to health providers, (2 training health providers on identification of women at high risk of preterm birth, (3 providing reminders to health providers on the use of the kits, and

  1. Ovine fetal thymus response to lipopolysaccharide-induced chorioamnionitis and antenatal corticosteroids.

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    Elke Kuypers

    Full Text Available RATIONALE: Chorioamnionitis is associated with preterm delivery and involution of the fetal thymus. Women at risk of preterm delivery receive antenatal corticosteroids which accelerate fetal lung maturation and improve neonatal outcome. However, the effects of antenatal corticosteroids on the fetal thymus in the settings of chorioamnionitis are largely unknown. We hypothesized that intra-amniotic exposure to lipopolysaccharide (LPS causes involution of the fetal thymus resulting in persistent effects on thymic structure and cell populations. We also hypothesized that antenatal corticosteroids may modulate the effects of LPS on thymic development. METHODS: Time-mated ewes with singleton fetuses received an intra-amniotic injection of LPS 7 or 14 days before preterm delivery at 120 days gestational age (term = 150 days. LPS and corticosteroid treatment groups received intra-amniotic LPS either preceding or following maternal intra-muscular betamethasone. Gestation matched controls received intra-amniotic and maternal intra-muscular saline. The fetal intra-thoracic thymus was evaluated. RESULTS: Intra-amniotic LPS decreased the cortico-medullary (C/M ratio of the thymus and increased Toll-like receptor (TLR 4 mRNA and CD3 expression indicating involution and activation of the fetal thymus. Increased TLR4 and CD3 expression persisted for 14 days but Foxp3 expression decreased suggesting a change in regulatory T-cells. Sonic hedgehog and bone morphogenetic protein 4 mRNA, which are negative regulators of T-cell development, decreased in response to intra-amniotic LPS. Betamethasone treatment before LPS exposure attenuated some of the LPS-induced thymic responses but increased cleaved caspase-3 expression and decreased the C/M ratio. Betamethasone treatment after LPS exposure did not prevent the LPS-induced thymic changes. CONCLUSION: Intra-amniotic exposure to LPS activated the fetal thymus which was accompanied by structural changes. Treatment

  2. Antenatal treatment with corticosteroids for preterm neonates: impact on the incidence of respiratory distress syndrome and intra-hospital mortality

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    Joice Fabíola Meneguel

    Full Text Available CONTEXT: Although the benefits of antenatal corticosteroids have been widely demonstrated in other countries, there are few studies among Brazilian newborn infants. OBJECTIVE: To evaluate the effectiveness of antenatal corticosteroids on the incidence of respiratory distress syndrome and intra-hospital mortality among neonates with a gestational age of less than 34 weeks. TYPE OF STUDY: Cross-sectional. SETTING: A tertiary-care hospital. PARTICIPANTS: Neonates exposed to any dose of antenatal corticosteroids for fetal maturation up to 7 days before delivery, and newborns paired by sex, birth weight, gestational age and time of birth that were not exposed to antenatal corticosteroids. The sample obtained consisted of 205 exposed newborns, 205 non-exposed and 39 newborns exposed to antenatal corticosteroids for whom it was not possible to find an unexposed pair. PROCEDURES: Analysis of maternal and newborn records. MAIN MEASUREMENTS: The primary clinical outcomes for the two groups were compared: the incidence of respiratory distress syndrome and intra-hospital mortality; as well as secondary outcomes related to neonatal morbidity. RESULTS: Antenatal corticosteroids reduced the occurrence of respiratory distress syndrome (OR: 0.33; 95% CI: 0.21-0.51 and the protective effect persisted when adjusted for weight, gestational age and the presence of asphyxia (adjusted OR: 0.27; 95% CI: 0.17-0.43. The protective effect could also be detected through the reduction in the need for and number of doses of exogenous surfactant utilized and the number of days of mechanical ventilation needed for the newborns exposed to antenatal corticosteroids. Their use also reduced the occurrence of intra-hospital deaths (OR: 0.51: 95% CI: 0.38-0.82. However, when adjusted for weight, gestational age, presence of prenatal asphyxia, respiratory distress syndrome, necrotizing enterocolitis and use of mechanical ventilation, the antenatal corticosteroids did not maintain the

  3. Cardiovascular risk factors in children after repeat doses of antenatal glucocorticoids: an RCT.

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    McKinlay, Christopher J D; Cutfield, Wayne S; Battin, Malcolm R; Dalziel, Stuart R; Crowther, Caroline A; Harding, Jane E

    2015-02-01

    Treatment of women at risk for preterm birth with repeat doses of glucocorticoids reduces neonatal morbidity but could have adverse long-term effects on cardiometabolic health in offspring. We assessed whether exposure to repeat antenatal betamethasone increased risk factors for later cardiometabolic disease in children whose mothers participated in the Australasian Collaborative Trial of Repeat Doses of Corticosteroids. Women were randomized to betamethasone or placebo treatment, ≥ 7 days after an initial course of glucocorticoids, repeated each week that they remained at risk for preterm birth at children were assessed at 6 to 8 years' corrected age for body composition, insulin sensitivity, ambulatory blood pressure, and renal function. Of 320 eligible childhood survivors, 258 were studied (81%; 123 repeat betamethasone group; 135 placebo [single course] group). Children exposed to repeat antenatal betamethasone and those exposed to placebo had similar total fat mass (geometric mean ratio 0.98, 95% confidence interval [CI] 0.78 to 1.23), minimal model insulin sensitivity (geometric mean ratio 0.89, 95% CI 0.74 to 1.08), 24-hour ambulatory blood pressure (mean difference systolic 0 mm Hg, 95% CI -2 to 2; diastolic 0 mm Hg, 95% CI -1 to 1), and estimated glomerular filtration rate (mean difference 1.2 mL/min/1.73 m(2), 95% CI -3.2 to 5.6). Exposure to repeat doses of antenatal betamethasone compared with a single course of glucocorticoids does not increase risk factors for cardiometabolic disease at early school age. Copyright © 2015 by the American Academy of Pediatrics.

  4. Effect of antenatal corticosteroid treatment on the fetal lung: a magnetic resonance imaging study.

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    Schmid, M; Kasprian, G; Kuessel, L; Messerschmidt, A; Brugger, P C; Prayer, D

    2011-07-01

    To investigate the effect of antenatal corticosteroid treatment on the fetal lung using magnetic resonance imaging. Prospective evaluation of 30 consecutive singleton pregnancies that received antenatal corticosteroid treatment (12 mg betamethasone i.m. on admission and 24 h later) because of threatened preterm birth. Fetal lungs were assessed using T2-weighted single-shot fast spin-echo images of a whole-body 1.5-T superconducting unit twice: less than 24 h and more than 48 h after the first course of betamethasone. Lung volumes and lung-liver signal-intensity ratios were compared between the two time points. Nine patients had to be excluded from the analysis because they did not complete the study protocol as required. Ten female and 11 male fetuses with a gestational age between 23.4 and 32.6 weeks were included in the final analysis. The mean gestational age of included fetuses was 27.5 ± 2.8 weeks. Using a linear regression model, a significant influence of gestational age on ln fetal lung volume (r(2)=0.414; P<0.0001) and lung-liver signal-intensity ratios (r(2)=0.271, P<0.0001) was found. Between the two evaluated time points, a significant increase in lung-liver signal-intensity ratios (2.34 ± 0.72 vs. 3.22 ± 1.12, P<0.0001), but not in mean lung volumes (46.6 ± 20.7 cm(3) vs. 48.8 ± 16.0 cm(3) , P=0.292), was observed. We demonstrate a significant increase in lung-liver signal-intensity ratios after antenatal corticosteroid treatment for induction of lung maturation which most likely reflects changing properties of the fetal lung parenchyma. This could potentially be useful in non-invasively assessing the effect of antenatal corticosteroid treatment on the lungs of fetuses at risk for preterm birth. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

  5. [Do antenatal corticosteroids in term elective cesarean sections reduce neonatal respiratory morbidity?].

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    Petour Gazitúa, Felipe; Pérez Velásquez, Javiera

    2015-10-07

    Neonatal respiratory distress syndrome is closely related to gestational age and mode of birth. Lowest gestational ages and caesarean section are associated with higher risk of developing respiratory distress syndrome. The efficacy of antenatal corticosteroids is well established in the induction of lung maturation in premature births. Its use could be a beneficial intervention in term fetuses that will be born by elective caesarean section. To find the best evidence available to determine whether the use of antenatal corticosteroids reduces the incidence of respiratory distress syndrome in term babies born by elective caesarean section. We searched the available medical literature in different databases: PubMed, LILACS, UpToDate, Trip database, SciELO and Cochrane. We considered controlled, randomized therapeutic studies, performed on humans, in which the intervention included corticosteroids as a treatment in elective term cesareans. We selected two studies. In both, the intervention was two doses of 12 mg of dexamethasone before the caesarean section. The primary objective in both studies was to analyze the incidence of respiratory distress syndrome and the admission of the newborn into intensive care units. In both studies, there was less incidence of neonatal respiratory distress syndrome, with statistically significant results. We concluded that the use of corticosteroids in elective term caesarean section reduces the incidence of neonatal respiratory distress syndrome and the admission into intensive care units. However, we evidenced certain weaknesses that could modify the internal validity of both studies, so it is necessary to develop new studies that could support these findings in order to modify clinical protocols in term elective caesarean sections.

  6. Ontogeny of hippocampal corticosteroid receptors: effects of antenatal glucocorticoids in human and mouse.

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    Noorlander, C W; De Graan, P N E; Middeldorp, J; Van Beers, J J B C; Visser, G H A

    2006-12-20

    Women at risk for preterm delivery are treated with synthetic glucocorticoids (GCs) to enhance fetal lung maturation. GCs can bind to two intracellular receptors, the glucocorticoid receptor (GR) and the mineralocorticoid receptor (MR), which function as transcription factors. Both are highly expressed in the hippocampus. Several studies have focused on adverse side effects of antenatal GC treatment. However, relatively little is known about the ontogeny of GR and MR, especially in human. Therefore, we studied the ontogeny of both receptors in the human and mouse hippocampus and investigated the effects of antenatal dexamethasone (dex) treatment, a synthetic glucocorticoid, on MR and GR mRNA levels during hippocampal development. The results demonstrate that MR mRNA was first expressed in mouse hippocampus at embryonic day (E)15.5, at the timepoint when dex was administered. In contrast, GR mRNA expression was first observed after birth at postnatal day (P)5. However, in the human hippocampus both receptors are expressed at 24 weeks of gestation, when antenatal GCs are administered in clinical practice. Quantitative in situ hybridization demonstrated that MR mRNA levels were reduced only shortly after dex treatment at E16, but were unaffected from E18 onwards. These findings indicate that a single antenatal dex administration at E15.5 transiently affects MR mRNA levels in the mouse hippocampus. No effect of antenatal dex treatment was found on the human hippocampus at the third trimester of pregnancy. These data on the prenatal ontogeny of both corticosteroid receptors in the human hippocampus is important for understanding the significance of fetal glucocorticoid or stress exposure and its potential effects on health and disease.

  7. Antenatal corticosteroids impact the inflammatory rather than the antiangiogenic profile of women with preeclampsia.

    Science.gov (United States)

    Nayeri, Unzila A; Buhimschi, Irina A; Laky, Christine A; Cross, Sarah N; Duzyj, Christina M; Ramma, Wenda; Sibai, Baha M; Funai, Edmund F; Ahmed, Asif; Buhimschi, Catalin S

    2014-06-01

    Circulating antiangiogenic factors and proinflammatory cytokines are implicated in the pathogenesis of preeclampsia. This study was performed to test the hypothesis that steroids modify the balance of inflammatory and proangiogenic and antiangiogenic factors that potentially contribute to the patient's evolving clinical state. Seventy singleton women, admitted for antenatal corticosteroid treatment, were enrolled prospectively. The study group consisted of 45 hypertensive women: chronic hypertension (n=6), severe preeclampsia (n=32), and superimposed preeclampsia (n=7). Normotensive women with shortened cervix (preeclampsia cases were obtained before steroids and then serially up until delivery. A clinical severity score was designed to clinically monitor disease progression. Serum levels of angiogenic factors (soluble fms-like tyrosine kinase-1 [sFlt-1], placental growth factor [PlGF], soluble endoglin [sEng]), endothelin-1 (ET-1), and proinflammatory markers (IL-6, C-reactive protein [CRP]) were assessed before and after steroids. Soluble IL-2 receptor (sIL-2R) and total immunoglobulins (IgG) were measured as markers of T- and B-cell activation, respectively. Steroid treatment coincided with a transient improvement in clinical manifestations of preeclampsia. A significant decrease in IL-6 and CRP was observed although levels of sIL-2R and IgG remained unchanged. Antenatal corticosteroids did not influence the levels of angiogenic factors but ET-1 levels registered a short-lived increase poststeroids. Although a reduction in specific inflammatory mediators in response to antenatal steroids may account for the transient improvement in clinical signs of preeclampsia, inflammation is unlikely to be the major contributor to severe preeclampsia or useful for therapeutic targeting.

  8. Preterm premature rupture of membranes and the rate of neonatal sepsis after two courses of antenatal corticosteroids.

    Science.gov (United States)

    Gyamfi-Bannerman, Cynthia; Son, Moeun

    2014-11-01

    To evaluate whether a second antenatal corticosteroid course is associated with an increased risk of neonatal sepsis after preterm premature rupture of membranes (PROM). This secondary analysis is a cohort study with data from the Maternal-Fetal Medicine Units study on magnesium for neuroprotection. Women with singleton gestations and preterm PROM were eligible. The primary exposure was one compared with two antenatal corticosteroid courses. The primary outcome, neonatal sepsis, was compared between exposed groups. Patient characteristics were analyzed by χ2 for categorical variables and Student t test or Wilcoxon rank-sum for continuous variables where appropriate. Predictors of neonatal sepsis were analyzed by multivariable logistic regression. One thousand six hundred forty-one patients were eligible. Neonatal sepsis was similar among neonates born to mothers who received one or two antenatal corticosteroid courses (16.2% compared with 17.2%, P=.756, respectively). Adjusting for confounders, the factors associated with neonatal sepsis were length of time from membrane rupture to delivery (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.02-2.26), respiratory distress syndrome (OR 2.11, 95% CI 1.45-3.07), gestational age at delivery in days (OR 0.98, 95% CI 0.95-0.99) and birth weight per 100 g (OR 0.85, 95% CI 0.77-0.94). A second maternal antenatal corticosteroid course was not associated with an increased rate neonatal sepsis.

  9. Effects of antenatal corticosteroid administration on mortality and long-term morbidity in early preterm, growth-restricted infants

    NARCIS (Netherlands)

    Schaap, AH; Wolf, H; Bruinse, HW; Smolders-De Haas, H; Van Ertbruggen, [No Value; Treffers, PE

    Objective: To evaluate the effect of antenatal corticosteroids on mortality, morbidity, and disability or handicap rate in early preterm, growth-restricted infants. Methods: This case-control study in two tertiary care centers included all live-born singleton infants with growth-restriction due to

  10. Cardiovascular risk factors in children after repeat doses of antenatal glucocorticoids: an RCT

    National Research Council Canada - National Science Library

    McKinlay, Christopher J D; Cutfield, Wayne S; Battin, Malcolm R; Dalziel, Stuart R; Crowther, Caroline A; Harding, Jane E

    2015-01-01

    .... We assessed whether exposure to repeat antenatal betamethasone increased risk factors for later cardiometabolic disease in children whose mothers participated in the Australasian Collaborative Trial...

  11. Can We Accurately Time the Administration of Antenatal Corticosteroids for Preterm Labor?

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    Paola Aghajanian

    2016-01-01

    Full Text Available Background. Accurate timing of antenatal corticosteroids (ACS has resulted in improved neonatal outcomes. Objectives. Our primary objective was to determine predictors for optimal timing of ACS in women presenting with spontaneous preterm labor. Study Design. A retrospective cohort study of women receiving ACS for spontaneous preterm birth was conducted. Women were included if they presented with preterm labor or preterm premature rupture of membranes. Accurate timing of ACS was defined as administration within 7 days of delivery. Maternal demographic and obstetrics characteristics were compared between the groups receiving ACS ≤7 days and >7 days from delivery. Statistical analyses were performed using parametric and nonparametric tests. P<0.05 was considered significant. Results. The study included 215 subjects. Median latency from ACS administration to delivery was 6 days (IQR 32. Accurate timing of ACS occurred in 113 (53% women and was associated with rupture of membranes (OR 13.8, 95% CI 5.9–32.6, cervical change (OR 7.1, 95% CI 3.0–17.1, and cervical dilation ≥ 2 cm (OR 3.9, 95% CI 1.5–10.3. Conclusions. Rupture of membranes, cervical change, and cervical dilation ≥ 2 cm were strong predictors of optimal timing. 53% of women with preterm labor received ACS optimally.

  12. Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials

    Science.gov (United States)

    Saccone, Gabriele

    2016-01-01

    Objective To evaluate the effectiveness of antenatal corticosteroids given at ≥34 weeks’ gestation. Design Systematic review with meta-analysis. Data sources Electronic databases were searched from their inception to February 2016. Eligibility criteria for study selection Randomized clinical trials comparing antenatal corticosteroids with placebo or no treatment in women with a singleton pregnancy at ≥34 weeks’ gestation. Trials on antenatal steroids in women expected to deliver late preterm (340-366 weeks) and trials given before planned cesarean delivery at term (≥37 weeks) were included. Data synthesis The primary outcome was the incidence of severe respiratory distress syndrome (RDS). The summary measures were reported as relative risks or mean differences with 95% confidence intervals. Results Six trials, including 5698 singleton pregnancies, were analyzed. Three included 3200 women at 340-366 weeks’ gestation and at risk of imminent premature delivery at the time of hospital admission. The three other trials included 2498 women undergoing planned cesarean delivery at ≥37 weeks. Overall, infants of mothers who received antenatal corticosteroids at ≥34 weeks had a significantly lower risk of RDS (relative risk 0.74, 95% confidence interval 0.61 to 0.91), mild RDS (0.67, 0.46 to 0.96), moderate RDS (0.39, 0.18 to 0.89), transient tachypnea of the newborn (0.56, 0.37 to 0.86), severe RDS (0.55, 0.33 to 0.91), use of surfactant, and mechanical ventilation, and a significantly lower time receiving oxygen (mean difference −2.06 hours, 95% confidence interval −2.17 to −1.95), lower maximum inspired oxygen concentration (−0.66%, −0.69% to −0.63%), shorter stay on a neonatal intensive care unit (−7.64 days, −7.65 to −7.64), and higher APGAR scores compared with controls. Infants of mothers who received antenatal betamethasone at 340-366 weeks’ gestation had a significantly lower incidence of transient tachypnea of the newborn

  13. Antenatal corticosteroid therapy for foetal maturation in women with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania

    NARCIS (Netherlands)

    Mooij, R.; Mwampagatwa, I. H.; van Dillen, J.; Stekelenburg, J.

    2016-01-01

    Background: Preterm birth is a major cause of neonatal mortality, especially in low and middle income countries. Antenatal corticosteroid therapy for foetal maturation could have a significant impact and therefore is often referred to as an important strategy to reduce neonatal mortality. A recently

  14. Antenatal corticosteroid therapy for foetal maturation in women with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania

    NARCIS (Netherlands)

    Mooij, R.; Mwampagatwa, I. H.; van Dillen, J.; Stekelenburg, J.

    2016-01-01

    Background: Preterm birth is a major cause of neonatal mortality, especially in low and middle income countries. Antenatal corticosteroid therapy for foetal maturation could have a significant impact and therefore is often referred to as an important strategy to reduce neonatal mortality. A recently

  15. Antenatal corticosteroid therapy for foetal maturation in women with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania

    NARCIS (Netherlands)

    Mooij, R.; Mwampagatwa, I.H.; Dillen, J. van; Stekelenburg, J.

    2016-01-01

    BACKGROUND: Preterm birth is a major cause of neonatal mortality, especially in low and middle income countries. Antenatal corticosteroid therapy for foetal maturation could have a significant impact and therefore is often referred to as an important strategy to reduce neonatal mortality. A recently

  16. Antenatal Corticosteroids Alter Insulin Signaling Pathways in Fetal Baboon Skeletal Muscle

    Science.gov (United States)

    BLANCO, Cynthia L.; MOREIRA, Alvaro G.; McGILL, Lisa L.; ANZUETO, Diana G.; NATHANIELSZ, Peter; MUSI, Nicolas

    2015-01-01

    Objective We hypothesize that prenatal exposure to glucocorticoids (GCs) will negatively alter the insulin signal transduction pathway and has differing effects on the fetus according to gestational age at exposure. Methods Twenty-three fetal baboons were delivered from twenty-three healthy, non-diabetic mothers. Twelve preterm (0.67 gestational age) and eleven near term (0.95 gestational age) baboons were euthanized immediately after delivery. Half of the pregnant baboons at each gestation received two doses of intramuscular betamethasone 24-hours apart (170 μg.kg−1) before delivery, while the other half received no intervention. Vastus lateralis muscle was obtained from postnatal animals to measure protein content and gene expression of insulin receptor (IR)-β, IR-β Tyr 1361 phosphorylation (pIR-β), IR substate-1 (IRS-1), IRS-1 tyrosine phosphorylation (pIRS-1), p85 subunit of PI3-kinase (p85), Akt (Protein Kinase B), phospho-Akt Ser473 (pAkt), Akt-1, Akt-2, and glucose transporters (GLUT1 and GLUT4). Results Skeletal muscle from preterm baboons exposed to glucocorticoids had markedly reduced protein content of Akt and Akt-1 (respectively, 73% and 72% from 0.67 gestational age Control, P<0.001); IR-β and pIR-β were decreased (respectively, 94% and 85%, P<0.01) in the muscle of premature GC exposed fetuses, but not in term fetuses. GLUT1 and GLUT4 tended to increase with GC exposure in preterm animals (P=0.09), while GLUT4 increased 6.0 fold in term animals after GC exposure (P<0.05). Conclusion Exposure to a single course of antenatal GCs during fetal life alters the insulin-signaling pathway in fetal muscle in a manner dependent on the stage of gestation. PMID:24756099

  17. Antenatal Corticosteroids and Postnatal Fluid Restriction Produce Differential Effects on AQP3 Expression, Water Handling, and Barrier Function in Perinatal Rat Epidermis

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    Johan Agren

    2010-01-01

    Full Text Available Loss of water through the immature skin can lead to hypothermia and dehydration in preterm infants. The water and glycerol channel aquaglyceroporin-3 (AQP3 is abundant in fetal epidermis and might influence epidermal water handling and transepidermal water flux around birth. To investigate the role of AQP3 in immature skin, we measured in vivo transepidermal water transport and AQP3 expression in rat pups exposed to clinically relevant fluid homeostasis perturbations. Preterm (E18 rat pups were studied after antenatal corticosteroid exposure (ANS, and neonatal (P1 rat pups after an 18 h fast. Transepidermal water loss (TEWL and skin hydration were determined, AQP3 mRNA was quantified by RT-PCR, and in-situ hybridization and immunocytochemistry were applied to map AQP3 expression. ANS resulted in an improved skin barrier (lower TEWL and skin hydration, while AQP3 mRNA and protein increased. Fasting led to loss of barrier integrity along with an increase in skin hydration. These alterations were not paralleled by any changes in AQP3. To conclude, antenatal corticosteroids and early postnatal fluid restriction produce differential effects on skin barrier function and epidermal AQP3 expression in the rat. In perinatal rats, AQP3 does not directly determine net water transport through the skin.

  18. Uso antenatal de corticosteróide e evolução clínica de recém-nascidos pré-termo Antenatal corticosteroid use and clinical evolution of preterm newborn infants

    Directory of Open Access Journals (Sweden)

    2004-08-01

    Full Text Available OBJETIVO: Descrever a freqüência de utilização de corticosteróide antenatal e a evolução clínica dos recém-nascidos pré-termo. MÉTODOS: Estudo observacional prospectivo tipo coorte de todos os neonatos com idade gestacional entre 23 e 34 semanas nascidos na Rede Brasileira de Pesquisas Neonatais entre agosto e dezembro de 2001. Os prontuários médicos foram revistos, as mães entrevistadas e os pré-termos acompanhados. A análise dos dados foi realizada com o teste do qui-quadrado, t de Student, Mann-Whitney, ANOVA e regressão logística múltipla, com nível de significância de 5%. RESULTADOS: Avaliaram-se 463 gestantes e seus 514 recém-nascidos. As gestantes tratadas tiveram mais gestações prévias, consultas de pré-natal, hipertensão arterial e maior uso de tocolíticos. Suas crianças apresentaram melhores escores de Apgar no 1º e 5º minutos, menor necessidade de intervenção na sala de parto e menor SNAPPE II. Nasceram com maior peso e idade gestacional, receberam menos surfatante exógeno, ventilação mecânica e oxigenoterapia. Após regressão logística, o uso pré-natal de corticosteróides manteve de forma independente o efeito protetor para as condições de nascimento e para a diminuição do tempo de ventilação mecânica e esteve associado com aumento na ocorrência de sepse neonatal. CONCLUSÃO: O uso do corticosteróide antenatal foi associado a melhor atendimento pré-natal. As crianças nasceram em melhores condições e tiveram melhor evolução, porém com maior risco de infecção.OBJECTIVES: To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. METHODS: An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal

  19. Reducing neonatal mortality associated with preterm birth: gaps in knowledge of the impact of antenatal corticosteroids on preterm birth outcomes in low-middle income countries.

    Science.gov (United States)

    McClure, Elizabeth M; Goldenberg, Robert L; Jobe, Alan H; Miodovnik, Menachem; Koso-Thomas, Marion; Buekens, Pierre; Belizan, Jose; Althabe, Fernando

    2016-05-24

    The Global Network's Antenatal Corticosteroids Trial (ACT), was a multi-country, cluster-randomized trial to improve appropriate use of antenatal corticosteroids (ACS) in low-resource settings in low-middle income countries (LMIC). ACT substantially increased ACS use in the intervention clusters, but the intervention failed to show benefit in the targeted < 5th percentile birth weight infants and was associated with increased neonatal mortality and stillbirth in the overall population. In this issue are six papers which are secondary analyses related to ACT that explore potential reasons for the increase in adverse outcomes overall, as well as site differences in outcomes. The African sites appeared to have increased neonatal mortality in the intervention clusters while the Guatemalan site had a significant reduction in neonatal mortality, perhaps related to a combination of ACS and improving obstetric care in the intervention clusters. Maternal and neonatal infections were increased in the intervention clusters across all sites and increased infections are a possible partial explanation for the increase in neonatal mortality and stillbirth in the intervention clusters, especially in the African sites. The analyses presented here provide guidance for future ACS trials in LMIC. These include having accurate gestational age dating of study subjects and having care givers who can diagnose conditions leading to preterm birth and predict which women likely will deliver in the next 7 days. All study subjects should be followed through delivery and the neonatal period, regardless of when they deliver. Clearly defined measures of maternal and neonatal infection should be utilized. Trials in low income country facilities including clinics and those without newborn intensive care seem to be of the highest priority.

  20. Antenatal corticosteroid treatment for the prevention of peri-intraventricular haemorrhage in preterm newborns: a retrospective cohort study using transfontanelle ultrasonography

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    Bianca A. Almeida

    2017-06-01

    Full Text Available Objective: The objective of this study was to assess the correlation between antenatal corticosteroids and peri-intraventricular haemorrhage (PIVH using transfontanelle ultrasonography, as well as to evaluate the risk factors for its incidence. Methods: We performed a retrospective cohort study using medical records of preterm newborns. The protocol for maternal corticoid administration for foetal lung maturation included dexamethasone 4 mg (intramuscular 8/8 hours per 48 hours, with one cycle per week. The diagnosis of periintraventricular haemorrhage was based on transfontanelle ultrasonography, using the Papile’s classification. The following risk factors for peri-intraventricular haemorrhage were assessed: birth weight, gestational age at delivery, type of delivery, newborn’s sex, surfactant administration, premature rupture of membranes and previous history of infection during the current pregnancy. The student’s t-test and chi-square test were used for statistical analysis. Results: Our sample population included 184 preterm newborns. Transfontanelle ultrasonography revealed peri-intraventricular haemorrhage in 32 (74.4% and periventricular leukomalacia in 11 (25.6% newborns. Grade I haemorrhage was found in 20 (62.5%, grade II in five (15.6%, and grade III in seven (21.8% newborns, as in accordance with Papile’s classification. Vaginal delivery (p = 0.010, birth weight <1500 g (p = 0.024, gestational age at delivery ≤32 weeks (p = 0.018, and previous history of infection during pregnancy (p = 0.013 were considered risk factors for peri-intraventricular haemorrhage in preterm newborns. Conclusion: Maternal corticoid administration for foetal lung maturation showed a protective effect against peri-intraventricular haemorrhage in preterm newborns. The risk factors for peri-intraventricular haemorrhage were determined.

  1. Optimal time interval between a single course of antenatal corticosteroids and delivery for reduction of respiratory distress syndrome in preterm twins.

    Science.gov (United States)

    Kuk, Jin-Yi; An, Jung-Ju; Cha, Hyun-Hwa; Choi, Suk-Joo; Vargas, Juan E; Oh, Soo-young; Roh, Cheong-Rae; Kim, Jong-Hwa

    2013-09-01

    The objective of the study was to investigate the effect of a single course of antenatal corticosteroid (ACS) therapy on the incidence of respiratory distress syndrome (RDS) in preterm twins according to the time interval between ACS administration and delivery. We performed a retrospective cohort study of twins born between 24 and 34 weeks of gestation from November 1995 to May 2011. Subjects were grouped on the basis of the time interval between the first ACS dose and delivery: the ACS-to-delivery interval of less than 2 days (n = 166), 2-7 days (n = 114), and more than 7 days (n = 66). Pregnancy and neonatal outcomes of each group were compared with a control group of twins who were not exposed to ACS (n = 122). Multiple logistic regression analysis was used to examine the association between the ACS-to-delivery interval and the incidence of RDS after adjusting for potential confounding variables. Compared with the ACS nonexposure group, the incidence of RDS in the group with an ACS-to-delivery interval of less than 2 days was not significantly different (adjusted odds ratio [aOR], 1.089; 95% confidence interval [CI], 0.524-2.262; P = .819). RDS occurred significantly less frequently when the ACS-to-delivery interval was between 2 and 7 days (aOR, 0.419; 95% CI, 0.181-0.968; P = .042). However, there was no significant reduction in the incidence of RDS when the ACS-to-delivery interval exceeded 7 days (aOR, 2.205; 95% CI, 0.773-6.292; P = .139). In twin pregnancies, a single course of ACS treatment was associated with a decreased rate of RDS only when the ACS-to-delivery interval was between 2 and 7 days. Copyright © 2013 Mosby, Inc. All rights reserved.

  2. Repeat prenatal corticosteroid prior to preterm birth: a systematic review and individual participant data meta-analysis for the PRECISE study group (prenatal repeat corticosteroid international IPD study group: assessing the effects using the best level of evidence - study protocol

    Directory of Open Access Journals (Sweden)

    Crowther Caroline A

    2012-02-01

    Full Text Available Abstract Background The aim of this individual participant data (IPD meta-analysis is to assess whether the effects of repeat prenatal corticosteroid treatment given to women at risk of preterm birth to benefit their babies are modified in a clinically meaningful way by factors related to the women or the trial protocol. Methods/Design The Prenatal Repeat Corticosteroid International IPD Study Group: assessing the effects using the best level of Evidence (PRECISE Group will conduct an IPD meta-analysis. The PRECISE International Collaborative Group was formed in 2010 and data collection commenced in 2011. Eleven trials with up to 5,000 women and 6,000 infants are eligible for the PRECISE IPD meta-analysis. The primary study outcomes for the infants will be serious neonatal outcome (defined by the PRECISE International IPD Study Group as one of death (foetal, neonatal or infant; severe respiratory disease; severe intraventricular haemorrhage (grade 3 and 4; chronic lung disease; necrotising enterocolitis; serious retinopathy of prematurity; and cystic periventricular leukomalacia; use of respiratory support (defined as mechanical ventilation or continuous positive airways pressure or other respiratory support; and birth weight (Z-scores. For the children, the primary study outcomes will be death or any neurological disability (however defined by trialists at childhood follow up and may include developmental delay or intellectual impairment (developmental quotient or intelligence quotient more than one standard deviation below the mean, cerebral palsy (abnormality of tone with motor dysfunction, blindness (for example, corrected visual acuity worse than 6/60 in the better eye or deafness (for example, hearing loss requiring amplification or worse. For the women, the primary outcome will be maternal sepsis (defined as chorioamnionitis; pyrexia after trial entry requiring the use of antibiotics; puerperal sepsis; intrapartum fever requiring the use

  3. Uso materno antenatal de corticosteroide e marcadores de estresse oxidativo e de inflamação no sangue de cordão umbilical de recém-nascidos pré-termo de muito baixo peso

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    Jamil P. S. Caldas

    2012-02-01

    Full Text Available OBJETIVO: Avaliar a associação entre o uso materno antenatal de corticosteroide e os níveis sanguíneos de intermediários reativos de oxigênio (ROI, glutationa reduzida (GR e interleucina-6 (IL-6 em recém-nascidos pré-termo de muito baixo peso ao nascer. MÉTODOS: Estudo de coorte. A dosagem foi feita em sangue de cordão umbilical. A dosagem de ROI por granulócitos foi realizada por citometria de fluxo nos estados basal e estimulado; a GR, por espectrofotometria; e a IL-6, por enzyme-linked immunosorbent assay. Foram considerados dois grupos em relação ao uso de corticosteroide (betametasona antenatal: uso ou não da medicação; e, se presente, se foi de modo completo ou parcial. Variáveis maternas e neonatais foram consideradas para efeito de comparação dos grupos. As variáveis categóricas foram comparadas usando os testes do qui-quadrado ou de Fischer, e as comparações dos valores dos marcadores sanguíneos foram feitas usando-se o teste de Mann-Whitney. RESULTADOS: Os grupos de corticoterapia foram comparáveis em relação às variáveis maternas e neonatais, exceto a ocorrência de parto vaginal, o qual foi associado significativamente à ausência de uso de corticosteroide antenatal. Os valores de ROI, GR e IL-6 não se mostraram diferentes quando se avaliou a presença ou ausência da administração de esteroide; porém, quando o ciclo se fez de modo completo, encontraram-se menores medianas de ROI e IL-6. CONCLUSÃO: A administração de ciclo completo de betametasona à mãe exerceu um efeito supressor sobre a produção basal de ROI e de IL-6 em recém-nascidos pré-termo de muito baixo peso.

  4. Effects of Antenatal Betamethasone and Dexamethasone in Preterm Neonates

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    Chen-Yu Chen

    2005-09-01

    Conclusion: In our study, no significant differences between antenatal betamethasone and dexamethasone were found in complications of preterm neonates. Incomplete courses of antenatal corticosteroids were associated with an increased incidence of RDS compared with complete courses.

  5. Avaliação do impacto da corticoterapia antenatal para aceleração da maturidade pulmonar fetal nos recém-nascidos em maternidade-escola brasileira Impact of antenatal corticosteroid therapy for the acceleration of fetal lung maturation in neonates at a teaching hospital in Brazil

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    Isabela Cristina Coutinho de Albuquerque

    2002-12-01

    Full Text Available OBJETIVOS: avaliar os efeitos da corticoterapia antenatal na incidência da síndrome do desconforto respiratório do recém-nascido (SDRN, outras morbidades e óbito em neonatos prematuros atendidos em maternidade-escola (IMIP no Brasil. MÉTODOS: realizou-se estudo analítico, observacional, tipo coorte, analisando a evolução de 155 recém-nascidos (RN de mulheres internadas no IMIP com parto prematuro, sendo que 78 receberam corticóide e 77 não receberam, verificando-se o esquema utilizado, a incidência de SDRN, e outras morbidades associadas com prematuridade e morte neonatal, entre fevereiro e novembro de 2001. Determinou-se a razão de risco e seu intervalo de confiança a 95% para SDRN e os diversos desfechos neonatais (variáveis dependentes, de acordo com o uso ou não de corticóide antenatal (variável independente. RESULTADOS: a corticoterapia foi administrada a 50,3% das pacientes (64% receberam esquema completo e 36% esquema incompleto. A incidência de SDRN foi significantemente menor entre os RN cujas mães receberam corticóide (37,2% em relação às que não receberam (63,6%. Não houve redução no risco das morbidades associadas à prematuridade. Verificou-se redução no risco de morte (39% e na freqüência de oxigenoterapia (37%, sem diferença no tempo de oxigenoterapia ou de hospitalização. Após análise de regressão logística múltipla, observou-se redução no risco de SDRN de 72% para o uso de corticóide e aumento de sete vezes neste risco para os RN com idade gestacional menor que 32 semanas. CONCLUSÕES: verificou-se impacto favorável da corticoterapia antenatal, com redução significativa da SDRN na idade gestacional entre 26 e 35 semanas. Embora não tenha se verificado redução de outras morbidades, isso pode ter sido devido ao pequeno tamanho da amostra.PURPOSE: to evaluate the effects of antenatal corticosteroid treatment on the incidence of respiratory distress syndrome (RDS, neonatal

  6. Antenatal steroids: can we optimize the dose?

    Science.gov (United States)

    Romejko-Wolniewicz, Ewa; Teliga-Czajkowska, Justyna; Czajkowski, Krzysztof

    2014-01-01

    Purpose of review The beneficial effects of antenatal steroids in women at risk of preterm birth are evident. A dose of 24 mg appears sufficient, but there are insufficient data to recommend betamethasone or dexamethasone, a single steroid dose, the optimal interval between doses and repeated courses, the gestational age at which treatment is beneficial and the long-term effects of steroid treatment. This review addresses these aspects of antenatal steroid treatment. Recent findings Although the 12-h and 24-h dosing intervals are equivalent with respect to prevention of respiratory distress syndrome, the former enables the completion of treatment in 50% more neonates delivered prematurely. Reducing the single steroid dose in patients at risk for premature birth reduces the associated maternal side effects. An inverse relationship has been demonstrated between the number of corticosteroid courses and foetal growth. The reduced size of exposed foetuses has been attributed to birth at earlier gestational ages and decreased foetal growth. Evidence suggests that antenatal exposure to synthetic glucocorticoids in term-born children has long-lasting effects, which may have important implications in the recommendation of steroids before elective caesarean at term. Summary The short-term and long-term effects of the dosage regimen on the pregnant mother and foetus remain unclear. PMID:24463225

  7. Uso antenatal de corticosteróide e condições de nascimento de pré-termos nos hospitais da Rede Brasileira de Pesquisas Neonatais Antenatal corticosteroid use and birth conditions of preterm infants at hospitals belonging to the Brazilian Network of Neonatal Research

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    Francisco Eulógio Martinez

    2004-04-01

    Full Text Available OBJETIVOS: avaliar o uso de corticosteróide antenatal (CA nas mães e as suas repercussões nas condições de nascimento das crianças nascidas pré-termo nas oito unidades neonatais universitárias da Rede Brasileira de Pesquisas Neonatais. MÉTODOS: estudo observacional do tipo coorte prospectivo. Foram avaliadas 463 gestantes com idade gestacional (IG entre 23 e 34 semanas e seus 514 recém-nascidos no período de 1 de agosto a 31 de dezembro de 2001. Os dados foram obtidos por entrevista materna, análise de prontuário e acompanhamento dos recém-nascidos, e analisados pelos testes do chi2, Mann-Whitney, ANOVA e regressão logística múltipla, com nível de significância de 0,05. RESULTADOS: 60,1% (282/463 das gestantes (variação de 12,5 a 87,3% entre as unidades receberam ao menos uma dose de CA. A freqüência do uso de CA foi diretamente associada ao número de consultas de pré-natal, hipertensão materna e uso antenatal de tocolíticos. Quando as gestantes foram tratadas, os RN apresentaram maior peso de nascimento (1379±421 vs 1244±543 g, idade gestacional mais avançada (30,9±2,0 vs 29,5±3,5 semanas, melhores valores do escore de Apgar no 1º e 5º minuto e menor freqüência de intervenção na sala de parto. O uso de CA, a IG e o fato de ser pequeno para a IG melhoraram, de forma independente, as condições de nascimento. CONCLUSÕES: o uso de CA, na maioria dos centros, foi feito em freqüência abaixo da desejada e em metade das vezes de forma inadequada. O tratamento foi mais aplicado a mães com melhor acompanhamento durante o pré-natal e foi associado com melhores condições de nascimento.PURPOSE: to assess the use of antenatal corticosteroid (AC by mothers and its repercussion on the birth conditions of preterm babies at the eight university neonatal units belonging to the Brazilian Network of Neonatal Research. METHODS: an observational prospective cohort study. All 463 pregnant women with a gestational age (GA

  8. Corticosteroid osteoporosis.

    Science.gov (United States)

    Sambrook, P; Lane, N E

    2001-07-01

    Corticosteroids are widely used and effective agents for the control of many inflammatory diseases, but corticosteroid osteoporosis is a common problem associated with their long term high dose use. Prevention of corticosteroid osteoporosis is preferable to treatment of established corticosteroid bone loss. Several large double-blind controlled clinical trials in patients with corticosteroid osteoporosis have recently been published that provide new insights into its treatment. Based upon available evidence, the rank order of choice for prophylaxis would be a bisphosphonate followed by a vitamin D metabolite or an oestrogen type medication. Calcium alone appears to be unable to prevent rapid bone loss in patients starting corticosteroids, especially with prednisolone doses at 10 mg a day or greater. If an active vitamin D metabolite is used, calcium supplementation should be avoided unless dietary calcium intake is low. Hormone replacement therapy should be considered if hypogonadism is present. Since vertebral fracture is a common and important complication of high dose corticosteroid therapy, these findings suggest that rapid bone loss and hence fractures, can be prevented by prophylactic treatment. Although the follow-up data is limited, it is likely that such therapy needs to be continued beyond 12 months whilst patients continue significant doses of corticosteroid therapy.

  9. Inhaled Corticosteroids

    Directory of Open Access Journals (Sweden)

    Peter J. Barnes

    2010-03-01

    Full Text Available Inhaled corticosteroids (ICS are the most effective controllers of asthma. They suppress inflammation mainly by switching off multiple activated inflammatory genes through reversing histone acetylation via the recruitment of histone deacetylase 2 (HDAC2. Through suppression of airway inflammation ICS reduce airway hyperresponsiveness and control asthma symptoms. ICS are now first-line therapy for all patients with persistent asthma, controlling asthma symptoms and preventing exacerbations. Inhaled long-acting β2-agonists added to ICS further improve asthma control and are commonly given as combination inhalers, which improve compliance and control asthma at lower doses of corticosteroids. By contrast, ICS provide much less clinical benefit in COPD and the inflammation is resistant to the action of corticosteroids. This appears to be due to a reduction in HDAC2 activity and expression as a result of oxidative stress. ICS are added to bronchodilators in patients with severe COPD to reduce exacerbations. ICS, which are absorbed from the lungs into the systemic circulation, have negligible systemic side effects at the doses most patients require, although the high doses used in COPD has some systemic side effects and increases the risk of developing pneumonia.

  10. Reasons for failure to administer antenatal corticosteroids in preterm ...

    African Journals Online (AJOL)

    labour. Therefore, although only 20% of mothers received ACs, there was no opportunity for their use in the majority of .... high-risk pregnancies to be identified and some general advice to be ... Crowley P. Promoting pulmonary maturity. ... dexamethasone administration on the prevention of respiratory distress syndrome.

  11. Number and timing of antenatal HIV testing

    DEFF Research Database (Denmark)

    Nguyen Thi Thuy, Hanh; Gammeltoft, Tine; Rasch, Vibeke

    2011-01-01

    ABSTRACT: BACKGROUND: HIV testing for pregnant women is an important component for the success of prevention of mother-to-child transmission of HIV (PMTCT). A lack of antenatal HIV testing results in loss of benefits for HIV-infected mothers and their children. However, the provision of unnecessary...... repeat tests at a very late stage of pregnancy will reduce the beneficial effects of PMTCT and impose unnecessary costs for the individual woman as well as the health system. This study aims to assess the number and timing of antenatal HIV testing in a low-income setting where PMTCT programmes have been...... scaled up to reach first level health facilities. METHODS: A cross-sectional community-based study was conducted among 1108 recently delivered mothers through face-to-face interviews following a structured questionnaire that focused on socio-economic characteristics, experiences of antenatal care and HIV...

  12. Number and timing of antenatal HIV testing

    DEFF Research Database (Denmark)

    Nguyen Thi Thuy, Hanh; Gammeltoft, Tine; Rasch, Vibeke

    2011-01-01

    ABSTRACT: BACKGROUND: HIV testing for pregnant women is an important component for the success of prevention of mother-to-child transmission of HIV (PMTCT). A lack of antenatal HIV testing results in loss of benefits for HIV-infected mothers and their children. However, the provision of unnecessary...... repeat tests at a very late stage of pregnancy will reduce the beneficial effects of PMTCT and impose unnecessary costs for the individual woman as well as the health system. This study aims to assess the number and timing of antenatal HIV testing in a low-income setting where PMTCT programmes have been...... scaled up to reach first level health facilities. METHODS: A cross-sectional community-based study was conducted among 1108 recently delivered mothers through face-to-face interviews following a structured questionnaire that focused on socio-economic characteristics, experiences of antenatal care and HIV...

  13. Hipersensitivity Reactions to Corticosteroids.

    Science.gov (United States)

    Berbegal, L; DeLeon, F J; Silvestre, J F

    2016-03-01

    Corticosteroids are widely used drugs in the clinical practice, especially by topic application in dermatology. These substances may act as allergens and produce immediate and delayed hypersensitivity reactions. Allergic contact dermatitis is the most frequent presentation of corticosteroid allergy and it should be studied by patch testing in specific units. The corticosteroids included in the Spanish standard battery are good markers but not ideal. Therefore, if those makers are positive, it is useful to apply a specific battery of corticosteroids and the drugs provided by patients. Immediate reactions are relatively rare but potentially severe, and it is important to confirm the sensitization profile and to guide the use of alternative corticosteroids, because they are often necessary in several diseases. In this article we review the main concepts regarding these two types of hypersensitivity reactions in corticosteroid allergy, as well as their approach in the clinical practice. Copyright © 2015 Elsevier España, S.L.U. and AEDV. All rights reserved.

  14. Effects of antenatal steroids on protein metabolism in preterm infants on the first day of life

    NARCIS (Netherlands)

    de Pipaon, M.S.; Vanbeek, R.H.T.; Zimmermann, L.J.J.; Wattimena, D.J.L.; Quero, J.; Sauer, P. J. J.

    Objective To analyze, in an existing cohort of infants, whether antenatal administered corticosteroids influence protein metabolism in preterm infants on the first day of life. Study design Three groups of infants were studied. The mothers of 25 infants had received 2 or more doses of

  15. Orbital inflammation: Corticosteroids first.

    Science.gov (United States)

    Dagi Glass, Lora R; Freitag, Suzanne K

    2016-01-01

    Orbital inflammation is common, and may affect all ages and both genders. By combining a thorough history and physical examination, targeted ancillary laboratory testing and imaging, a presumptive diagnosis can often be made. Nearly all orbital inflammatory pathology can be empirically treated with corticosteroids, thus obviating the need for histopathologic diagnosis prior to initiation of therapy. In addition, corticosteroids may be effective in treating concurrent systemic disease. Unless orbital inflammation responds atypically or incompletely, patients can be spared biopsy.

  16. a meta-analysis of the use of corticosteroids in pregnancies ...

    African Journals Online (AJOL)

    no reason to suggest that use of corticosteroids in women with PPROM needs .... aspects to study, i.e. antenatal infection, most likely clinical chorio-amnionitis, and .... was no indication of any increase of infection in the Dexiprom. Study,' either ...

  17. REVIEW OF FOCUSSED ANTENATAL CARE

    Directory of Open Access Journals (Sweden)

    Sreelatha

    2015-09-01

    Full Text Available INTRODUCTION: Antenatal care is a comprehensive antepartum programme which involves a coordinated approach to medical care , continuous risk assessment , and psychological support that optimally begins before conception and extends throughout the postpartum period and int erconceptional period . [1] One of major responsibility of obstetrician providing antenatal care is to identify high risk factors based on past history, examination and investigation results. The objective of antenatal care therefore is to assure that every wanted pregnancy results in the delivery of a healthy baby without impairing the mothers health . [2] In a 1914 study by Williams antenatal care reduced fetal mortality by 40%

  18. [Inhaled corticosteroids for COPD

    NARCIS (Netherlands)

    Dekhuijzen, P.N.R.

    2003-01-01

    Over 60% of patients with COPD are treated with inhaled corticosteroids (ICS), even though their use is still subject to debate. The inflammatory process in the lungs of patients with COPD is dominated by macrophages, CD8+ T-lymphocytes, neutrophilic granulocytes and mast cells, as well as an increa

  19. Antenatal cardiotocography and intrauterine death.

    Science.gov (United States)

    Solum, T; Sjöberg, N O

    1980-01-01

    The purpose of the present study was to elucidate the reliability of antenatal cardiotocography (CTG) in predicting fetal death. During a 4-year period, 1 455 patients eith risk pregnancies have been routinely monitored with antenatal CTG. The total number of tracings amounted to more than 10 000. Five cases of fetal death occurred, in all of which pathological CTG patterns were found. Our experience in the present study indicates that antenatal CTG is a reliable technique for the predicting of fetal death and its use should reduce fetal mortality rates.

  20. [Corticosteroids and septic shock].

    Science.gov (United States)

    Bouletreau, P; Petit, P; Latarjet, J

    1976-01-01

    According to the data in the literature, the authors attempted to sum-up present attitudes on the value of corticoids in the treatment of septic shock. If their cardiovascular effects after a period of enthusiasm, are presently rather controversial, their cellular and sub-cellular actions, on the lysosomal membranes, capillary permeability and perhaps the intimate mechanisms of cellular oxygenation seem to be more real. However, the contra-indications which persist in the results of clinical works have resulted in the fact that the exact place of cortico-steroids in the therapeutic arsenal of septic shock still remains to be specified.

  1. Corticosteroid Treatment in Diabetic Macular Edema

    Directory of Open Access Journals (Sweden)

    Burcu Nurözler Tabakcı

    2017-06-01

    Full Text Available Diabetic macular edema is the most common cause of visual impairment in patients with diabetes mellitus. The pathogenesis of macular edema is complex and multifactorial. For many years, laser photocoagulation has been considered the standard therapy for the treatment of diabetic macular edema; however, few patients achieve significant improvements in visual acuity. Today the intravitreal administration of anti-inflammatory or anti-angiogenic agents together with the use of laser photocoagulation represents the standard of care for the treatment of this complication. The intravitreal route of administration minimizes the systemic side effects of corticosteroids. Steroid-related ocular side effects are elevated intraocular pressure and cataract, while injection-related complications include endophthalmitis, vitreous hemorrhage, and retinal detachment. In order to reduce the risks and complications, intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated injections for the management of diabetic macular edema. In this review, the efficacy, safety, and therapeutic potential of intravitreal corticosteroids in diabetic macular edema are discussed with a review of recent literature.

  2. Postnatal Imaging of Antenatal Hydronephrosis

    Directory of Open Access Journals (Sweden)

    David M. Kitchens

    2009-01-01

    Full Text Available Radiologic imaging of the newborn detected prenatally with hydronephrosis should follow a systematic approach. Upper and lower urinary tract imaging should be performed in most cases in order to determine the etiology and gauge the use of future imaging. An overview of renal ultrasound, voiding cystourethrography, renal scintigraphy, and magnetic resonance urography in the setting of antenatal hydronephrosis are discussed.

  3. Anti-Inflammatories and Corticosteroids

    Science.gov (United States)

    ... to understand that anabolic steroids are not the type of steroids used in asthma or other lung diseases. Another common fear about corticosteroids is that they will cause growth suppression in children. To date, many studies ...

  4. CEREBRAL PALSY : ANTENATAL RISK FACTORS

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao

    2015-05-01

    Full Text Available INTRODUCTION: Cerebral palsy (CP is a group of permanent movement disorders that appear in early childhood. Cerebral palsy is caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture. Most often the problems occur during pregnancy; however, they may also occur during childbirth, or shortly after birth. Often the cause is unknown. AIM: To study the different antenatal maternal risk factors associated with cerebral palsy in the study group. MATERIA LS AND METHODS: Retrospective study was done to assess possible associated antenatal risk factors for cerebral palsy. Mothers of 100 cerebral palsy children were selected who are treated in Rani Chandramani Devi Hospital, a Government hospital in Visakhapa tn am, Andhra Pradesh State, India , from 2012 to 2014 and 100 controls, mothers of normal children were studied. Detailed antenatal history was obtained from the mothers of the children in both affected and control group. RESULTS: From the data, we conclude that the association of maternal anaemia with cerebral palsy is 7.3 times higher; association of maternal hypertension with cerebral palsy is 6.6 time higher, association with Pre - eclampsia is 6 times higher; association with Eclampsia is 8.6 times higher ; with antepartum haemorrhage, the association is 8.6 times higher and association of multiple pregnancy with cerebral palsy is 4.8 times higher than with controls. CONCLUSION: From this study of the role of antenatal risk factors, in the occurrence of cer ebral palsy in children it is concluded that the most common risk factor associated with cerebral palsy is the maternal anaemia and the other important risk factors associated being hypertension, pre eclampsia, eclampsia, antepartum haemorrhage and multipl e births.

  5. Antenatal calcium intake in Malaysia.

    Science.gov (United States)

    Mahdy, Zaleha Abdullah; Basri, Hashimah; Md Isa, Zaleha; Ahmad, Shuhaila; Shamsuddin, Khadijah; Mohd Amin, Rahmah

    2014-04-01

    To determine the adequacy of antenatal calcium intake in Malaysia, and the influencing factors. A cross-sectional study was conducted among postnatal women who delivered in two tertiary hospitals. Data were collected from antenatal cards, hospital documents and diet recall on daily milk and calcium intake during pregnancy. SPSS version 19.0 was used for statistical analyses. A total of 150 women were studied. The total daily calcium intake was 834 ± 43 mg (mean ± standard error of the mean), but the calcium intake distribution curve was skewed to the right with a median intake of 725 mg daily. When calcium intake from milk and calcium supplements was excluded, the daily dietary calcium intake was only 478 ± 25 mg. Even with inclusion of milk and calcium supplements, more than a third (n=55 or 36.7%) of the women consumed less than 600 mg calcium in their daily diet. The adequacy of daily calcium intake was not influenced by maternal age, ethnicity, income or maternal job or educational status as well as parity. The daily dietary calcium intake of the Malaysian antenatal population is far from adequate without the addition of calcium supplements and milk. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

  6. Systemic corticosteroids for acute sinusitis.

    Science.gov (United States)

    Venekamp, Roderick P; Thompson, Matthew J; Hayward, Gail; Heneghan, Carl J; Del Mar, Chris B; Perera, Rafael; Glasziou, Paul P; Rovers, Maroeska M

    2014-03-25

    Acute sinusitis is the inflammation and swelling of the nasal and paranasal mucous membranes and is a common reason for patients to seek primary care consultations. The related impairment of daily functioning and quality of life is attributable to symptoms such as facial pain and nasal congestion. To assess the effects of systemic corticosteroids on clinical response rates and to determine adverse effects and relapse rates of systemic corticosteroids compared to placebo or standard clinical care in children and adults with acute sinusitis. We searched CENTRAL (2014, Issue 1), MEDLINE (1966 to February week 1, 2014) and EMBASE (January 2009 to February 2014). Randomised controlled trials (RCTs) comparing systemic corticosteroids to placebo or standard clinical care for patients with acute sinusitis. Two review authors independently assessed the methodological quality of the trials and extracted data. Five RCTs with a total of 1193 adult participants met our inclusion criteria. We judged methodological quality to be moderate in four trials and high in one trial. Acute sinusitis was defined clinically in all trials. However, the three trials performed in ear, nose and throat (ENT) outpatient clinics also used radiological assessment as part of their inclusion criteria. All participants were assigned to either oral corticosteroids (prednisone 24 mg to 80 mg daily or betamethasone 1 mg daily) or the control treatment (placebo in four trials and non-steroidal anti-inflammatory drugs (NSAIDs) in one trial). In four trials antibiotics were prescribed in addition to oral corticosteroids or control treatment, while one trial investigated the effects of oral corticosteroids as a monotherapy.When combining data from the five trials, participants treated with oral corticosteroids were more likely to have short-term resolution or improvement of symptoms than those receiving the control treatment: at days three to seven (risk ratio (RR) 1.3, 95% confidence interval (CI) 1.1 to 1

  7. Corticosteroid signaling in frog metamorphosis.

    Science.gov (United States)

    Kulkarni, Saurabh S; Buchholz, Daniel R

    2014-07-01

    Stress in fetal and larval life can impact later health and fitness in humans and wildlife. Long-term effects of early life stress are mediated by altered stress physiology induced during the process of relaying environmental effects on development. Amphibian metamorphosis has been an important model system to study the role of hormones in development in an environmental context. Thyroid hormone (TH) is necessary and sufficient to initiate the dramatic morphological and physiological changes of metamorphosis, but TH alone is insufficient to complete metamorphosis. Other hormones, importantly corticosteroid hormones (CSs), influence the timing and nature of post-embryonic development. Stressors or treatments with CSs delay or accelerate metamorphic change, depending on the developmental stage of treatment. Also, TH and CSs have synergistic, antagonistic, and independent effects on gene regulation. Importantly, the identity of the endogenous corticosteroid hormone or receptor underlying any gene induction or remodeling event has not been determined. Levels of both CSs, corticosterone and aldosterone, peak at metamorphic climax, and the corticosteroid receptors, glucocorticoid and mineralocorticoid receptors, have wide expression distribution among tadpole tissues. Conclusive experiments to identify the endogenous players have been elusive due to difficulties in experimental control of corticosteroid production and signaling. Current data are consistent with the hypothesis that the two CSs and their receptors serve largely overlapping functions in regulating metamorphosis and synergy with TH. Knowledge of the endogenous players is critical to understanding the basic mechanisms and significance of corticosteroid action in regulating post-embryonic development in environmental contexts.

  8. Multiple Antenatal Dexamethasone Treatment Alters Brain Vessel Differentiation in Newborn Mouse Pups.

    Directory of Open Access Journals (Sweden)

    Winfried Neuhaus

    Full Text Available Antenatal steroid treatment decreases morbidity and mortality in premature infants through the maturation of lung tissue, which enables sufficient breathing performance. However, clinical and animal studies have shown that repeated doses of glucocorticoids such as dexamethasone and betamethasone lead to long-term adverse effects on brain development. Therefore, we established a mouse model for antenatal dexamethasone treatment to investigate the effects of dexamethasone on brain vessel differentiation towards the blood-brain barrier (BBB phenotype, focusing on molecular marker analysis. The major findings were that in total brains on postnatal day (PN 4 triple antenatal dexamethasone treatment significantly downregulated the tight junction protein claudin-5, the endothelial marker Pecam-1/CD31, the glucocorticoid receptor, the NR1 subunit of the N-methyl-D-aspartate receptor, and Abc transporters (Abcb1a, Abcg2 Abcc4. Less pronounced effects were found after single antenatal dexamethasone treatment and in PN10 samples. Comparisons of total brain samples with isolated brain endothelial cells together with the stainings for Pecam-1/CD31 and claudin-5 led to the assumption that the morphology of brain vessels is affected by antenatal dexamethasone treatment at PN4. On the mRNA level markers for angiogenesis, the sonic hedgehog and the Wnt pathway were downregulated in PN4 samples, suggesting fundamental changes in brain vascularization and/or differentiation. In conclusion, we provided a first comprehensive molecular basis for the adverse effects of multiple antenatal dexamethasone treatment on brain vessel differentiation.

  9. Corticosteroid Injections for Common Musculoskeletal Conditions.

    Science.gov (United States)

    Foster, Zoë J; Voss, Tyler T; Hatch, Jacquelynn; Frimodig, Adam

    2015-10-15

    Family physicians considering corticosteroid injections as part of a comprehensive treatment plan for musculoskeletal diagnoses will find few high-quality studies to assist with evidence-based decision making. Most studies of corticosteroid injections for the treatment of osteoarthritis, tendinopathy, bursitis, or neuropathy include only small numbers of patients and have inconsistent long-term follow-up. Corticosteroid injections for the treatment of adhesive capsulitis result in short-term improvements in pain and range of motion. For subacromial impingement syndrome, corticosteroid injections provide short-term pain relief and improvement in function. In medial and lateral epicondylitis, corticosteroid injections offer only short-term improvement of symptoms and have a high rate of symptom recurrence. Corticosteroid injections for carpal tunnel syndrome may help patients avoid or delay surgery. Trigger finger and de Quervain tenosynovitis may be treated effectively with corticosteroid injections. Patients with hip or knee osteoarthritis may have short-term symptom relief with corticosteroid injections.

  10. About Steroids (Inhaled and Oral Corticosteroids)

    Science.gov (United States)

    ... Medications Long-Term Control Medications About Steroids About Steroids Make an Appointment Ask a Question Refer Patient ... considerations when your dosage changes? What are corticosteroids (‘steroids’)? Corticosteroids (steroids) are medicines that are used to ...

  11. Systemic corticosteroid therapy for acute sinusitis

    NARCIS (Netherlands)

    Venekamp, R.P.; Thompson, M.J.; Rovers, M.M.

    2015-01-01

    CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibiotics may be associated with modest bene

  12. Systemic corticosteroid therapy for acute sinusitis

    NARCIS (Netherlands)

    Venekamp, Roderick P.; Thompson, Matthew J.; Rovers, Maroeska M.

    2015-01-01

    CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibioticsmay be associated with modest benef

  13. Systemic corticosteroid therapy for acute sinusitis

    NARCIS (Netherlands)

    Venekamp, R.P.; Thompson, M.J.; Rovers, M.M.

    2015-01-01

    CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibiotics may be associated with modest

  14. Systemic corticosteroid therapy for acute sinusitis

    NARCIS (Netherlands)

    Venekamp, Roderick P.; Thompson, Matthew J.; Rovers, Maroeska M.

    2015-01-01

    CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibioticsmay be associated with modest

  15. Systemic corticosteroid therapy for acute sinusitis

    NARCIS (Netherlands)

    Venekamp, R.P.; Thompson, M.J.; Rovers, M.M.

    2015-01-01

    CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibiotics may be associated with modest bene

  16. Systemic corticosteroid therapy for acute sinusitis

    NARCIS (Netherlands)

    Venekamp, Roderick P.; Thompson, Matthew J.; Rovers, Maroeska M.

    2015-01-01

    CLINICAL QUESTION: Are oral or parenteral corticosteroids associated with improved clinical outcomes in patients with acute sinusitis compared with placebo or nonsteroidal anti-inflammatory drugs (NSAIDs)? BOTTOM LINE: Oral corticosteroids combined with antibioticsmay be associated with modest benef

  17. Thanatophoric dysplasia: Antenatal to postmortem

    Directory of Open Access Journals (Sweden)

    Chanabasappa V Chavadi

    2015-01-01

    Full Text Available Thanatophoric dwarfism (TD, literally meaning death seeking dwarf, is the most common form of lethal bone dysplasia characterized by severe micromelia, extra folds of skin and narrow chest. Other signs include small ribs, underdeveloped lungs, cloverleaf skull, hypertelorism and protuberant abdomen. A short neck, depressed nasal bridge and hypoplastic mandible may also be present. Hydrocephalus is uncommon but is another poor prognostic sign. The diagnosis is usually made with the ultrasonography in the second trimester. Based on the morphological characters, this condition is sub-divided into type 1 and type 2. Fetuses with this condition are either still-born or die shortly after birth. Antenatal sonographic, postpartum radiological and autopsy findings of a case of type 1 TD with a relatively uncommon association of hydrocephalus is discussed.

  18. Corticosteroids compromise survival in glioblastoma.

    Science.gov (United States)

    Pitter, Kenneth L; Tamagno, Ilaria; Alikhanyan, Kristina; Hosni-Ahmed, Amira; Pattwell, Siobhan S; Donnola, Shannon; Dai, Charles; Ozawa, Tatsuya; Chang, Maria; Chan, Timothy A; Beal, Kathryn; Bishop, Andrew J; Barker, Christopher A; Jones, Terreia S; Hentschel, Bettina; Gorlia, Thierry; Schlegel, Uwe; Stupp, Roger; Weller, Michael; Holland, Eric C; Hambardzumyan, Dolores

    2016-05-01

    Glioblastoma is the most common and most aggressive primary brain tumour. Standard of care consists of surgical resection followed by radiotherapy and concomitant and maintenance temozolomide (temozolomide/radiotherapy→temozolomide). Corticosteroids are commonly used perioperatively to control cerebral oedema and are frequently continued throughout subsequent treatment, notably radiotherapy, for amelioration of side effects. The effects of corticosteroids such as dexamethasone on cell growth in glioma models and on patient survival have remained controversial. We performed a retrospective analysis of glioblastoma patient cohorts to determine the prognostic role of steroid administration. A disease-relevant mouse model of glioblastoma was used to characterize the effects of dexamethasone on tumour cell proliferation and death, and to identify gene signatures associated with these effects. A murine anti-VEGFA antibody was used in parallel as an alternative for oedema control. We applied the dexamethasone-induced gene signature to The Cancer Genome Atlas glioblastoma dataset to explore the association of dexamethasone exposure with outcome. Mouse experiments were used to validate the effects of dexamethasone on survival in vivo Retrospective clinical analyses identified corticosteroid use during radiotherapy as an independent indicator of shorter survival in three independent patient cohorts. A dexamethasone-associated gene expression signature correlated with shorter survival in The Cancer Genome Atlas patient dataset. In glioma-bearing mice, dexamethasone pretreatment decreased tumour cell proliferation without affecting tumour cell viability, but reduced survival when combined with radiotherapy. Conversely, anti-VEGFA antibody decreased proliferation and increased tumour cell death, but did not affect survival when combined with radiotherapy. Clinical and mouse experimental data suggest that corticosteroids may decrease the effectiveness of treatment and shorten

  19. Use of inhaled corticosteroids in pediatric asthma

    DEFF Research Database (Denmark)

    Bisgaard, H

    1997-01-01

    Inhaled corticosteroids reduce asthma symptoms and exacerbations, improve lung function, and reduce airway inflammation and bronchial hyperreactivity more effectively than other treatments. However, inhaled corticosteroids may be unable to return lung function and bronchial hyperreactivity...... of the disease. Therefore, a change in treatment strategy toward earlier introduction of corticosteroids may impede airway remodeling, bronchial hyperreactivity, and airway damage. No other treatment has been found to affect the course of the disease. Systemic side-effects, particularly inhibition of growth...... in asthmatic children using inhaled corticosteroids, do not seem to be cause for concern. Growth retardation has not been reported when inhaled corticosteroid doses of

  20. Antenatal glucocorticoid treatment affects hippocampal development in mice.

    Directory of Open Access Journals (Sweden)

    Cornelle W Noorlander

    Full Text Available Synthetic glucocorticoids are administered to pregnant women at risk for preterm delivery, to enhance fetal lung maturation. The benefit of this treatment is well established, however caution is necessary because of possible unwanted side effects on development of different organ systems, including the brain. Actions of glucocorticoids are mediated by corticosteroid receptors, which are highly expressed in the hippocampus, a brain structure involved in cognitive functions. Therefore, we analyzed the effects of a single antenatal dexamethasone treatment on the development of the mouse hippocampus. A clinically relevant dose of dexamethasone (0.4 mg/kg was administered to pregnant mice at embryonic day 15.5 and the hippocampus was analyzed from embryonic day 16 until adulthood. We investigated the effects of dexamethasone treatment on anatomical changes, apoptosis and proliferation in the hippocampus, hippocampal volume and on total body weight. Our results show that dexamethasone treatment reduced body weight and hippocampal volume transiently during development, but these effects were no longer detected at adulthood. Dexamethasone treatment increased the number of apoptotic cells in the hippocampus until birth, but postnatally no effects of dexamethasone treatment on apoptosis were found. During the phase with increased apoptosis, dexamethasone treatment reduced the number of proliferating cells in the subgranular zone of the dentate gyrus. The number of proliferative cells was increased at postnatal day 5 and 10, but was decreased again at the adult stage. This latter long-term and negative effect of antenatal dexamethasone treatment on the number of proliferative cells in the hippocampus may have important implications for hippocampal network function.

  1. Antenatal glucocorticoid treatment affects hippocampal development in mice.

    Science.gov (United States)

    Noorlander, Cornelle W; Tijsseling, Deodata; Hessel, Ellen V S; de Vries, Willem B; Derks, Jan B; Visser, Gerard H A; de Graan, Pierre N E

    2014-01-01

    Synthetic glucocorticoids are administered to pregnant women at risk for preterm delivery, to enhance fetal lung maturation. The benefit of this treatment is well established, however caution is necessary because of possible unwanted side effects on development of different organ systems, including the brain. Actions of glucocorticoids are mediated by corticosteroid receptors, which are highly expressed in the hippocampus, a brain structure involved in cognitive functions. Therefore, we analyzed the effects of a single antenatal dexamethasone treatment on the development of the mouse hippocampus. A clinically relevant dose of dexamethasone (0.4 mg/kg) was administered to pregnant mice at embryonic day 15.5 and the hippocampus was analyzed from embryonic day 16 until adulthood. We investigated the effects of dexamethasone treatment on anatomical changes, apoptosis and proliferation in the hippocampus, hippocampal volume and on total body weight. Our results show that dexamethasone treatment reduced body weight and hippocampal volume transiently during development, but these effects were no longer detected at adulthood. Dexamethasone treatment increased the number of apoptotic cells in the hippocampus until birth, but postnatally no effects of dexamethasone treatment on apoptosis were found. During the phase with increased apoptosis, dexamethasone treatment reduced the number of proliferating cells in the subgranular zone of the dentate gyrus. The number of proliferative cells was increased at postnatal day 5 and 10, but was decreased again at the adult stage. This latter long-term and negative effect of antenatal dexamethasone treatment on the number of proliferative cells in the hippocampus may have important implications for hippocampal network function.

  2. [Prenatal corticosteroids: short-term and long-term effects of multiple courses. Literature review in 2013].

    Science.gov (United States)

    Fuchs, F; Audibert, F; Senat, M-V

    2014-03-01

    Prenatal corticosteroids administration is one of the major advances in obstetrics and neonatology for the prevention of preterm-birth related complications. However, concerns have been raised about its safety regarding neonatal growth and children development. Therefore, some obstetricians have restricted the use of corticosteroids to precisely defined indications. It remains some uncertainty regarding the choice of antenatal corticosteroids, the interval between injections, the timing of effectiveness and the maximum number of courses per pregnancy that is acceptable without causing complications among children. Thus, we performed a current literature review in 2013 regarding short- and long-term efficacy and safety in order to give clear recommendations to practitioners. Copyright © 2014. Published by Elsevier Masson SAS.

  3. Do antenatal corticosteroids in term elective cesarean sections reduce neonatal respiratory morbidity?

    Directory of Open Access Journals (Sweden)

    Felipe Petour Gazitúa

    2015-10-01

    Full Text Available INTRODUCCIÓN El síndrome de distrés respiratorio neonatal se relaciona con la edad gestacional y vía de parto. Menor edad gestacional y parto vía cesárea se asocian a mayor riesgo. Con lo anterior, surge la necesidad de evaluar estrategias que reduzcan su incidencia. El uso de corticoides antenatales en la inducción de maduración pulmonar en partos prematuros, podría ser beneficioso en fetos de término en que se programe cesárea. OBJETIVO Buscar evidencia bibliográfica que determine si el uso de corticoides antenatales disminuyen la incidencia de síndrome de distrés respiratorio en cesáreas electivas de término. MÉTODOS Se realizó búsqueda de literatura médica en PubMed, LILACS, UpToDate, Trip, SciELO y Cochrane. Se incluyeron estudios terapéuticos aleatorizados y controlados, en humanos, cuya intervención fuera con corticoides en cesáreas electivas de término. RESULTADOS Se seleccionaron dos estudios cuya intervención fueron dos dosis de 12 mg de dexametasona previas a la cesárea. El objetivo primario de ambos estudios fue analizar la incidencia de síndrome de distrés respiratorio y el ingreso a unidad de cuidados intensivos. En ambos hubo menor incidencia de síndrome de distrés respiratorio en el grupo tratado, con resultados estadísticamente significativos. CONCLUSIÓN Se concluye que el uso de corticoides en cesáreas electivas de término disminuye la incidencia de distrés respiratorio e ingreso a unidad de cuidados intensivos. Sin embargo, evidenciamos debilidades que afectan la validez interna de ambos estudios, por lo que es necesario el desarrollo de nuevos estudios que avalen los resultados encontrados para poder cambiar las conductas clínicas en este grupo de estudio.

  4. Injectable Corticosteroids: Take Precautions and Use Caution.

    Science.gov (United States)

    Freire, Véronique; Bureau, Nathalie J

    2016-11-01

    Corticosteroids are routinely injected into soft tissues, tendon sheaths, bursae, and joints. These anti-inflammatory agents have different potency and solubility, and solubility is inversely correlated with the duration of action. Corticosteroids carry a low risk of complications but commonly cause systemic and local adverse effects. The use of intra-articular corticosteroid injections in the treatment of inflammatory arthritis and osteoarthritis is well established. Evidence also supports the use of injectable corticosteroids in the treatment of inflammatory tenosynovitis and bursitis associated with rheumatic diseases, trigger finger and de Quervain disease, and carpal tunnel syndrome. The role of corticosteroid injections in the management of rotator cuff disease remains unclear. Strong scientific evidence indicates that corticosteroid injections for lateral epicondylosis worsen the long-term outcomes of patients. This review article discusses the considerations related to the use of corticosteroid injections in the management of nonspinal musculoskeletal conditions.

  5. Systemic corticosteroid hypersensitivity in children

    OpenAIRE

    Sousa, NG; Santa Marta, C; Morais-Almeida, M.

    2010-01-01

    We describe 5 cases of immediate-type reactions to systemic corticosteroids observed during the last 2 decades in boys aged 2, 4, 8, 9, and 10 years. Symptoms ranged from generalized urticaria and angioedema to anaphylactic shock immediately after administration. Oral betamethasone was implicated in 2 cases, oral prednisolone in 2 cases, and intravenous prednisolone in 1 case. The parents of patient 5 refused the skin tests. The remaining patients underwent skin prick tests with the following...

  6. Fibrochondrogenesis, an Antenatal and Postnatal Correlation

    Directory of Open Access Journals (Sweden)

    Nischal G Kundaragi

    2012-01-01

    Full Text Available Fibrochondrogenesis is a rare, neonatally lethal osteochondrodysplasia, with autosomal recessive inheritance. It differs from other lethal dwarfisms in that it leads to broad, long-bone metaphyses (dumb-bell shaped and pear-shaped vertebral bodies. We report a case of fibrochondrogenesis with severe pear-shaped platyspondyly, suspected antenatally, and give a comprehensive pictorial review of the antenatal ultrasound and postnatal radiographic findings. Only few cases of fibrochondrogenesis are diagnosed before the termination of pregnancy.

  7. Antenatal hypnosis training and childbirth experience

    DEFF Research Database (Denmark)

    Werner, Anette; Uldbjerg, Niels; Zachariae, Robert

    2013-01-01

    Childbirth is a demanding event in a woman's life. The aim of this study was to explore whether a brief intervention in the form of an antenatal course in self-hypnosis to ease childbirth could improve the childbirth experience.......Childbirth is a demanding event in a woman's life. The aim of this study was to explore whether a brief intervention in the form of an antenatal course in self-hypnosis to ease childbirth could improve the childbirth experience....

  8. Asymptomatic bacteriuria in antenatal women

    Directory of Open Access Journals (Sweden)

    Lavanya S

    2002-01-01

    Full Text Available A total of 500 antenatal women in their first or second trimesters were screened over a period of 2 years for asymptomatic bacteriuria. Out of them, 8.4% (42 were culture positive. A control group of 100 non-pregnant women, both married and unmarried, was also simultaneously screened. The control group yielded an overall culture positivity of 3% (4% in the married non-pregnant women and 2% in the unmarried women. Primigravida had highest percent culture positivity of 66.6%. The incidence was higher in less than 20 years age group i.e. 71.42%. Of the screening tests, Gram stained smear when compared with the standard loop method, showed the highest sensitivity of 95.2%. The specificity of the screening tests was high [Gram stained smear (98.6%, catalase test (97.1% and pus cell count(96.5%]. Escherichia coli was the most common organism isolated in the test and control groups. The organisms were sensitive to cephalexin, nitrofurantoin, amoxycillin and norfloxacin in decreasing order. Incidence of prematurity was 75% and that of low birth weight was 50% in untreated patients.

  9. Antenatal Bartter Syndrome: A Review

    Directory of Open Access Journals (Sweden)

    Y. Ramesh Bhat

    2012-01-01

    Full Text Available Antenatal Bartter syndrome (ABS is a rare autosomal recessive renal tubular disorder. The defective chloride transport in the loop of Henle leads to fetal polyuria resulting in severe hydramnios and premature delivery. Early onset, unexplained maternal polyhydramnios often challenges the treating obstetrician. Increasing polyhydramnios without apparent fetal or placental abnormalities should lead to the suspicion of this entity. Biochemical analysis of amniotic fluid is suggested as elevated chloride level is usually diagnostic. Awareness, early recognition, maternal treatment with indomethacin, and amniocentesis allow the pregnancy to continue. Affected neonates are usually born premature, have postnatal polyuria, vomiting, failure to thrive, hypercalciuria, and subsequently nephrocalcinosis. Hypokalemia, metabolic alkalosis, secondary hyperaldosteronism and hyperreninaemia are other characteristic features. Volume depletion due to excessive salt and water loss on long term stimulates renin-angiotensin-aldosterone system resulting in juxtaglomerular hyperplasia. Clinical features and electrolyte abnormalities may also depend on the subtype of the syndrome. Prenatal diagnosis and timely indomethacin administration prevent electrolyte imbalance, restitute normal growth, and improve activity. In this paper, authors present classification, pathophysiology, clinical manifestations, laboratory findings, complications, and prognosis of ABS.

  10. Costs of hospitalization in preterm infants: impact of antenatal steroid therapy.

    Science.gov (United States)

    Ogata, Joice Fabiola Meneguel; Fonseca, Marcelo Cunio Machado; Miyoshi, Milton Harumi; Almeida, Maria Fernanda Branco de; Guinsburg, Ruth

    2016-01-01

    To estimate the costs of hospitalization in premature infants exposed or not to antenatal corticosteroids (ACS). Retrospective cohort analysis of premature infants with gestational age of 26-32 weeks without congenital malformations, born between January of 2006 and December of 2009 in a tertiary, public university hospital. Maternal and neonatal demographic data, neonatal morbidities, and hospital inpatient services during the hospitalization were collected. The costs were analyzed using the microcosting technique. Of 220 patients that met the inclusion criteria, 211 (96%) charts were reviewed: 170 newborns received at least one dose of antenatal corticosteroid and 41 did not receive the antenatal medication. There was a 14-37% reduction of the different cost components in infants exposed to ACS when the entire population was analyzed, without statistical significance. Regarding premature infants who were discharged alive, there was a 24-47% reduction of the components of the hospital services costs for the ACS group, with a significant decrease in the length of stay in the neonatal intensive care unit (NICU). In very-low birth weight infants, considering only the survivors, ACS promoted a 30-50% reduction of all elements of the costs, with a 36% decrease in the total cost (p=0.008). The survivors with gestational age <30 weeks showed a decrease in the total cost of 38% (p=0.008) and a 49% reduction of NICU length of stay (p=0.011). ACS reduces the costs of hospitalization of premature infants who are discharged alive, especially those with very low birth weight and <30 weeks of gestational age. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  11. Corticosteroids

    Science.gov (United States)

    ... a clinical trial of experimental treatments. Interactive Disease Tracker Use GI Buddy to keep a daily log ... also are immunosuppressive. That means they decrease the activity of the immune system, which experts believe may ...

  12. Corticosteroids

    Science.gov (United States)

    ... Genitals and Urinary Tract Glands & Growth Head Neck & Nervous System Heart Infections Learning Disabilities Obesity Orthopedic Prevention Sexually Transmitted Skin Tobacco Treatments Injuries & ...

  13. Corticosteroid contact allergy: an EECDRG multicentre study

    DEFF Research Database (Denmark)

    Dooms-Goossens, A; Andersen, Klaus Ejner; Brandäo, F M;

    1996-01-01

    This article describes the results of an EECDRG multicentre study on contact allergy to corticosteroids. A total of 7238 patients were investigated: 6238 in 13 centres in the course of 1993, and 1000 patients in 1 centre in 1993 and 1994. The 5 corticosteroids tested were budesonide 0.1% pet......., betamethasone-17-valerate 1% pet., clobetasol-17-propionate 1% pet., hydrocortisone-17-butyrate 1% eth., and tixocortol-21-pivalate 1% pet.; 189 (2.6%) gave a positive patchtest reaction (+, ++, + + +) to at least 1 of the corticosteroids. The data regarding the corticosteroid-sensitive patients, as well...

  14. Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews.

    Science.gov (United States)

    Shepherd, Emily; Salam, Rehana A; Middleton, Philippa; Makrides, Maria; McIntyre, Sarah; Badawi, Nadia; Crowther, Caroline A

    2017-08-08

    evidence ranged from very low to high. Effective interventions: high-quality evidence of effectiveness There was a reduction in cerebral palsy in children born to women at risk of preterm birth who received magnesium sulphate for neuroprotection of the fetus compared with placebo (risk ratio (RR) 0.68, 95% confidence interval (CI) 0.54 to 0.87; five RCTs; 6145 children). Probably ineffective interventions: moderate-quality evidence of harm There was an increase in cerebral palsy in children born to mothers in preterm labour with intact membranes who received any prophylactic antibiotics versus no antibiotics (RR 1.82, 95% CI 0.99 to 3.34; one RCT; 3173 children). There was an increase in cerebral palsy in children, who as preterm babies with suspected fetal compromise, were born immediately compared with those for whom birth was deferred (RR 5.88, 95% CI 1.33 to 26.02; one RCT; 507 children). Probably ineffective interventions: moderate-quality evidence of lack of effectiveness There was no clear difference in the presence of cerebral palsy in children born to women at risk of preterm birth who received repeat doses of corticosteroids compared with a single course (RR 1.03, 95% CI 0.71 to 1.50; four RCTs; 3800 children). No conclusions possible: low- to very low-quality evidence Low-quality evidence found there was a possible reduction in cerebral palsy for children born to women at risk of preterm birth who received antenatal corticosteroids for accelerating fetal lung maturation compared with placebo (RR 0.60, 95% CI 0.34 to 1.03; five RCTs; 904 children). There was no clear difference in the presence of cerebral palsy with interventionist care for severe pre-eclampsia versus expectant care (RR 6.01, 95% CI 0.75 to 48.14; one RCT; 262 children); magnesium sulphate for pre-eclampsia versus placebo (RR 0.34, 95% CI 0.09 to 1.26; one RCT; 2895 children); continuous cardiotocography for fetal assessment during labour versus intermittent auscultation (average RR 1.75, 95% CI

  15. Antenatal imaging of cutis verticis gyrata

    Energy Technology Data Exchange (ETDEWEB)

    Kennedy, Ana [Starship Hospital, Department of Paediatric Cardiology, Auckland (New Zealand); Perry, David [Starship Children' s Hospital, Radiology Department, Auckland (New Zealand); Battin, Malcolm [Auckland City Hospital, Newborn Services, National Women' s Health, Auckland (New Zealand); University of Auckland, Department of Paediatrics, Auckland (New Zealand)

    2008-05-15

    Cutis verticis gyrata (CVG) is a skin condition characterized by thick folds and deep furrows, resembling a cortical gyral pattern. There is a recognized but rare association with Noonan syndrome. We report the antenatal imaging, including three-dimensional surface-rendered sonography and MRI, of a fetus with CVG who was subsequently diagnosed with Noonan syndrome. The case illustrates the antenatal appearances of congenital CVG and the potential yield of antenatal imaging in excluding a major central nervous system anomaly. This is important because without prior knowledge of this condition and its imaging characteristics, it is possible to get a false impression of an underlying skull defect on mid-trimester imaging. (orig.)

  16. Corticosteroids for fat embolism after multiple fractures

    Institute of Scientific and Technical Information of China (English)

    CHEN Huai-sheng; ZHANG Qing-mei; WEN Jun-min; WEN Shun-kang; YI Jing; ZHOU Zhi-qiang; WU Sheng-nan

    2007-01-01

    @@ Fat embolism is a common complication of multiple fractures. Corticosteroids are usually prescribed in prophylactic and treatment of fat embolism. A case of fat embolism followed multiple fractures was hospitalized, and we searched best evidences about corticosteroids for fat embolism so as to provide best therapeutics for the patient.

  17. Corticosteroids and the risk of atrial fibrillation

    NARCIS (Netherlands)

    van der Hooft, CS; Heeringa, J; Brusselle, GG; Hofman, A; Witteman, JCM; Kingma, JH; Sturkenboom, MCJM; Stricker, BHC

    2006-01-01

    Background: High-dose ( pulse) corticosteroid therapy has been associated with the development of atrial fibrillation. This association, however, is mainly based on case reports. Methods: To test the hypothesis that high-dose corticosteroid exposure increases the risk of new-onset atrial fibrillatio

  18. Cash Transfers to Increase Antenatal Care Utilization in Kisoro ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    Cash Transfers Antenatal Care, Uganda. African Journal of ... We examined whether modest cash transfers for participation in antenatal ... maternal mortality rates has been debated, it is ..... Outcome effectiveness of community health workers: ...

  19. Antenatal care and pregnancy outcome in Ghana, the importance of ...

    African Journals Online (AJOL)

    Antenatal care and pregnancy outcome in Ghana, the importance of women\\'s education. ... African Journal of Food, Agriculture, Nutrition and Development ... The antenatal characteristics of 503 pregnant women attending maternal and child

  20. Neurodevelopmental Outcome After a Single Course of Antenatal Steroids in Children Born Preterm: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Sotiriadis, Alexandros; Tsiami, Alexandra; Papatheodorou, Stefania; Baschat, Ahmet A; Sarafidis, Kosmas; Makrydimas, George

    2015-06-01

    To systematically review and integrate data on the neurodevelopmental outcome of children after administration of a single course of antenatal corticosteroids for threatened preterm labor. MEDLINE, Scopus, CENTRAL, and www.clinicaltrials.gov (inception to August 2014) using combinations of the terms "prenatal," "antenatal," "cortico*," "*steroid*," "betamethasone," "dexamethasone," "neurodevelopment*," "*development*," and "follow-up." We perused the references of the retrieved articles. We included randomized and nonrandomized trials reporting on the neurodevelopmental outcomes of children whose mothers were administered a single course of betamethasone or dexamethasone antenatally for threatened preterm birth as opposed to placebo or no treatment. Summary risk ratio (RR) was calculated for dichotomous data; standardized mean difference was calculated for trials that measured the same outcome but used different methods. Heterogeneity was assessed using the I statistic. Sensitivity and subgroup analyses were planned according to study design, specific steroid, and mean gestational age at birth. A single course of antenatal corticosteroids was associated with reduced risk for cerebral palsy (seven studies; treated: 390 of 5,199, untreated: 146 of 1,379; RR 0.678, 95% confidence interval [CI] 0.564-0.815), psychomotor development index less than 70 (two studies; treated: 783 of 3,049, untreated: 258 of 969; RR 0.829, 95% CI 0.737-0.933), and severe disability (five studies; treated: 1,567 of 4,840, untreated: 475 of 1,211; RR 0.787, 95% CI 0.729-0.850). Steroid treatment increased the rates of intact survival (six studies; treated: 1,082 of 2,013, untreated: 273 of 561; RR 1.186, 95% CI 1.056-1.332). Betamethasone was found to significantly decrease the risk for severe disability and increase the rate of intact survival. Dexamethasone increased the rate of intact survival; however, data for dexametasone and the other planned subgroup analyses were limited (fewer than

  1. Topical corticosteroid addiction and phobia

    Directory of Open Access Journals (Sweden)

    Aparajita Ghosh

    2014-01-01

    Full Text Available Corticosteroids, one of the most widely prescribed topical drugs, have been used for about six decades till date. However, rampant misuse and abuse down the years has given the drug a bad name. Topical steroid abuse may lead to two major problems which lie at the opposing ends of the psychosomatic spectrum. Topical steroid addiction, a phenomenon that came to be recognized about a decade after the introduction of the molecule is manifested as psychological distress and rebound phenomenon on stoppage of the drug. The rebound phenomenon, which can affect various parts of the body particularly the face and the genitalia has been reported by various names in the literature. TC phobia which lies at the opposite end of the psychiatric spectrum of steroid abuse has been reported particularly among parents of atopic children. Management of both conditions is difficult and frustrating. Psychological counseling and support can be of immense help in both the conditions.

  2. Mobile phones improve antenatal care attendance in Zanzibar

    DEFF Research Database (Denmark)

    Lund, Stine; Nielsen, Birgitte B; Hemed, Maryam

    2014-01-01

    measure was four or more antenatal care visits during pregnancy. Secondary outcome measures were tetanus vaccination, preventive treatment for malaria, gestational age at last antenatal care visit, and antepartum referral. RESULTS: The mobile phone intervention was associated with an increase in antenatal...

  3. Antenatal care in practice: an exploratory study in antenatal care clinics in the Kilombero Valley, south-eastern Tanzania

    Directory of Open Access Journals (Sweden)

    Kessy Flora

    2011-05-01

    Full Text Available Abstract Background The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed. Methods Combining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. Results The delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy". Conclusions Efforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker

  4. Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth.

    Science.gov (United States)

    Brownfoot, Fiona C; Gagliardi, Daniela I; Bain, Emily; Middleton, Philippa; Crowther, Caroline A

    2013-08-29

    Despite the widespread use of antenatal corticosteroids to prevent respiratory distress syndrome in preterm infants, there is currently no consensus as to the type of corticosteroid to use; nor the dose, frequency, timing of use or the route of administration. To assess the effects of different corticosteroid regimens for women at risk of preterm birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 February 2013). All identified published and unpublished randomised controlled trials or quasi-randomised control trials comparing any two corticosteroids (dexamethasone or betamethasone or any other corticosteroid that can cross the placenta), comparing different dose regimens (including frequency and timing of administration) in women at risk of preterm birth were included. We planned to exclude cross-over trials and cluster-randomised trials. We included studies published as abstracts only along with studies published as full-text manuscripts Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Data were checked for accuracy. For this update, 12 trials (1557 women and 1661 infants) were included. Dexamethasone was associated with a reduced risk of intraventricular haemorrhage (IVH) compared with betamethasone (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.21 to 0.92; four trials, 549 infants). No statistically significant differences were seen for other primary outcomes: respiratory distress syndrome (RDS) (RR 1.06, 95% CI 0.88 to 1.27; five trials, 753 infants) and perinatal death (neonatal death RR 1.41, 95% CI 0.54 to 3.67; four trials, 596 infants). Similarly, very few differences were seen for secondary outcomes such as rate of admission to the neonatal intensive care unit (NICU) although in one trial, those infants exposed to dexamethasone, compared with betamethasone, had a significantly shorter length of NICU admission (mean difference (MD) -0

  5. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy

    Science.gov (United States)

    Woudstra, Douglas M; Chandra, Sue; Hofmeyr, G Justus; Dowswell, Therese

    2014-01-01

    Background Pre-eclampsia is a relatively common complication of pregnancy. HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is a severe manifestation of pre-eclampsia with significant morbidity and mortality for pregnant women and their children. Corticosteroids are commonly used in the treatment of HELLP syndrome in the belief that they improve outcomes. Objectives To determine the effects of corticosteroids on women with HELLP syndrome and their children. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 June 2010). Selection criteria Randomized controlled trials comparing any corticosteroid with placebo, no treatment, or other drug; or comparing one corticosteroid with another corticosteroid or dosage in women with HELLP syndrome. Data collection and analysis Two review authors assessed trial quality and extracted data independently. Main results Eleven trials (550 women) compared corticosteroids with placebo or no treatment. There was no difference in the risk of maternal death (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.28 to 3.21), maternal death or severe maternal morbidity (RR 0.27, 95% CI 0.03 to 2.12), or perinatal/infant death (RR 0.64, 95% CI 0.21 to 1.97). The only clear effect of treatment on individual outcomes was improved platelet count (standardized mean difference (SMD) 0.67, 95% CI 0.24 to 1.10). The effect on platelet count was strongest for women who commenced treatment antenatally (SMD 0.80, 95% CI 0.25 to 1.35). Two trials (76 women) compared dexamethasone with betamethasone. There was no clear evidence of a difference between groups in respect to perinatal/infant death (RR 0.95, 95% CI 0.15 to 6.17) or severe perinatal/infant morbidity or death (RR 0.64, 95% CI 0.27 to 1.48). Maternal death and severe maternal morbidity were not reported. In respect to platelet count, dexamethasone was superior to betamethasone (MD 6.02, 95% CI 1.71 to 10.33), both when treatment was

  6. Antenatal cytogenetic testing in Havana, Cuba.

    Science.gov (United States)

    Méndez-Rosado, Luis A; Quiñones, Olga; Molina, Odalys; González, Nereida; del Sol, Marylin; Maceiras, Luanda; Bravo, Yomisleidy

    2014-01-01

    INTRODUCTION Antenatal cytogenetic testing was started in Havana in 1984, as a diagnostic option for fetal chromosome complement. The techniques applied are amniocyte culture, chorionic villus sampling, cordocentesis and fluorescence in situ hybridization in interphase cells. OBJECTIVE Describe the results of antenatal cytogenetic testing in the cytogenetic laboratory of the Cuba's National Medical Genetics Center in Havana, from 1984 through 2012. METHODS A retrospective descriptive study was carried out of the 22,928 pregnant women who had antenatal testing with conclusive results during the period 1984-2012. Information was obtained from laboratory databases for four antenatal diagnostic techniques. Variables studied were: antenatal diagnostic method, indications for genetic testing, type of chromosomal abnormality detected and couple's decision concerning pregnancy continuation if hereditary disease was diagnosed. Results were reported in absolute numbers and percentages. RESULTS Overall positivity was 2.8% (641 cases). Of the total, 20,565 samples were from amniocyte culture (558 positive cases, 2.7%); 1785 chorionic villus sampling (38 positive, 2.1%); 407 cord blood culture (28 positive, 6.9%); and 171 fluorescence in situ hybridization in interphase cells (17 positive, 9.9%). Advanced maternal age was the predominant indication for amniocyte culture and chorionic villus sampling. Positivity was higher for the two less frequently used methods, cordocentesis (6.9% positivity) and fluorescence in situ hybridization (9.9%). The predominant chromosomal abnormality was Down syndrome, with 45.4% of cases detected (291/641; 279 pure lines and 12 mosaic trisomies), followed by Edward syndrome with 12% (77/641, 71 pure lines and 6 mosaics) and Patau syndrome 4.7% (30/641, 27 pure lines and 3 mosaics). Sexual aneuploidy with pure lines affected 6.9% of cases (44/641) and with mosaicism 4.7% (30/641). Structural chromosomal abnormalities were detected in 22.5% of cases

  7. Antenatal breastfeeding education for increasing breastfeeding duration

    Science.gov (United States)

    Lumbiganon, Pisake; Martis, Ruth; Laopaiboon, Malinee; Festin, Mario R; Ho, Jacqueline J; Hakimi, Mohammad

    2014-01-01

    Background Breastfeeding (BF) is well recognised as the best food for infants. The impact of antenatal BF education on the duration of BF has not been evaluated. Objectives To evaluate the effectiveness of antenatal BF education for increasing BF initiation and duration. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (21 April 2010), CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE (1966 to April 2010) and SCOPUS (January 1985 to April 2010). We contacted experts and searched reference lists of retrieved articles. We updated the search of the Pregnancy and Childbirth Group’s Trials Register on 28 September 2011 and added the results to the awaiting classification section of the review. Selection criteria All identified published, unpublished and ongoing randomised controlled trials (RCTs) assessing the effect of formal antenatal BF education or comparing two different methods of formal antenatal BF education, on duration of BF. We excluded RCTs that also included intrapartum or postpartum BF education. Data collection and analysis We assessed all potential studies identified as a result of the search strategy. Two review authors extracted data from each included study using the agreed form and assessed risk of bias. We resolved discrepancies through discussion. Main results We included 17 studies with 7131 women in the review and 14 studies involving 6932 women contributed data to the analyses. We did not do any meta-analysis because there was only one study for each comparison. Five studies compared a single method of BF education with routine care. Peer counselling significantly increased BF initiation. Three studies compared one form of BF education versus another. No intervention was significantly more effective than another intervention in increasing initiation or duration of BF. Seven studies compared multiple methods versus a single method of BF education. Combined BF educational interventions were not

  8. Does an Antenatal Care make a difference?

    Directory of Open Access Journals (Sweden)

    Jaspinder Kaur

    2013-04-01

    Full Text Available Antenatal Care utilization and its effects among booked and unbooked women were studied retrospectively in Obstetrics-Gynaecology Department, Punjab Institute of Medical Sciences, Jalandhar (India during April- June, 2012. Demographic variables, obstetric history and event outcomes were explored. Unbooked (58% status was seen with primiparity, low socioeconomic status (p<0.01 and younger age (p<0.001; 20-25 yrs. 37.21% of unbooked mothers had Anemia (p<0.01 while fetuses of 24.14% mothers developed Fetal Distress. Incidence of Oligohydraminos, Pregnancy Induced Hypertension, Intrauterine Growth Retardation, Preterm Premature Rupture Of Membrane and Preterm Labour were higher among unbooked mothers. Unbooked status had higher Preterm (22.42% and Low Birth Weight babies (51.73%. Majority of mothers of moderate age (40.48%; 26-30yrs, high socioeconomic status (26.20% and multiparity (54.77% booked themselves. The lack of required antenatal care might have led to higher obstetric complications among unbooked mothers. Improving socioeconomic status and women literacy rate may increase the number of booked mothers which may provide them the needed antenatal care.

  9. Rh isoimmunization during pregnancy: antenatal prophylaxis.

    Science.gov (United States)

    Bowman, J M; Chown, B; Lewis, M; Pollock, J M

    1978-03-18

    Of 3533 Rh-negative women who began a pregnancy without detectable Rh antibodies, 62 (1.8%) demonstrated evidence of Rh isoimmunization during pregnancy or within 3 days after delivery. All denied transfusions as well as abortions or previous pregnancies not followed by the administration of Rh immune globulin. Rh isoimmunization during pregnancy or within 3 days after delivery, which will not be prevented by the administration of Rh immune globulin after delivery, is the most important cause of residual Rh isoimmunization. A clinical trial of antenatal administration of Rh immune globulin, initially at 34 weeks's and subsequently at 28 and 34 weeks' gestation, in 1357 Rh-negative pregnant women who were delivered of Rh-positive babies, was effective in preventing the development of Rh isoimmunization during pregnancy or within 3 days after delivery. Antenatal prophylaxis with Rh immune globulin will be necessary if the incidence of Rh isoimmunization is to be reduced to its lowest possible level. Antenatal prophylaxis at 28 weeks' gestation is now an insured service in Manitoba.

  10. Corticosteroids increase protein breakdown and loss in newly diagnosed pediatric Crohn disease.

    Science.gov (United States)

    Steiner, Steven J; Noe, Joshua D; Denne, Scott C

    2011-11-01

    Children with Crohn disease have altered growth and body composition. Previous studies have demonstrated decreased protein breakdown after either corticosteroid or anti-TNF-α therapy. The aim of this study was to evaluate whole body protein metabolism during corticosteroid therapy in children with newly diagnosed Crohn disease. Children with suspected Crohn disease and children with abdominal symptoms not consistent with Crohn disease underwent outpatient metabolic assessment. Patients diagnosed with Crohn disease and prescribed corticosteroid therapy returned in 2 wk for repeat metabolic assessment. Using the stable isotopes [d5] phenylalanine, [1-(13)C] leucine, and [(15)N(2)] urea, protein kinetics were determined in the fasting state. Thirty-one children (18 controls and 13 newly diagnosed with Crohn disease) completed the study. There were no significant differences in protein breakdown or loss between patients with Crohn disease at diagnosis and controls. After corticosteroid therapy in patients with Crohn disease, the rates of appearance of phenylalanine (32%) and leucine (26%) increased significantly, reflecting increased protein breakdown, and the rate of appearance of urea also increased significantly (273%), reflecting increased protein loss. Whole body protein breakdown and loss increased significantly after 2 wk of corticosteroid therapy in children with newly diagnosed Crohn disease, which may have profound effects on body composition.

  11. Peripapillary subretinal neovascularization in sarcoidosis: remission and exacerbation during oral corticosteroid therapy.

    Science.gov (United States)

    Abe, Koji; Shiraki, Kunihiko; Yasunari, Takaharu; Kohno, Takeya; Miki, Tokuhiko

    2002-01-01

    In sarcoidosis, peripapillary subretinal neovascularization is rare. The role of corticosteroid therapy for subretinal neovascularization is controversial. A 38-year-old female patient weighing 38 kg with histologically diagnosed sarcoidosis presented with peripapillary subretinal neovascularization, retinal phlebitis, a hyperemic disc, and snowball vitreous opacities in the left eye. Oral betamethasone therapy at an initial dose of 3 mg/day reduced the size of subretinal neovascular membrane, and the membrane became fibrous. Despite the total initial 140 mg of betamethasone given over 2.5 months and the additional total 700 mg of prednisolone given over the next 2 months, the subretinal neovascularization recurred. Six months after the first recurrence, a second recurrence developed during the tapering-off period of oral corticosteroid therapy. At the second recurrence, the oral corticosteroid therapy was ineffective in reducing the size of the neovascular membrane. In our patient, oral corticosteroids temporarily suppressed peripapillary subretinal neovascularization but failed to prevent extension of neovascular membrane to the fovea because of recurrent sarcoidosis. Over time, oral corticosteroids appear to lose their effectiveness for treating repeated recurrence of peripapillary subretinal neovascularization associated with sarcoidosis.

  12. Antenatal and delivery care in rural western Kenya: the effect of training health care workers to provide "focused antenatal care"

    Directory of Open Access Journals (Sweden)

    Odhiambo Frank O

    2010-04-01

    Full Text Available Abstract Background Maternal mortality remains high in developing countries and data to monitor indicators of progress in maternal care is needed. We examined the status of maternal care before and after health care worker (HCW training in WHO recommended Focused Antenatal Care. Methods An initial cross-sectional survey was conducted in 2002 in Asembo and Gem in western Kenya among a representative sample of women with a recent birth. HCW training was performed in 2003 in Asembo, and a repeat survey was conducted in 2005 in both areas. Results Antenatal clinic (ANC attendance was similar in both areas (86% in 2005 and not significantly different from 2002 (90%. There was no difference in place of delivery between the areas or over time. However, in 2005, more women in Asembo were delivered by a skilled assistant compared to Gem (30% vs.23%, P = 0.04, and this proportion increased compared to 2002 (17.6% and 16.1%, respectively. Provision of iron (82.4%, folic acid (72.0%, sulfadoxine-pyrimethamine (61.7%, and anthelminths (12.7% had increased in Asembo compared to 2002 (2002: 53.3%, 52.8%, 20.3%, and 4.6%, respectively, and was significantly higher than in Gem in 2005 (Gem 2005: 69.7%, 47.8%, 19.8%, and 4.1%, respectively (P Conclusions We observed improvements in some ANC services in the area where HCWs were trained. However, since our evaluation was carried out 2 years after three-day training, we consider any significant, sustained improvement to be remarkable.

  13. Psychiatric adverse effects of pediatric corticosteroid use.

    Science.gov (United States)

    Drozdowicz, Linda B; Bostwick, J Michael

    2014-06-01

    Corticosteroids, highly effective drugs for myriad disease states, have considerable neuropsychiatric adverse effects that can manifest in cognitive disorders, behavioral changes, and frank psychiatric disease. Recent reviews have summarized these effects in adults, but a comprehensive review on corticosteroid effects in children has not been published since 2005. Here, we systematically review articles published since then that, we find, naturally divide into 3 main areas: (1) chronic effects of acute prenatal and neonatal exposure associated with prematurity and congenital conditions; (2) immediate behavioral effects of acute exposure via oncological protocols; and (3) acute behavioral effects of sporadic use in children and adolescents with other conditions. PsycInfo, MEDLINE, Embase, and Scopus were queried to identify articles reporting psychiatric adverse effects of corticosteroids in pediatric patients. Search terms included corticosteroids, adrenal cortex hormones, steroid psychosis, substance-induced psychoses, glucocorticoids, dexamethasone, hydrocortisone, prednisone, adverse effects, mood disorders, mental disorders, psychosis, psychotic, psychoses, side effect, chemically induced, emotions, affective symptoms, toxicity, behavior, behavioral symptoms, infant, child, adolescent, pediatric, paediatric, neonatal, children, teen, and teenager. Following guidelines for systematic reviews from the Potsdam Consultation on Meta-Analysis, we have found it difficult to draw specific conclusions that are more than general impressions owing to the quality of the available studies. We find a mixed picture with neonates exposed to dexamethasone, with some articles reporting eventual deficits in neuropsychiatric functioning and others reporting no effect. In pediatric patients with acute lymphoblastic leukemia, corticosteroid use appears to correlate with negative psychiatric and behavioral effects. In children treated with corticosteroids for noncancer conditions

  14. Use of intranasal corticosteroids in adenotonsillar hypertrophy.

    Science.gov (United States)

    Sakarya, E U; Bayar Muluk, N; Sakalar, E G; Senturk, M; Aricigil, M; Bafaqeeh, S A; Cingi, C

    2017-05-01

    This review examined the efficacy of intranasal corticosteroids for improving adenotonsillar hypertrophy. The related literature was searched using PubMed and Proquest Central databases. Adenotonsillar hypertrophy causes mouth breathing, nasal congestion, hyponasal speech, snoring, obstructive sleep apnoea, chronic sinusitis and recurrent otitis media. Adenoidal hypertrophy results in the obstruction of nasal passages and Eustachian tubes, and blocks the clearance of nasal mucus. Adenotonsillar hypertrophy and obstructive sleep apnoea are associated with increased expression of various mediators of inflammatory responses in the tonsils, and respond to anti-inflammatory agents such as corticosteroids. Topical nasal steroids most likely affect the anatomical component by decreasing inspiratory upper airway resistance at the nasal, adenoidal or tonsillar levels. Corticosteroids, by their lympholytic or anti-inflammatory effects, might reduce adenotonsillar hypertrophy. Intranasal corticosteroids reduce cellular proliferation and the production of pro-inflammatory cytokines in a tonsil and adenoid mixed-cell culture system. Intranasal corticosteroids have been used in adenoidal hypertrophy and adenotonsillar hypertrophy patients, decreasing rates of surgery for adenotonsillar hypertrophy.

  15. Immediate allergic reaction to methylprednisolone with tolerance of other corticosteroids

    Directory of Open Access Journals (Sweden)

    Atanasković-Marković Marina

    2012-01-01

    Full Text Available Introduction. In spite of the wide usage of corticosteroids for the treatment of a plethora of diseases, sometimes they can induce immediate hypersensitivity reactions, which are however uncommon. Case Outline. We report a case of immediate allergic reaction induced by intravenous methylprednisolone given before operation for surgical repair of an arm contracture as a sequel of burns, which the child had tolerated a month before. Six weeks later the patient repeated the anaphylactic reaction during skin testing to methylprednisolone. In addition, basophile activation test with methylprednisolone (BAT was positive. Conclusion. This case report describes a patient who experienced intraoperative anaphylaxis and anaphylactic reaction induced by skin testing. This is the first report on induction of both anaphylactic reactions by methylprednisolone in the same child. Clinical findings, positive BAT and positive skin tests with methylprednisolone imply that the child developed type-I hypersensitivity. The lack of cross-reactivity with other corticosteroids emphasizes that the reactions were caused by the steroid molecule.

  16. Psychoprophylaxis - Antenatal preparation and actual use during labour

    OpenAIRE

    Bergström, Malin

    2010-01-01

    The aim of this thesis was to study the effects of a model of antenatal education, focusing on natural childbirth preparation by including psychoprophylaxis, breathing and relaxation techniques to cope with labour pain, and the actual use of psychoprophylaxis during labour. Satisfaction with antenatal education and experiences of a subgroup of men with antenatal fear of childbirth were also explored. The principal design was a randomised controlled trial where the new mo...

  17. Women's education level, antenatal visits and the quality of skilled antenatal care: a study of three African countries.

    Science.gov (United States)

    Babalola, Stella

    2014-02-01

    Many pregnant women in Africa who access professional antenatal care do not receive all the WHO-recommended components of care. Using Demographic and Health Survey (DHS) data from Kenya, Malawi and Nigeria, this study assesses the relationship of education level with the quality of antenatal care received and highlights how the number of antenatal visits mediates this relationship. The results show that a large proportion of the effect of education level on quality of care is direct, while only a small portion is mediated through the number of antenatal visits. Efforts to improve pregnancy outcomes for under-privileged women should focus on removing structural barriers to access, strengthening the technical and interpersonal skills of providers, and addressing providers' biases and discriminatory practices towards these women. Such efforts should also seek to empower underprivileged women to insist on quality antenatal care by explaining what to expect during an antenatal visit.

  18. Crusted (Norwegian) scabies following systemic and topical corticosteroid therapy.

    Science.gov (United States)

    Binić, Ivana; Janković, Aleksandar; Jovanović, Dragan; Ljubenović, Milanka

    2010-01-01

    It is a case study of a 62-yr-old female with crusted (Norwegian) scabies, which appeared during her treatment with systemic and topical corticosteroid therapy, under the diagnosis of erythroderma. In the same time, the patient had been suffered from hypothyoidism, and her skin changes were misdiagnosed, because it was thought that they are associated with her endocrine disorder. Suddenly, beside the erythema, her skin became hyperkeratotic, with widespread scaling over the trunk and limbs, and crusted lesions appeared on her scalp and ears. The microscopic examination of the skin scales with potassium hydroxide demonstrated numerous scabies mites and eggs. Repeated topical treatments with lindan, benzoyl benzoat and 10% precipitated sulphur ointment led to the complete resolution of her skin condition.

  19. [Corticosteroids in the treatment of infectious diseases].

    Science.gov (United States)

    Kronig, I; Schibler, M; Rougemont, M; Emonet, S

    2013-04-24

    The addition of a corticosteroid has become a common practice for the treatment of some infectious diseases, such as meningitis, septic shock, moderate to severe Pneumocystis jirovecii pneumonia. The belief that steroids may have a beneficial effect in the early stage of pro-inflammatory infections explains the renewed interest for these treatments. This review of recent literature helps determine the use of steroids in the treatment of infectious diseases as formal guidance, questionable or rather contraindicated. When there is a clear scientific indication for the use of corticosteroids regardless of the current infection, the latter is never a formal contraindication.

  20. Antenatal care strengthening in Jimma, Ethiopia

    DEFF Research Database (Denmark)

    Villadsen, Sarah Fredsted; Tersbøl, Britt Pinkowski; Negussie, Dereje

    2014-01-01

    Objective. We assessed how health system priorities matched user expectations and what the needs for antenatal care (ANC) strengthening were for improved maternal health in Jimma, Ethiopia. Methods. A questionnaire survey among all recent mothers in the study area was conducted to study the content...... was given high priority, and that contributed to a lack of continuity and privacy. To the women, poor user-provider interaction was a serious concern hindering the trust in the health care providers. Further, the care provision was compromised by the inadequate laboratory facilities, unstructured health...

  1. Use of Antenatal Services in Kampung District, Cambodia

    Directory of Open Access Journals (Sweden)

    Ahmed A. Zafar

    2003-01-01

    Full Text Available This study was conducted to assess factors that influence use of antenatal care services with both quantitative and qualitative designs. Methods used were structured questionnaire interviews and focus group discussions in the Kampung District, Kampot Province in Cambodia with a volunteer sample of 260 postnatal mothers. The outcome measure was factors influencing use of antenatal care services. The results showed that first-time mothers (primigravidas were more likely to use antenatal services than multiparous mothers (OR = 1.87; p = 0.001. Mothers with some school education used antenatal services more than those with no school education (OR = 2.0; p = 0.01. Mothers engaged in professional occupations by virtue of their higher levels of educational attainment were more likely to use antenatal services than those engaged in agriculture (OR = 2.54; p = 0.001. Use of antenatal care services was higher in the districts whose health centers were supported by a foreign nongovernmental organization as compared to other districts with no such support (OR = 2.44; p = 0.001. Although services were generally inadequate, those that existed were underutilized by the mothers. Major factors influencing use of services include distance, lack of transport, and lack of awareness of the benefits of antenatal care by the mothers, thus resulting in a general notion that antenatal care is only important when problems occur during pregnancy. It is concluded that for remote villages, mobile antenatal clinics should be provided to improve access, and greater emphasis should be placed on health educating the mothers about the potential benefits of antenatal care, with special attention to multiparous mothers and those from the lower socio-economic class, among whom use of antenatal services was lowest.

  2. Systemic corticosteroids for acute gout (Review)

    NARCIS (Netherlands)

    Janssens, H.J.; Lucassen, P.L.B.J.; Laar, F.A. van de; Janssen, M.; Lisdonk, E.H. van de

    2008-01-01

    BACKGROUND: Gout is one of the most frequently occurring rheumatic diseases, worldwide. Given the well-known drawbacks of the regular treatments for acute gout (non-steroidal anti-inflammatory drugs (NSAIDs), colchicine), systemic corticosteroids might be safe alternatives. OBJECTIVES: To assess the

  3. Update on corticosteroids for diabetic macular edema

    Directory of Open Access Journals (Sweden)

    Schwartz SG

    2016-09-01

    Full Text Available Stephen G Schwartz,1 Ingrid U Scott,2,3 Michael W Stewart,4 Harry W Flynn Jr1 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 2Department of Ophthalmology, 3Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, 4Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, FL, USA Abstract: Diabetic macular edema (DME remains an important cause of visual loss. Although anti-vascular endothelial growth factor (VEGF agents are generally used as first-line treatments for patients with center-involving DME, there is an important role for corticosteroids as well. Corticosteroids may be especially useful in pseudophakic patients poorly responsive to anti-VEGF therapies, in patients wishing to reduce the number of required injections, and in pregnant patients. Intravitreal triamcinolone acetonide has been used for many years but is not approved for this indication. An extended-release bioerodable dexamethasone delivery system and an extended-release nonbioerodable fluocinolone acetonide insert have both achieved regulatory approval for the treatment of DME. All intravitreal corticosteroids are associated with risks of cataract progression, elevation of intraocular pressure, and endophthalmitis. There is no current consensus regarding the use of corticosteroids, but they are valuable for selected patients with center-involving DME. Keywords: diabetic macular edema, vascular endothelial growth factor, triamcinolone acetonide, dexamethasone, fluocinolone acetonide, randomized clinical trial

  4. Inhaled corticosteroids do not affect behaviour

    NARCIS (Netherlands)

    de Vries, T. W.; van Roon, E. N.; Duiverman, E. J.

    2008-01-01

    Aim: To determine whether children with asthma and on inhaled corticosteroids have more behavioural problems, such as aggressiveness and hyperactivity, as compared with healthy controls and with children under medical care because of other disorders. Methods: Questionnaires were given to three group

  5. Systemic corticosteroids for acute gout (Review)

    NARCIS (Netherlands)

    Janssens, H.J.; Lucassen, P.L.B.J.; Laar, F.A. van de; Janssen, M.; Lisdonk, E.H. van de

    2008-01-01

    BACKGROUND: Gout is one of the most frequently occurring rheumatic diseases, worldwide. Given the well-known drawbacks of the regular treatments for acute gout (non-steroidal anti-inflammatory drugs (NSAIDs), colchicine), systemic corticosteroids might be safe alternatives. OBJECTIVES: To assess the

  6. Corticosteroids for acute adult bacterial meningitis

    NARCIS (Netherlands)

    D. van de Beek

    2009-01-01

    Bacterial meningitis in adults is a severe disease, with high fatality and morbidity rates. Experimental studies showed that the inflammatory response in the subarachnoid space is associated with unfavorable outcome. In these experiments, corticosteroids, and in particular dexamethasone, were able t

  7. Corticosteroid injection for de Quervain's tenosynovitis

    NARCIS (Netherlands)

    Peters-Veluthamaningal, Cyriac; van der Windt, Danielle A. W. M.; Winters, Jan C.; Jong, Betty Meyboom-de

    2009-01-01

    Back ground De Quervain's tenosynovitis is a disorder characterised by pain on the radial (thumb) side of the wrist and functional disability of the hand. It can be treated by corticosteroid injection, splinting and surgery. Objectives To summarise evidence on the efficacy and safety of corticostero

  8. Corticosteroid injection for de Quervain's tenosynovitis

    NARCIS (Netherlands)

    Peters-Veluthamaningal, Cyriac; van der Windt, Danielle A. W. M.; Winters, Jan C.; Jong, Betty Meyboom-de

    2009-01-01

    Back ground De Quervain's tenosynovitis is a disorder characterised by pain on the radial (thumb) side of the wrist and functional disability of the hand. It can be treated by corticosteroid injection, splinting and surgery. Objectives To summarise evidence on the efficacy and safety of

  9. Corticosteroid injection for trigger finger in adults

    NARCIS (Netherlands)

    Peters-Veluthamaningal, Cyriac; van der Windt, Danielle A. W. M.; Winters, Jan C.; Meyboom-de Jong, Betty

    2009-01-01

    Background Trigger finger is a disease of the tendons of the hand leading to triggering (locking) of affected fingers, dysfunction and pain. Available treatments include local injection with corticosteroids, surgery, or splinting. Objectives To summarize the evidence on the efficacy and safety of

  10. Case report: Antenatal MRI diagnosis of esophageal duplication cyst.

    Science.gov (United States)

    Rangasami, Rajeswaran; Chandrasekharan, Anupama; Archana, Lal; Santhosh, Joseph

    2009-02-01

    Esophageal duplication cysts are classified as a subgroup of foregut duplication cysts. They are very rare and are predominantly detected in children. Antenatal detection is very rare. We report a case of an esophageal duplication cyst that was accurately identified antenatally by USG and MRI.

  11. Antenatal Ultrasound and Risk of Autism Spectrum Disorders

    Science.gov (United States)

    Grether, Judith K.; Li, Sherian Xu; Yoshida, Cathleen K.; Croen, Lisa A.

    2010-01-01

    We evaluated antenatal ultrasound (U/S) exposure as a risk factor for autism spectrum disorders (ASD), comparing affected singleton children and control children born 1995-1999 and enrolled in the Kaiser Permanente health care system. Among children with ASD (n = 362) and controls (n = 393), 13% had no antenatal exposure to U/S examinations;…

  12. Stability of corticosteroids under anaerobic conditions. C6 and C9 fluorine-containing corticosteroids

    NARCIS (Netherlands)

    Dekker, D.; Buijs, D.J.

    1980-01-01

    The decomposition of corticosteroids due to a fluorine atom at C6 and/or C9 is investigated. Chromatographic properties, the isolation and the structure elucidation of decomposition products are given.

  13. Stability of corticosteroids under anaerobic conditions. C6 and C9 fluorine-containing corticosteroids

    NARCIS (Netherlands)

    Dekker, D.; Buijs, D.J.

    1980-01-01

    The decomposition of corticosteroids due to a fluorine atom at C6 and/or C9 is investigated. Chromatographic properties, the isolation and the structure elucidation of decomposition products are given.

  14. Measuring the Corticosteroid Responsiveness Endophenotype in Asthma

    Science.gov (United States)

    Clemmer, George L.; Wu, Ann Chen; Rosner, Bernard; McGeachie, Michael J.; Litonjua, Augusto A.; Tantisira, Kelan G.; Weiss, Scott T.

    2015-01-01

    Background Inhaled corticosteroids are the most commonly used controller therapies for asthma, producing treatment responses in six clinical phenotypes; lung function, bronchodilator response, airway responsiveness, symptoms, need for oral steroids and frequency of emergency department visits and hospitalizations. We hypothesize that treatment response in all of these phenotypes is modulated by a single, quantative corticosteroid responsiveness endophenotype. Objective To develop a composite phenotype that combines multiple clinical phenotypes to measure corticosteroid responsiveness with high accuracy, high stability across populations, and high robustness to missing data. Methods We employed principal component analysis (PCA) to determine a composite corticosteroid responsiveness phenotype that we tested in four replication populations. We evaluated the relative accuracy with which the composite and clinical phenotypes measure the endophenotype using treatment effect area under the receiver operating characteristic curve (AUC). Results In the study population, the composite phenotype measured the endophenotype with an AUC of 0.74, significantly exceeding the AUCs of the six individual clinical phenotypes, which ranged from 0.56 (p-value <.001) to 0.67 (p-value 0.015). In four replication populations with a total of 22 clinical phenotypes available, the composite phenotype AUC ranged from 0.69 to 0.73, significantly exceeded the AUCs of 14 phenotypes, and was not significantly exceeded by any single phenotype. Conclusion The composite phenotype measured the endophenotype with higher accuracy, higher stability across populations, and higher robustness to missing data than any clinical phenotype. This should provide the capability to model corticosteroid pharmacologic response and resistance with increased accuracy and reproducibility. PMID:25951964

  15. Topical corticosteroids: clinical pharmacology and therapeutic use.

    Science.gov (United States)

    Miller, J A; Munro, D D

    1980-02-01

    The development of topical corticosteroids has enabled many dermatoses to be more effectively treated than previously, but there is also no doubt that misuse of these preparations can lead to troublesome local effects and potentially serious systemic problems. The most effective assay for comparing different compounds has been their vasoconstrictive activity, and this on the whole correlates well with clinical effect. To be effective, corticosteroid must be absorbed and the importance of concentration, occlusion, the type of vehicle, added penetrants such as urea and the anatomical site, on the amount of absorption and therefore on clinical activity has been demonstrated. Ointments have been shown to be more effective than creams but because of the considerable choice of potencies now available most dermatologists tend to prescribe the different formulations according to the wishes of the patient. For the same reason, dilution of the commercially marketed preparations is now not generally recommended. The main therapeutic activity of topical corticosteroids is their nonspecific anti-inflammatory effect, thought to be primarily a result of their action on the chemical mediators of inflammation. They have also been shown to be antimitotic which may well be relevant not only to the treatment of scaling dermatoses but also to their dermal thinning effect resulting from inhibition of fibroblasts. Combinations of corticosteroids with antibacterial and antifungal agents have been shown to be very effective in flexural eruptions and secondarily infected dermatoses. As a general rule, the use of topical corticosteroids in outpatients, unless badly misused, is not associated with any significant risk of adrenal axis suppression, but care must be exercised as to the amount prescribed, especially if large areas of the body are to be treated with highly potent preparations. Certain groups such as young children and patients with liver failure, and certain anatomical sites such

  16. Asthma and Therapeutics: Inhaled Corticosteroids, Corticosteroid Osteoporosis, and the Risk of Fracture in Chronic Asthma

    Directory of Open Access Journals (Sweden)

    Toogood John H

    2005-03-01

    Full Text Available Abstract Current guidelines for the diagnosis and treatment of osteoporosis do not address the risks to bone density and the likelihood of fracture that may be associated with inhaled corticosteroid treatment for asthma. This review outlines an approach to the use of bone densitometry in clinical practice for the diagnosis, prevention, and treatment of osteoporosis in asthmatic patients receiving inhaled corticosteroid therapy.

  17. Increasing awareness of corticosteroid hypersensitivity reactions is important

    DEFF Research Database (Denmark)

    Knarborg, Malene; Bendstrup, Elisabeth; Hilberg, Ole

    2013-01-01

    the tolerability to other corticosteroid preparations and thus identify a safe treatment alternative. We report a case of corticosteroid hypersensitivity in a 65-year-old woman with a history of difficult-to-treat asthma and systemic corticosteroid allergy admitted with increasing dyspnea and dry cough...

  18. Postnatal Treatment in Antenatally Diagnosed Meconium Peritonitis.

    Science.gov (United States)

    Ionescu, S; Andrei, B; Oancea, M; Licsandru, E; Ivanov, M; Marcu, V; Popa-Stanila, R; Mocanu, M

    2015-01-01

    Meconium peritonitis is a rare prenatal disease with an increased rate of morbidity and mortality in the neonatal period. Distinctive features revealed by prenatal and postnatal ultrasoundmay be present: abdominal calcifications, ascites, polyhydramnios, meconium pseudocyst, echogenic mass and dilated bowel or intestinal obstruction. Establishing clear postnatal treatment and prognosis is difficult because of the heterogeneity of the results obtained by ultrasound. The aim of the study is to determine how prenatal diagnosis of meconium peritonitis is associated with perinatal management and further evolution. Clinical results are different depending on the presence of antenatal diagnosis of meconium peritonitis and its form, which can be mild or severe. Surgical treatment and management of meconium peritonitis depend on the clinical presentation of the newborn. Meconium peritonitis diagnosed prenatally differs from that of the newborn, not only concerning the mortality rates but also through reduced morbidity and overall better prognosis. Celsius.

  19. Antenatal stress: An Irish case study.

    LENUS (Irish Health Repository)

    Carolan-Olah, Mary

    2013-05-16

    BACKGROUND:: stress in pregnancy is common and impacts negatively on women, infants and families. A number of factors contribute to high levels of stress in pregnancy, including financial concerns, marital discord, low support systems and low socio-economic status. OBJECTIVES:: the aim of this study was to evaluate stress anxiety levels and depressive symptoms among low risk women in an area in Ireland that was particularly impacted by the 2008 economic crisis. DESIGN:: a quantitative descriptive cross-sectional design was used. Data were collected using the Edinburgh Postnatal Depression Scale (EPDS), the Perceived Stress Scale and the State Trait Anxiety Inventory (STAI). Data was collected at a single time during the second trimester. SETTING:: this paper reports a case study of one maternity service in Ireland. Participants included low risk pregnant women who were attending the hospital clinic for routine antenatal care. RESULTS:: of 150 questionnaires distributed, 74 completed questionnaires were returned indicating a 49.3% return rate. Findings indicated high levels of stress, anxiety and depressive symptomatology among participants. There were no significant difference in mean EPDS score for different age groups (F4,69=2.48, P=0.052), living arrangements (F4,68=0.90, P=0.5) or usual occupation (F4,69=1.45, P=0.2). A score of ≥12 was taken as indicative of probable antenatal depression and 86.5% of participants responded with a score of 12 or above. PSS scores were also high and more than three quarters of respondents scored ≥15 (75.6%) and more than a third had scores ≥20 (35.1%), out of a total score of 40. There was a significant difference in mean PSS score between the different age groups (F4,69=3.60, P=0.010) but not for living arrangements or usual occupation. A STAI score of ≥39 was taken as indicative of antenatal anxiety, and 74.3% of participants responded with a score of 39 or above. There were no significant differences in mean STAI

  20. Teaching antenatal counseling skills to neonatal providers.

    Science.gov (United States)

    Stokes, Theophil A; Watson, Katie L; Boss, Renee D

    2014-02-01

    Counseling a family confronted with the birth of a periviable neonate is one of the most difficult tasks that a neonatologist must perform. The neonatologist's goal is to facilitate an informed, collaborative decision about whether life-sustaining therapies are in the best interest of this baby. Neonatologists are trained to provide families with a detailed account of the morbidity and mortality data they believe are necessary to facilitate a truly informed decision. Yet these complicated and intensely emotional conversations require advanced communication and counseling skills that our current fellowship-training strategies are not adequately providing. We review educational models for training neonatology fellows to provide antenatal counseling at the threshold of viability. We believe that training aimed at teaching these skills should be incorporated into the neonatal-perinatal medicine fellowship. The optimal approaches for teaching these skills remain uncertain, and there is a need for continued innovation and outcomes-based research.

  1. Use of inhaled corticosteroids in pediatric asthma

    DEFF Research Database (Denmark)

    Bisgaard, H

    1997-01-01

    Inhaled corticosteroids reduce asthma symptoms and exacerbations, improve lung function, and reduce airway inflammation and bronchial hyperreactivity more effectively than other treatments. However, inhaled corticosteroids may be unable to return lung function and bronchial hyperreactivity...... to normal when introduced for moderately severe asthma. This finding highlights the need to improve treatment strategy in pediatric asthma. The natural progression of persistent asthma may lead to loss of lung function and chronic bronchial hyperreactivity for children and adults. There is evidence...... to suggest that asthma acts via a chronic inflammatory process that causes remodeling of the airways with mucosal thickening and smooth muscle hypertrophy. An optimal treatment strategy would be one aimed at reducing the ongoing airway inflammation. Inhaled steroids ameliorate the inflammation, whereas...

  2. Asthma and Adherence to Inhaled Corticosteroids

    DEFF Research Database (Denmark)

    Bårnes, Camilla Boslev; Ulrik, Charlotte Suppli

    2015-01-01

    Inhaled corticosteroids (ICS) are the cornerstone of maintenance asthma therapy. However, in spite of this, adherence to ICS remains low. The aim of this systematic literature review was to provide an overview of the current knowledge of adherence to ICS, effects of poor adherence, and means...... was found to be between 22 and 63%, with improvement up to and after an exacerbation. Poor adherence was associated with youth, being African-American, having mild asthma, ... prescribed fixed-combination therapy (ICS and long-acting β2 agonists). Good adherence was associated with higher FEV1, a lower percentage of eosinophils in sputum, reduction in hospitalizations, less use of oral corticosteroids, and lower mortality rate. Overall, 24% of exacerbations and 60% of asthma...

  3. Association of Short Antenatal Corticosteroid Administration-to-Birth Intervals With Survival and Morbidity Among Very Preterm Infants

    DEFF Research Database (Denmark)

    Norman, Mikael; Piedvache, Aurelie; Børch, Klaus

    2017-01-01

    -to-birth interval and survival and morbidity among very preterm infants. Design, Setting, and Participants: The Effective Perinatal Intensive Care in Europe (EPICE) study, a population-based prospective cohort study, gathered data from 19 regions in 11 European countries in 2011 and 2012 on 4594 singleton infants...

  4. Endogenous synthesis of corticosteroids in the hippocampus.

    Directory of Open Access Journals (Sweden)

    Shimpei Higo

    Full Text Available BACKGROUND: Brain synthesis of steroids including sex-steroids is attracting much attention. The endogenous synthesis of corticosteroids in the hippocampus, however, has been doubted because of the inability to detect deoxycorticosterone (DOC synthase, cytochrome P450(c21. METHODOLOGY/PRINCIPAL FINDINGS: The expression of P450(c21 was demonstrated using mRNA analysis and immmunogold electron microscopic analysis in the adult male rat hippocampus. DOC production from progesterone (PROG was demonstrated by metabolism analysis of (3H-steroids. All the enzymes required for corticosteroid synthesis including P450(c21, P450(2D4, P450(11β1 and 3β-hydroxysteroid dehydrogenase (3β-HSD were localized in the hippocampal principal neurons as shown via in situ hybridization and immunoelectron microscopic analysis. Accurate corticosteroid concentrations in rat hippocampus were determined by liquid chromatography-tandem mass spectrometry. In adrenalectomized rats, net hippocampus-synthesized corticosterone (CORT and DOC were determined to 6.9 and 5.8 nM, respectively. Enhanced spinogenesis was observed in the hippocampus following application of low nanomolar (10 nM doses of CORT for 1 h. CONCLUSIONS/SIGNIFICANCE: These results imply the complete pathway of corticosteroid synthesis of 'pregnenolone →PROG→DOC→CORT' in the hippocampal neurons. Both P450(c21 and P450(2D4 can catalyze conversion of PROG to DOC. The low nanomolar level of CORT synthesized in hippocampal neurons may play a role in modulation of synaptic plasticity, in contrast to the stress effects by micromolar CORT from adrenal glands.

  5. Dapsone versus corticosteroids in lichen planus

    Directory of Open Access Journals (Sweden)

    Chopra Adarsh

    1999-01-01

    Full Text Available Seventy five patients with Lichen Planus (LP were enrolled from out-patient department for screening the therapeutic effect of dapsone. Patients were divided into two groups of 50 and 25. In regimen - 1 (RI 25 patients were given local corticosteroids and oral chlorpheniramine maleate. In regimen - 2 (R2 50 patients were given oral dapsone and chlorpheniramine maleate and topical coconut oil. It was found that total efficacy of R2 was 18% higher than R1.

  6. Antenatal betamethasone and fetal growth in prematurely born children: implications for temperament traits at the age of 2 years.

    Science.gov (United States)

    Pesonen, Anu-Katriina; Räikkönen, Katri; Lano, Aulikki; Peltoniemi, Outi; Hallman, Mikko; Kari, M Anneli

    2009-01-01

    We explored whether repeated dose of antenatal betamethasone and variation in intrauterine growth of prematurely born children predict temperament characteristics at the age of 2 years. The patients (n = 142) were prematurely born children (mean gestational age: 31.0 weeks; range: 24.6-35.0 weeks) who participated in a randomized and blinded trial testing the effects of a repeated dose of antenatal betamethasone in imminent preterm birth. Fetal growth was estimated as weight, length, and head circumference in SDs according to Finnish growth charts. Parents assessed their toddlers' temperament with 201 items of the Early Childhood Temperament Questionnaire (mean child corrected age: 2.1 years). No significant main effects of repeated betamethasone on toddler temperament existed. However, a significant interaction between study group and duration of exposure to betamethasone emerged; those exposed to a repeated dose for >24 hours before delivery were more impulsive. One-SD increases in weight, length, and head circumference at birth were associated with 0.14- to 0.19-SD lower levels of negative affectivity (fearfulness, anger proneness, and sadness); 1-SD increases in length, weight, and head circumference at birth were associated with 0.14- to 0.18-SD higher levels of effortful control (self-regulation). Repeated antenatal betamethasone did not induce alterations in toddler temperament. The results, however, suggest that a longer duration of exposure is associated with higher impulsivity scores. Regardless of betamethasone exposure, slower fetal growth exerted influences on temperament. Our findings indicate prenatal programming of psychological development and imply that more attention is needed to support the development of infants born at the lower end of the fetal growth distribution.

  7. Attitude and perceptions of women on routine antenatal ultrasound ...

    African Journals Online (AJOL)

    Attitude and perceptions of women on routine antenatal ultrasound ... 16 (34.7%) felt that ultrasound should only be done on the doctor's request. ... df=2, P=0.00) were significantly, more favourably disposed to routine scan in pregnancy.

  8. Pattern of Family Planning Methods used by Antenatal Patients in ...

    African Journals Online (AJOL)

    Pattern of Family Planning Methods used by Antenatal Patients in Owo,Nigeria. ... Information obtained from the respondents with the aid of the study instrument ... The reasons for getting pregnant were desire to have more children (79%), and ...

  9. Patterns of Antenatal Care Seeking Behavior in South East Nigeria ...

    African Journals Online (AJOL)

    The effects of age, education, SES, and ANC seeking behavior were analyzed. ... KEY WORDS: Antenatal care, health seeking behavior, inequities, Nigeria, women of childbearing age ..... individual, family or community choice of health care.

  10. PHACE syndrome in antenatally diagnosed posterior fossa anomaly

    Directory of Open Access Journals (Sweden)

    Seema Pavaman Sindgikar

    2014-01-01

    Full Text Available PHACE is a neurocutaneous syndrome, an acronym to describe patients with facial segmental hemangiomas and other malformations. We describe a newborn antenatally diagnosed to have posterior fossa anomaly and subsequently as PHACE syndrome.

  11. HIV Prevalence amongst Clients Attending Antenatal Clinic at the ...

    African Journals Online (AJOL)

    Nigerian Journal of Medicine. Journal Home ... HIV Prevalence amongst Clients Attending Antenatal Clinic at the Federal Medical Centre, Makurdi. ET Agida, P Abu, ... 2007 to 30 April, 2007 was carried out. Information ... Article Metrics.

  12. Risk factors for antenatal depression, postnatal depression and parenting stress

    Directory of Open Access Journals (Sweden)

    Milgrom Jeannette

    2008-04-01

    Full Text Available Abstract Background Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite the strong link with depression. The aim of this study was to further elucidate which of some previously identified risk factors are most predictive of three outcome measures: antenatal depression, postnatal depression and parenting stress and to examine the relationship between them. Methods Primipara and multiparae women were recruited antenatally from two major hoitals as part of the beyondblue National Postnatal Depression Program 1. In this subsidiary study, 367 women completed an additional large battery of validated questionnaires to identify risk factors in the antenatal period at 26–32 weeks gestation. A subsample of these women (N = 161 also completed questionnaires at 10–12 weeks postnatally. Depression level was measured by the Beck Depression Inventory (BDI. Results Regression analyses identified significant risk factors for the three outcome measures. (1. Significant predictors for antenatal depression: low self-esteem, antenatal anxiety, low social support, negative cognitive style, major life events, low income and history of abuse. (2. Significant predictors for postnatal depression: antenatal depression and a history of depression while also controlling for concurrent parenting stress, which was a significant variable. Antenatal depression was identified as a mediator between seven of the risk factors and postnatal depression. (3. Postnatal depression was the only significant predictor for parenting stress and also acted as a mediator

  13. Risk factors for antenatal depression, postnatal depression and parenting stress.

    Science.gov (United States)

    Leigh, Bronwyn; Milgrom, Jeannette

    2008-04-16

    Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite the strong link with depression. The aim of this study was to further elucidate which of some previously identified risk factors are most predictive of three outcome measures: antenatal depression, postnatal depression and parenting stress and to examine the relationship between them. Primipara and multiparae women were recruited antenatally from two major hoitals as part of the beyondblue National Postnatal Depression Program 1. In this subsidiary study, 367 women completed an additional large battery of validated questionnaires to identify risk factors in the antenatal period at 26-32 weeks gestation. A subsample of these women (N = 161) also completed questionnaires at 10-12 weeks postnatally. Depression level was measured by the Beck Depression Inventory (BDI). Regression analyses identified significant risk factors for the three outcome measures. (1). Significant predictors for antenatal depression: low self-esteem, antenatal anxiety, low social support, negative cognitive style, major life events, low income and history of abuse. (2). Significant predictors for postnatal depression: antenatal depression and a history of depression while also controlling for concurrent parenting stress, which was a significant variable. Antenatal depression was identified as a mediator between seven of the risk factors and postnatal depression. (3). Postnatal depression was the only significant predictor for parenting stress and also acted as a mediator for other risk factors. Risk factor profiles for

  14. Antenatal diagnosis of a Morgagni hernia in the second trimester.

    Science.gov (United States)

    Jain, Krishan Kumar; Sen, Jyotsna; Rathee, Suresh Kanta; Saini, Jitender

    2008-02-01

    Morgagni hernia is an uncommon type of congenital hernia that is rarely diagnosed antenatally. Herniation of the liver into the fluid-filled pericardial sac resulting in a thoracic mass is a particularly rare form of Morgagni hernia; only 3 cases have been reported in the literature, all with a diagnosis made at 32 weeks' gestation or later. We report a case of Morgagni hernia diagnosed on antenatal sonography at 24 weeks' gestation.

  15. Risk factors for antenatal depression, postnatal depression and parenting stress

    OpenAIRE

    Leigh, Bronwyn; Milgrom, Jeannette

    2008-01-01

    Background Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite the stro...

  16. Risk factors for antenatal depression, postnatal depression and parenting stress

    OpenAIRE

    Milgrom Jeannette; Leigh Bronwyn

    2008-01-01

    Abstract Background Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite...

  17. Risk factors for antenatal depression, postnatal depression and parenting stress

    OpenAIRE

    Milgrom Jeannette; Leigh Bronwyn

    2008-01-01

    Abstract Background Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite...

  18. Risk factors for antenatal depression, postnatal depression and parenting stress

    OpenAIRE

    Leigh, Bronwyn; Milgrom, Jeannette

    2008-01-01

    Background Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite the stro...

  19. A review of longitudinal studies on antenatal and postnatal depression.

    Science.gov (United States)

    Underwood, Lisa; Waldie, Karen; D'Souza, Stephanie; Peterson, Elizabeth R; Morton, Susan

    2016-10-01

    Antenatal depression is a known risk factor for postnatal depression; both are common disorders associated with negative impacts on child development. Few studies have followed up women from pregnancy and through the postnatal period to explore how rates of depression change. This review evaluates recent evidence on depression during pregnancy and after childbirth. A search of Embase, PsychINFO, MEDLINE and Cochrane Reviews was carried out to identify longitudinal studies on antenatal and postnatal depression. Studies that measured depression during pregnancy and up to 1 year after childbirth were evaluated against a set of criteria (e.g. less than 50 % attrition). Of the initial 523 studies identified, 16 studies met the final inclusion criteria with a total of 35,419 women. The average rate of antenatal depression across these studies was 17 and 13 % postnatal depression. The longitudinal nature of the studies revealed that on average 39 % of those who experienced antenatal depression went on to have postnatal depression. Similarly, on average, 47 % of those with postnatal depression had also experienced antenatal depression. On average, almost 7 % of women reported significant depressive symptoms in pregnancy that persisted after childbirth. The review provided evidence that rates of depression tend to be higher during pregnancy than in the first year following childbirth. Furthermore, the longitudinal data show that there is much movement between the groups categorised as depressed or not depressed. There is evidence that postnatal depression is often a continuation of existing antenatal depression.

  20. Nutritional Epidemiology of Antenatal Smoking Cessation Among Japanese Women.

    Science.gov (United States)

    Mak, Kwok-Kei; Watanabe, Hiroko; Nomachi, Shinobu; Suganuma, Nobuhiko

    2016-01-01

    This study compared the nutritional status before pregnancy, as well as dietary profiles and biomarkers during first trimester, between never-smokers and antenatal quitters among Japanese women. One hundred fifty pregnant women (79 never-smokers and 71 antenatal quitters) from two obstetrics and gynecology clinics were recruited in Japan. Subjects' prepregnancy nutritional status was indicated by their body mass index (BMI). In the first trimester, their dietary profiles were assessed by the Brief Diet-History Questionnaire (BDHQ) and pregnancy outcomes were screened by biomarker tests. Generalized linear regression was used to examine the differences of energy-adjusted dietary intakes and biomarker results between the two smoking groups, with adjustment of maternal age, BMI, gestation week, and parity. The results showed that antenatal quitters were more likely to have a prepregnancy underweight status than never-smokers. During the first trimester, antenatal quitters had significantly higher intakes of unsaturated fatty acids and antioxidants (vegetable lipids and isoflavone), and lower intakes of total cholesterol than never-smokers. Moreover, antenatal quitters had a significantly higher level of serum homocysteine (6.36 nmol/mL vs 4.88 nmol/mL) than never-smokers. In conclusion, antenatal quitters are more likely to have a poor nutritional status before pregnancy than never-smokers. Quitting smoking before pregnancy and having a good nutritional profile during the trimester may not sufficiently reverse the adverse effects of former smoking behaviors on pregnancy outcomes.

  1. Prevalence of antenatal depressive symptoms among women in Sabah, Malaysia.

    Science.gov (United States)

    Mohamad Yusuff, Aza Sherin; Tang, Li; Binns, Colin W; Lee, Andy H

    2016-01-01

    To investigate the prevalence of antenatal depression and to assess whether the common risk factors identified in previous studies were applicable to women in Sabah, Malaysia. A prospective cohort study of 2072 women was conducted in Sabah during 2009-2010. Participants were recruited at 36-38 weeks of gestation to complete a self-administered questionnaire regarding their demographic, socioeconomic and health characteristics. The presence of depression was assessed using the validated Malay version of the Edinburgh Postnatal Depression Scale. The prevalence of antenatal depression was 13.8% [95% confidence interval (CI) 12.3%, 15.3%]. Women who were happy with the pregnancy [odds ratio (OR) 0.43, 95% CI 0.21, 0.89] and those with a planned pregnancy (OR 0.45, 95% CI 0.33, 0.60) were less likely to suffer from antenatal depression. Pregnant mothers who were taking oral contraceptives before pregnancy (OR 1.63, 95% CI 1.20, 2.22) and women who experienced antenatal anxiety (OR 3.17, 95% CI 2.35, 4.26) appeared to have an increased risk of antenatal depression. A substantial proportion of women suffered from antenatal depression in Sabah, Malaysia. Screening and culturally tailored intervention programs targeting vulnerable subgroups of women in the early stage of pregnancy are recommended to deal with the problem.

  2. Deployment Repeatability

    Science.gov (United States)

    2016-04-01

    controlled to great precision, but in a Cubesat , there may be no attitude determination at all. Such a Cubesat might treat sun angle and tumbling rates as...could be sensitive to small differences in motor controller timing. In these cases, the analyst might choose to model the entire deployment path, with...knowledge of the material damage model or motor controller timing precision. On the other hand, if many repeated and environmentally representative

  3. Enhancing nuclear translocation: perspectives in inhaled corticosteroid therapy.

    Science.gov (United States)

    Hakim, Amir; Usmani, Omar S

    2015-01-01

    Corticosteroids are widely used in the treatment of asthma and chronic obstructive pulmonary disease (COPD). In contrast to their use in mild-to-moderate asthma, they are less efficacious in improving lung function and controlling the underlying inflammation in COPD. In most clinical trials, corticosteroids have shown little benefit in COPD, but have shown a greater clinical effect in combination with long-acting bronchodilators. Impaired corticosteroid activation of the glucocorticoid receptor (GR) has been reported in corticosteroid-insensitive individuals. Reversal of corticosteroid-insensitivity by enhancing GR nuclear translocation is a potential therapeutic target. Preclinical studies suggest members of the nuclear receptor superfamily may facilitate glucocorticoid receptor nuclear translocation. Unravelling the mechanisms that govern GR nuclear translocation may identify novel therapeutic targets for reversing corticosteroid-insensitivity.

  4. Malawi: HIV surveillance in antenatal women.

    Science.gov (United States)

    1997-12-01

    From October to December 1996, a surveillance for HIV among antenatal clinic attenders (ANC) was conducted in 19 hospitals serving as sentinel sites in Malawi. The sites consisted of 3 urban, 8 semiurban, and 8 rural hospitals drawn from all 3 regions of the country. Findings showed that of the 4163 samples, 793 were HIV positive, giving an overall prevalence of 19%, with a range from 27% in the urban areas to 18% in the semiurban areas and 10% in the rural areas. The age distribution of infection showed that seroprevalence was highest in the 25-29 age group. In terms of syphilis infection, the rate was more common in the southern than in the central or northern regions, but it did not vary according to urban, semiurban, or rural sites or according to age. Overall, the results showed that ANC HIV seroprevalence remained relatively stable from 1994 to 1996, increasing from 17.4% in 1994 to 18% in 1995 and 19% in 1996. Moreover, the national estimate for seroprevalence in the entire population was 6.4%, essentially the same as that for 1995 (6.6%), indicating that the level of HIV infection had been fairly stable since 1993. Continued close monitoring is required to assess whether the incidence of new infection is actually declining, particularly among young people, and to identify what interventions have the greatest impact.

  5. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects

    Science.gov (United States)

    Sharma, Deepak; Shastri, Sweta; Sharma, Pradeep

    2016-01-01

    Intrauterine growth restriction (IUGR), a condition that occurs due to various reasons, is an important cause of fetal and neonatal morbidity and mortality. It has been defined as a rate of fetal growth that is less than normal in light of the growth potential of that specific infant. Usually, IUGR and small for gestational age (SGA) are used interchangeably in literature, even though there exist minute differences between them. SGA has been defined as having birth weight less than two standard deviations below the mean or less than the 10th percentile of a population-specific birth weight for specific gestational age. These infants have many acute neonatal problems that include perinatal asphyxia, hypothermia, hypoglycemia, and polycythemia. The likely long-term complications that are prone to develop when IUGR infants grow up includes growth retardation, major and subtle neurodevelopmental handicaps, and developmental origin of health and disease. In this review, we have covered various antenatal and postnatal aspects of IUGR. PMID:27441006

  6. Environments For Healthy Living (EFHL Griffith birth cohort study: characteristics of sample and profile of antenatal exposures

    Directory of Open Access Journals (Sweden)

    Cameron Cate M

    2012-12-01

    Full Text Available Abstract Background The Environments for Healthy Living (EFHL study is a repeated sample, longitudinal birth cohort in South East Queensland, Australia. We describe the sample characteristics and profile of maternal, household, and antenatal exposures. Variation and data stability over recruitment years were examined. Methods Four months each year from 2006, pregnant women were recruited to EFHL at routine antenatal visits on or after 24 weeks gestation, from three public maternity hospitals. Participating mothers completed a baseline questionnaire on individual, familial, social and community exposure factors. Perinatal data were extracted from hospital birth records. Descriptive statistics and measures of association were calculated comparing the EFHL birth sample with regional and national reference populations. Data stability of antenatal exposure factors was assessed across five recruitment years (2006–2010 inclusive using the Gamma statistic for ordinal data and chi-squared for nominal data. Results Across five recruitment years 2,879 pregnant women were recruited which resulted in 2904 live births with 29 sets of twins. EFHL has a lower representation of early gestational babies, fewer still births and a lower percentage of low birth weight babies, when compared to regional data. The majority of women (65% took a multivitamin supplement during pregnancy, 47% consumed alcohol, and 26% reported having smoked cigarettes. There were no differences in rates of a range of antenatal exposures across five years of recruitment, with the exception of increasing maternal pre-pregnancy weight (p=0.0349, decreasing rates of high maternal distress (p=0.0191 and decreasing alcohol consumption (p Conclusions The study sample is broadly representative of births in the region and almost all factors showed data stability over time. This study, with repeated sampling of birth cohorts over multiple years, has the potential to make important contributions to

  7. Anaphylactic reaction to intralesional corticosteroid injection.

    Science.gov (United States)

    Laing, M E; Fallis, B; Murphy, G M

    2007-08-01

    We report the case of anaphylactic reaction to carboxymethylcellulose, a dispersant in corticosteroid preparation and contrast media. Skin prick testing in this patient revealed a positive response to carboxymethylcellulose at a dilution of 1/1000. Anaphylaxis secondary to carboxymethylcellulose has previously been reported. To avoid further problems, this patient was advised to alert medical staff for the presence of allergy to carboxymethylcellulose in the event of the need for further interventional procedures. Care should be taken when giving intradermal steroids to patients with a history of anaphylaxis after contrast media.

  8. Corticosteroids: clinical pharmacology and therapeutic use.

    Science.gov (United States)

    Swartz, S L; Dluhy, R G

    1978-09-01

    The widespread use of corticosteroids in clinical practice emphasises the need for a thorough understanding of their metabolic effects. In general, the actions of corticosteroids on carbohydrate, protein, and lipid metabolism result in increased hepatic capacity for gluconeogenesis and enhanced catabolic actions upon muscle, skin, lymphoid, adipose and connective tissues. Because of the morbidity associated with steroid therapy, the clinician must carefully consider in each case the gains that can reasonably be expected from corticosteroid therapy versus the inevitable undesirable side effects of prolonged therapy. Thus, it is important to remember that the enhanced anti-inflammatory activity of the various synthetic analogues of cortisol is not dissociated from the expected catabolic actions of glucocorticoid hormones. Replacement therapy with physiological doses of cortisol in primary or secondary adrenal insufficiency is intended to simulate the normal daily secretion of cortisol. Short term, high dose suppressive glucocorticoid therapy is indicated in the treatment of medical emergencies such as necrotising vasculitis, status asthmaticus and anaphylactic shock. With improvement of the underlying disorder, the steroid dosage can be rapidly tapered and then discontinued over a 2 to 3 day period. Long term, high dose suppressive therapy is often commonly used to treat certain diseases (see sections 4.7.2 and 4.7.3). In this setting, suppression of the hypothalamic-pituitary-adrenal axis may persist for as long as 9 to 12 months following steroid withdrawal if steroid doses are administered in the supraphysiological range for longer than 2 weeks. In general, higher doses, longer duration of usage, and frequent daily administration are all correlated with the severity of pituitary ACTH suppression. When steroid therapy is to be withdrawn, gradual tapering of the dosage is necessary; the steroid dosage should also be given as a single morning dose if possible. Rapid

  9. Perioperative corticosteroid management for patients with inflammatory bowel disease.

    Science.gov (United States)

    Hicks, Caitlin W; Wick, Elizabeth C; Salvatori, Roberto; Ha, Christina Y

    2015-01-01

    Guidelines on the appropriate use of perioperative steroids in patients with inflammatory bowel disease (IBD) are lacking. As a result, corticosteroid supplementation during and after colorectal surgery procedures has been shown to be highly variable. A clearer understanding of the indications for perioperative corticosteroid administration relative to preoperative corticosteroid dosing and duration of therapy is essential. In this review, we outline the basic tenets of the hypothalamic-pituitary-adrenal (HPA) axis and its normal response to stress, describe how corticosteroid use is thought to affect this system, and provide an overview of the currently available data on perioperative corticosteroid supplementation including the limited evidence pertaining to patients with inflammatory bowel disease. Based on currently existing data, we define "adrenal suppression," and propose a patient-based approach to perioperative corticosteroid management in the inflammatory bowel disease population based on an individual's historical use of corticosteroids, the type of surgery they are undergoing, and HPA axis testing when applicable. Patients without adrenal suppression (corticosteroid supplementation in the perioperative period; patients with adrenal suppression (>20 mg prednisone per day) should be treated with additional perioperative corticosteroid coverage above their baseline home regimen; and patients with unclear HPA axis function (>5 and <20 mg prednisone per day) should undergo preoperative HPA axis testing to determine the best management practices. The proposed management algorithm attempts to balance the risks of adrenal insufficiency and immunosuppression.

  10. KAJIAN PEMBERIAN ANTENATAL KORTIKOSTEROID UNTUK IBU HAMIL YANG BERISIKO MELAHIRKAN BAYI PREMATUR

    Directory of Open Access Journals (Sweden)

    Yuyun Yuniar

    2016-03-01

    Full Text Available Latar Belakang: Kelahiran prematur merupakan salah satu penyebab utama kematian bayi terkait dengan komplikasi yang terjadi khususnya sindrom gagal nafas. Pemberian antenatal corticosteroid (ACS merupakan intervensi yang efektif untuk mencegah gangguan pernafasan pada bayi prematur. Cakupan pemberian ACS diperkirakan hanya 10 persen dari yang membutuhkan. Tujuan: Kajian ini dilakukan untuk mengumpulkan data mengenai kebijakan, manfaat dan kerugian ACS, serta rekomendasi berbagai organisasi profesi terkait pemberian ACS. Metode: Data dikumpulkan melalui penelusuran data kebijakan, penelusuran literatur secara online untuk dibuat telaah secara sistematik serta pertemuan dengan narasumber dari organisasi profesi terkait. Hasil: Kebijakan yang sudah ada belum menjadi landasan hukum pemberian ACS dan belum ada prosedur teknis pelaksanaannya. ACS terbukti bermanfaat untuk membantu pematangan paru-paru pada janin sehingga mengurangi risiko komplikasi pada bayi prematur dan tidak memberikan komplikasi yang serius pada ibu. Pemberian ACS harus dilakukan sebagai satu paket komprehensif oleh tenaga kesehatan yang meliputi proses deteksi dini, pemberian tokolitik, pemberian ACS dan diikuti dengan rujukan ke fasilitas yang memadai. Pemahaman dan kompetensi tenaga kesehatan baik di rumah sakit maupun puskesmas perlu ditingkatkan dan didukung dengan peraturan yang memadai. Kesimpulan: Peningkatan cakupan pemberian ACS memerlukan dukungan kebijakan pemerintah serta peran organisasi profesi dan tenaga kesehatan.

  11. Tablet computers for implementing NICE antenatal mental health guidelines: protocol of a feasibility study.

    Science.gov (United States)

    Marcano-Belisario, José S; Gupta, Ajay K; O'Donoghue, John; Morrison, Cecily; Car, Josip

    2016-01-22

    Depression is one of the most common mental health disorders that may affect women during pregnancy. The prompt identification of this disorder, and the provision of treatment, may help to reduce the likelihood of post-partum depression, prevent severe forms of the disease, and reduce its intergenerational impact. Despite women's repeated encounters with health services throughout their antenatal care, depression often goes undiagnosed. This is one area where mobile health could prove useful. We will assess the feasibility of using tablets to incorporate depression screening into antenatal pathways. We will also assess if survey layout could affect the quality of the data collected through these devices. We will test the feasibility of using iPad Airs for the administration of the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) to pregnant women attending antenatal clinics in England. We will assess the impact of survey layout on the quality of the responses given to these screening scales using a parallel, randomised controlled study design. We will calculate the positive predictive value, the negative predictive value and the false omission rate of the Whooley questions in comparison with the EPDS. We will calculate differences in data equivalence, time needed to complete the surveys, break-off rates, data completeness and requests for help between the 2 experimental groups: using all questions in one screen and navigation by vertical scrolling, or a single question per screen and navigation by multiple pages. This study has been approved by the National Research Ethics Service Committee South East Coast--Surrey. Our findings will be disseminated through academic peer-reviewed publications, conferences and discussion with peers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Plantar fascia rupture associated with corticosteroid injection.

    Science.gov (United States)

    Sellman, J R

    1994-07-01

    A series of 37 patients, all with a presumptive diagnosis of plantar fascia rupture, is presented. All had had prior heel pain diagnosed as plantar fasciitis, and all had been treated with corticosteroid injection into the calcaneal origin of the fascia. One third described a sudden tearing episode in the heel, while the rest had a gradual change in symptoms. Most of the patients had relief of the original heel pain, which had been replaced by a variety of new foot problems, including dorsal and lateral midfoot pain, swelling, foot weakness, metatarsal pain, and metatarsal fracture. In all 37 patients, there was a palpable diminution in the tension of the plantar fascia on the involved side, and footprints often showed a flattening of the involved arch. Magnetic resonance imaging done on one patient showed attenuation of the plantar fascia. From these observations and data, the author concluded that plantar fascia rupture had occurred. Treatment following rupture included supportive shoes, orthoses, and time. The majority had resolution of their new symptoms, but this often took 6 to 12 months to occur. In the remainder, there were persisting symptoms. Corticosteroid injections, although helpful in the treatment of plantar fasciitis, appear to predispose to plantar fascia rupture.

  13. Detection of contact hypersensitivity to corticosteroids in allergic contact dermatitis patients who do not respond to topical corticosteroids.

    Science.gov (United States)

    Gönül, Müzeyyen; Gül, Ulker

    2005-08-01

    The delayed hypersensitivity development against topical corticosteroids which are used in allergic contact dermatitis (ACD) treatment is an important clinical problem. In our study, 41 ACD patients who did not show any response to topical corticosteroid treatment were patch tested with corticosteroid series and the commercial preparations of corticosteroids and their vehicles. In corticosteroid series, there were budesonide, bethametasone-17-valerate, triamcinolone acetonide, tixocortol pivalate, alclomethasone-17-21-dipropionate, clobetasole-17-propionate, dexamethasone-21-phosphate disodium and hydrocortisone-17-butyrate. We detected positive reaction to corticosteroids in 9 of our cases (22%) (5 single and 4 multiple). The sensitivity was mostly produced by tixocortol pivalate (6 patients). This was followed by triamcinolone acetonide (2 patients) budesonide (2 patients), alclomethasone dipropionate (2 patients), dexamethasone 21 phosphate disodium (2 patients) and betamethasone-17-valerate (1 patient). As a result, it should not be forgotten that the corticosteroids used to treat ACD patients may cause ACD themselves. In ACD patients who did not respond to corticosteroid treatment, routinely applying patch test with corticosteroids should be helpful in directing the treatment.

  14. Corticosteroids and pediatric septic shock outcomes: a risk stratified analysis.

    Directory of Open Access Journals (Sweden)

    Sarah J Atkinson

    Full Text Available The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE, 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high. Subjects receiving corticosteroids during the initial 7 days of admission (n = 252 were compared to subjects who did not receive corticosteroids (n = 244. Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3-4.0, p = 0.004 and a complicated course (OR 1.7, 95% CI 1.1-2.5, p = 0.012. Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort.

  15. Including expectant fathers in antenatal education programmes in Istanbul, Turkey.

    Science.gov (United States)

    Turan, J M; Nalbant, H; Bulut, A; Sahip, Y

    2001-11-01

    In this article we present the results of three studies investigating methods for including men in antenatal education in Istanbul, Turkey. Participants were first-time expectant parents living in low and middle-income areas. After a formative study on the roles of various family members in health during the period surrounding a first birth, an antenatal-clinic-based education programme for women and for couples was carried out as a randomised, controlled study. Based on the results, separate community-based antenatal education programmes for expectant mothers and expectant fathers were tested. There was demand among many pregnant women and some of their husbands for including expectant fathers in antenatal education. In the short term, these programmes seemed to have positive effects on women and men's reproductive health knowledge, attitudes and behaviours. In the clinic-based programme the positive effects of including men were mainly in the area of post-partum family planning, while in the community-based programme positive effects among men were also seen in the areas of infant health, infant feeding and spousal communication and support. Free antenatal education should be made available to all expectant mothers and when possible, men should be included, either together with their wives or in a culture such as that of Turkey, in separate groups.

  16. Corticosteroids: friends or foes of teleost fish reproduction?

    OpenAIRE

    2009-01-01

    Reproduction in vertebrates is controlled by the Hypothalamus-Pituitary-Gonad axis and the main hormone actions have been extensively described. Still, despite the scattered information in fish, accumulating evidence strongly indicates that corticosteroids play essential roles in reproductive mechanisms. An integrative approach is important for understanding these implications. Animal husbandry and physiological studies at molecular to organismal levels have revealed that these corticosteroid...

  17. Risk of miscarriage among users of corticosteroid hormones

    DEFF Research Database (Denmark)

    Bjørn, Anne-Mette Bay; Nielsen, Rikke B; Nørgaard, Mette Lone

    2013-01-01

    The purpose of this nested case-control study in Denmark was to study the association between use of corticosteroids and risk of miscarriage.......The purpose of this nested case-control study in Denmark was to study the association between use of corticosteroids and risk of miscarriage....

  18. Corticosteroids reduce the tensile strength of isolated collagen fascicles

    DEFF Research Database (Denmark)

    Haraldsson, Bjarki Thor; Langberg, Henning; Aagaard, Per

    2006-01-01

    Overuse tendon injuries are frequent. Corticosteroid injections are commonly used as treatment, although their direct effects on the material properties of the tendon are poorly understood.......Overuse tendon injuries are frequent. Corticosteroid injections are commonly used as treatment, although their direct effects on the material properties of the tendon are poorly understood....

  19. Unintended effects of inhaled corticosteroids : disease or drugs?

    NARCIS (Netherlands)

    Vries, F. de

    2007-01-01

    Patients with asthma or COPD are often treated with inhaled corticosteroids. These drugs reduce the inflammation in the lungs and patients suffer fewer exacerbations. In the late nineties, a tendency to treat patients in general with higher doses of inhaled corticosteroids was accompanied with an in

  20. Intranasal corticosteroids compared with oral antihistamines in allergic rhinitis

    DEFF Research Database (Denmark)

    Juel-Berg, Nanna; Darling, Peter; Bolvig, Julie

    2017-01-01

    Background: Intranasal corticosteroids (INS) (corticosteroid nasal sprays) and oral antihistamines (OA) are two of the most common treatments for patients with allergic rhinitis (AR). To our knowledge, there are no systematic reviews on this topic including trials published after 2007. Objective...

  1. Corticosteroids for all adult patients with community-acquired pneumonia?

    OpenAIRE

    Ger Rijkers; Simone Spoorenberg; Stefan Vestjens; Werner Albrich

    2015-01-01

    Corticosteroid therapy as adjunctive treatment in community-acquired pneumonia (CAP) is a promising but controversial subject. The potentially beneficial effect of corticosteroids is based on the ability of steroids to dampen an excessive inflammatory response that often occurs in patients with CAP. This excessive inflammatory response can cause damage to the lungs and other organs, and is associated with poor outcome.

  2. Factors impacting the combination of topical corticosteroid therapies for psoriasis: perspectives from the international psoriasis council

    NARCIS (Netherlands)

    Kerkhof, P.C. van de; Kragballe, K.; Segaert, S.; Lebwohl, M.

    2011-01-01

    Corticosteroids are the mainstay of topical therapies for the treatment of mild to moderate psoriasis. Selection of vehicle, concentrations of corticosteroid and coadministered medications, and frequency of administration are critical factors that enhance bioavailability of topical corticosteroids.

  3. Corticosteroids In Infections Of Central Nervous System

    Directory of Open Access Journals (Sweden)

    Meena AK

    2003-01-01

    Full Text Available Infections of central nervous system are still a major problem. Despite the introduction of newer antimicrobial agents, mortality and long-term sequelace associated with these infections is unacceptably high. Based on the evidence that proinflammtory cytokines have a role in pathophysiology of bacterial and tuberculous meningitis, corticosteroids with a potent anti-inflammatory and immunomodulating effect have been tested and found to be of use in experimental and clinical studies, Review of the available literature suggests steroid administration just prior to antimicrobial therapy is effective in decreasing audiologic and neurologic sequelae in childern with H. influenzae nenigitis. Steroid use for bacterial meningitis in adults is found to be beneficial in case of S. pneumoniae. The value of adjunctive steroid therapy for other bacterial causes of meningitis remains unproven. Corticocorticoids are found to be of no benefit in viral meningitis, Role of steroids in HIV positive patients needs to be studied.

  4. Antenatal information sources for maternal and infant diet.

    Science.gov (United States)

    Newby, Ruth; Brodribb, Wendy; Ware, Robert S; Davies, Peter S W

    2015-07-01

    This report describes information sources accessed by pregnant women around antenatal and early infant diet. Australian women in their first pregnancy (n = 277) responded to questionnaires online and on paper between June 2010 and March 2011 as part of the Feeding Queensland Babies Study. Antenatal information sources are reported for maternal diet, breastfeeding and formula-feeding. Pregnant women sought and encountered information for their own and their infants' diet from many sources. Health care professionals provided antenatal dietary information for 80% of respondents and infant feeding advice for 69%. Relatives or friends were the respondents' largest reported information source for infant feeding, reported by 78%. Information on artificial baby milk was accessed on television by 77% and on the internet by 52% of respondents. Health care professionals should proactively support clients' informational needs and address encountered nutrition misinformation. Further research is necessary to establish the nature and accuracy of dietary information in the mass media.

  5. HIV testing and treatment in the antenatal care setting.

    LENUS (Irish Health Repository)

    Coulter-Smith, S

    2012-02-01

    Routine linked HIV antenatal screening, with "opt-out", was introduced at the Rotunda in January 1998. This paper reviews the screening and subsequent pregnancy management and outcome in HIV positive women from 1998 to 2006. During this time 225 women (280 pregnancies) were HIV positive and 194 women subsequently delivered at the Rotunda, representing 233 liveborn infants. Overall anti-HIV prevalence was 0.42%, increasing from 0.06% in 1998 to 0.57% in 2006. Of 233 livebirths, 111 (48%) were delivered by spontaneous vaginal delivery (SVD). HIV treatment was started pre-pregnancy in 14 (6%) pregnancies and antenatally in 208 (90%). The vertical transmission rate in mothers receiving >4 weeks of treatment was 0%. We conclude that routine antenatal HIV screening is effective and significantly benefits the health of mother and child.

  6. HIV testing and treatment in the antenatal care setting.

    LENUS (Irish Health Repository)

    Coulter-Smith, S

    2010-01-01

    Routine linked HIV antenatal screening, with "opt-out", was introduced at the Rotunda in January 1998. This paper reviews the screening and subsequent pregnancy management and outcome in HIV positive women from 1998 to 2006. During this time 225 women (280 pregnancies) were HIV positive and 194 women subsequently delivered at the Rotunda, representing 233 liveborn infants. Overall anti-HIV prevalence was 0.42%, increasing from 0.06% in 1998 to 0.57% in 2006. Of 233 livebirths, 111 (48%) were delivered by spontaneous vaginal delivery (SVD). HIV treatment was started pre-pregnancy in 14 (6%) pregnancies and antenatally in 208 (90%). The vertical transmission rate in mothers receiving >4 weeks of treatment was 0%. We conclude that routine antenatal HIV screening is effective and significantly benefits the health of mother and child.

  7. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion

    DEFF Research Database (Denmark)

    Thurn, L; Lindqvist, P G; Jakobsson, M;

    2016-01-01

    of women at high risk will likely strengthen antenatal suspicion. Prior PPH is a novel risk factor associated with an increased prevalence of AIP. TWEETABLE ABSTRACT: An ultrasound assessment in women with placenta praevia or prior CS may double the awareness for AIP.......OBJECTIVE: The objective was to investigate prevalence, estimate risk factors, and antenatal suspicion of abnormally invasive placenta (AIP) associated with laparotomy in women in the Nordic countries. DESIGN: Population-based cohort study. SETTING AND POPULATION: A 3-year Nordic collaboration...... National health registries. MAIN OUTCOME MEASURES: Prevalence, risk factors, antenatal suspicion, birth complications, and risk estimations using aggregated national data. RESULTS: A total of 205 cases of AIP in association with laparotomy were identified, representing 3.4 per 10 000 deliveries. The single...

  8. Corticosteroid therapy of zoster-associated pain

    Directory of Open Access Journals (Sweden)

    Cvjetković Dejan M.

    2004-01-01

    Full Text Available Introduction Lack of exact clinical studies on effects of corticosteroids in therapy and prevention of herpes zoster-related pain, elicited many controversies in the past. The aim of our study was to estimate effects of prednisone on frequency, intensity and duration of postherpetic neuralgia. Material and methods 68 immunocompetent herpes zoster patients, 8-90 years of age (37 females and 31 males, mean age 55,7 years were enrolled for study; 30 patients were treated with acyclovir (5x800 mg daily for a 7-day period and prednisone (initial daily dose 60 mg, tapering over 14 days, and the control group of 38 patients with acyclovir only. Patients were clinically followed up for 3 months after complete resolution of skin lesions. Chi-square test was used in statistical data analysis. Results The difference regarding incidence of postherpetic neuralgia in acyclovir/prednisone group and acyclovir group (although slightly less in the former one was not significant. Duration of postherpetic neuralgia over 3 months was similar in both groups. Mild postherpetic pain was more common in the acyclovir/prednisone group (44.4% than in the acyclovir group (28.6%; however, statistical validation requires more patients to be studied. Discussion Results of our study didn’t confirm efficiency of prednisone regarding occurrence and characteristics of postherpetic neuralgia. Failure of prednisone therapy may be partly contributed to advanced age of patients and delayed onset of therapy. Conclusion Use of corticosteroids in zoster patients gives neither reliable protection from appearance of postherpetic neuralgia, nor shortens its duration. Further investigations are necessary to estimate their effects on postherpetic pain.

  9. EFFECT OF THYROID DYSFUNCTION IN ANTENATAL MOTHERS

    Directory of Open Access Journals (Sweden)

    Anasooya Parail Sankaran

    2016-12-01

    Full Text Available BACKGROUND The aim of the study is to study the effect of thyroid dysfunction in antenatal mothers in Alappuzha one of the coastal areas in South Kerala over a period from January 2012 to January 2015. MATERIALS AND METHODS It is a descriptive study of the effect of thyroid dysfunction among pregnant ladies attending OBG Department in Government Medical College, Alappuzha, a rural medical college at coastal areas of Kerala over a period of 3 years. RESULTS The incidence is found to be maximum in the coastal area, i.e. 84.9%, but p-valve 0.625 is not statistically significant. Thyroid disorder is mostly seen in primigravida (57.8% and between the age of 20 and 25 yrs. (43.2% and the most commonly seen disorder among is subclinical hypothyroidism (73.7% (p valve <.005, which is statistically significant. There is significant increase in maternal complications like preeclampsia, (RR-8.54, p-value 0.014 recurrent abortion (RR-91.13, p-value 0.000, prolonged period of infertility (RR-55.16, p-value 0.000, anaemia (RR-11.37, p-value 0.003 is seen in subclinical hypothyroidism. The foetal complications seen are oligamnios (7.8%, MSAF (9.2%, foetal distress (12.1%, PROM (5.1% and FGR (10.9%. The neonates were admitted in NICU in view of NEC (1.5%, NNJ (24.1%, MAS (6.9%, TTNB (9.5% and HIE (2.9%. CONCLUSION The present study is intended to study the maternal and foetal effects of thyroid dysfunction. After the study, we concluded that there are many adverse maternal, foetal and neonatal effects in pregnancies complicated with thyroid dysfunction. In coastal area, the disease has got a high prevalence and hence there is a need for proper screening and early diagnosis. Proper treatment options are given to the patient.

  10. Periodontal disease and high doses of inhaled corticosteroids alter NTPDase activity in the blood serum of rats.

    Science.gov (United States)

    Scarabelot, Vanessa L; Cavagni, Juliano; Medeiros, Liciane F; Detânico, Bernardo; Rozisky, Joanna R; de Souza, Andressa; Daudt, Luciana Dondonis; Gaio, Eduardo José; Ferreira, Maria Beatriz Cardoso; Rösing, Cassiano Kuchenbecker; Battastini, Ana Maria O; Torres, Iraci L S

    2014-08-01

    Certain drugs such as glucocorticoids may interfere with the modulation of periodontal disease. In contrast, corticosteroid treatment has been associated with a protective effect with regard to periodontal breakdown, depending on the dose, pathway, and exposure time. Considering the potential relevance of nucleotidases in coordinating the cardiovascular system and inflammation processes, the aim of this study was to investigate the nucleotidase activities in the blood serum of rats with periodontal disease exposed chronically to inhaled corticosteroids. Adult male Wistar rats (n=26) were randomly assigned to one of the following four study groups: a control group that received no intervention; a periodontal disease group that received saline solution; a 'low dose' group that received 30 μg of budesonide daily; and a corresponding 'high dose' group that received 100 μg daily over a 15-day time course. The hydrolysis of ATP, ADP, and AMP were analysed in blood serum. Periodontal disease diminished the hydrolysis of ATP and enhanced the hydrolysis of ADP. Repeated administration of either a low or high dose in the periodontal disease model of inhaled corticosteroids reversed the observed increase in ADP hydrolysis, and only the repeated administration of low doses of inhaled corticosteroids was able to reverse the decrease in the hydrolysis of ATP induced by periodontal disease. The variables investigated in this study may be involved in the pathophysiology of periodontal disease and may participate in the mechanisms that mediate the development of some of the side effects of inhaled corticosteroids. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Midwives' views on of appropriate antenatal counselling for congenital anomaly tests: do they match clients' preferences?

    NARCIS (Netherlands)

    Martin, L.; Hutton, E.K.; Spelten, E.R.; Gitsels-van der Wal, J.T.; Dulmen, S. van

    2014-01-01

    Objective: this study aims to provide insight into: (a) midwives' views on appropriate antenatal counselling for congenital anomaly tests, and (b) whether these views match clients' preferences regarding antenatal counselling. Design: a comparative (midwives versus clients) questionnaire survey. Cog

  12. Midwives' views on appropriate antenatal counselling for congenital anomaly tests: Do they match clients' preferences?

    NARCIS (Netherlands)

    Martin, L.; Hutton, E.K.; Spelten, E.R.; Gitsels-van der Wal, J.T.; Dulmen, S. van

    2014-01-01

    OBJECTIVE: this study aims to provide insight into: (a) midwives' views on appropriate antenatal counselling for congenital anomaly tests, and (b) whether these views match clients' preferences regarding antenatal counselling. DESIGN: a comparative (midwives versus clients) questionnaire survey. Cog

  13. Antenatal treatment in two Dutch families with pyridoxine-dependent seizures.

    NARCIS (Netherlands)

    Bok, L.A.; Been, J.V.; Struys, E.A.; Jakobs, C.; Rijper, E.A.; Willemsen, M.A.A.P.

    2010-01-01

    Incidental reports suggest that antenatal treatment of pyridoxine dependent seizures (PDS) may improve neurodevelopmental outcome of affected patients. Two families with PDS are reported, both with two affected siblings. Antenatal treatment with pyridoxine was instituted during the second pregnancy

  14. Antenatal treatment in two Dutch families with pyridoxine-dependent seizures.

    NARCIS (Netherlands)

    Bok, L.A.; Been, J.V.; Struys, E.A.; Jakobs, C.; Rijper, E.A.; Willemsen, M.A.A.P.

    2010-01-01

    Incidental reports suggest that antenatal treatment of pyridoxine dependent seizures (PDS) may improve neurodevelopmental outcome of affected patients. Two families with PDS are reported, both with two affected siblings. Antenatal treatment with pyridoxine was instituted during the second pregnancy

  15. Midwives' views on of appropriate antenatal counselling for congenital anomaly tests: do they match clients' preferences?

    NARCIS (Netherlands)

    Martin, L.; Hutton, E.K.; Spelten, E.R.; Gitsels-van der Wal, J.T.; Dulmen, S. van

    2014-01-01

    Objective: this study aims to provide insight into: (a) midwives' views on appropriate antenatal counselling for congenital anomaly tests, and (b) whether these views match clients' preferences regarding antenatal counselling. Design: a comparative (midwives versus clients) questionnaire survey.

  16. Midwives' views on appropriate antenatal counselling for congenital anomaly tests: Do they match clients' preferences?

    NARCIS (Netherlands)

    Martin, L.; Hutton, E.K.; Spelten, E.R.; Gitsels-van der Wal, J.T.; Dulmen, S. van

    2014-01-01

    OBJECTIVE: this study aims to provide insight into: (a) midwives' views on appropriate antenatal counselling for congenital anomaly tests, and (b) whether these views match clients' preferences regarding antenatal counselling. DESIGN: a comparative (midwives versus clients) questionnaire survey.

  17. Quality of antenatal and childbirth care in northern Ghana.

    Science.gov (United States)

    Duysburgh, E; Williams, A; Williams, J; Loukanova, S; Temmerman, M

    2014-09-01

    The QUALMAT research project aims to improve maternal and newborn health by improving the quality of antenatal and childbirth care provided in primary healthcare facilities. Within the frame of this project, a comprehensive quality assessment took place in selected health centres in northern Ghana. The results of this assessment showed that overall quality of routine antenatal and childbirth care was satisfactory, although some critical gaps were identified. Counselling and health education practices need to be improved; laboratory investigations are often not performed; examination and monitoring of mother and newborn during childbirth are inadequate; partographs are often not used and poorly completed; and equipment to provide assisted vaginal deliveries was absent.

  18. Cataractogenesis after Repeat Laser in situ Keratomileusis

    Directory of Open Access Journals (Sweden)

    Ahmad M. Mansour

    2012-08-01

    Full Text Available There has been the unsubstantiated clinical impression that laser refractive surgery accelerates cataract development along with solid experimental data about the cataractogenic effects of excimer laser treatment. We present the first documented case of significant cataract formation in a young myope after repeat excimer laser ablation necessitating phacoemulsification with a posterior chamber implant. Proposed explanations include focusing of the ablation wave on the posterior capsule (acoustic wave lens epithelial damage, photooxidative stress of the lens (ultraviolet and inflammatory oxidative stress, and corticosteroid-induced cataract (lens toxicity.

  19. 11-Deoxycortisol is a corticosteroid hormone in the lamprey

    Science.gov (United States)

    Close, D.A.; Yun, S.-S.; McCormick, S.D.; Wildbill, A.J.; Li, W.

    2010-01-01

    Corticosteroid hormones are critical for controlling metabolism, hydromineral balance, and the stress response in vertebrates. Although corticosteroid hormones have been well characterized in most vertebrate groups, the identity of the earliest vertebrate corticosteroid hormone has remained elusive. Here we provide evidence that 11-deoxycortisol is the corticosteroid hormone in the lamprey, a member of the agnathans that evolved more than 500 million years ago. We used RIA, HPLC, and mass spectrometry analysis to determine that 11-deoxycortisol is the active corticosteroid present in lamprey plasma. We also characterized an 11-deoxycortisol receptor extracted from sea lamprey gill cytosol. The receptor was highly specific for 11-deoxycortisol and exhibited corticosteroid binding characteristics, including DNA binding. Furthermore, we observed that 11-deoxycortisol was regulated by the hypothalamus-pituitary axis and responded to acute stress. 11-Deoxycortisol implants reduced sex steroid concentrations and upregulated gill Na+, K+-ATPase, an enzyme critical for ion balance. We show here that 11-deoxycortisol functioned as both a glucocorticoid and a mineralocorticoid in the lamprey. Our findings indicate that a complex and highly specific corticosteroid signaling pathway evolved at least 500 million years ago with the arrival of the earliest vertebrate.

  20. Corticosteroids in chronic obstructive pulmonary disease. Clinical benefits and risks.

    Science.gov (United States)

    McEvoy, C E; Niewoehner, D E

    2000-12-01

    The use of systemic and inhaled corticosteroids for COPD has increased appreciably over the past 20 years. Clearer indications for corticosteroid therapy in COPD are beginning to emerge as the results from large clinical trials become available. Systemic corticosteroids are only modestly effective for acute COPD exacerbations, increase the risk for hyperglycemia, and should be given for no more than 2 weeks. The efficacy of long-term systemic corticosteroid therapy has not been adequately evaluated in this patient population. If longer term use of systemic steroids in COPD should be found to be useful, this conclusion would have to be weighed against the risk for serious adverse effects. High doses of inhaled corticosteroids cause a small sustained increase of the FEV1 in patients with mild and moderately severe COPD, but they do not slow the rate of FEV1 decline. Based on analyses of secondary outcome, inhaled corticosteroids may improve the respiratory symptoms and decrease the number and severity of COPD exacerbations in patients with more advanced disease. Low doses of inhaled corticosteroids appear to be safe, but there is growing awareness that higher doses may not be so benign.

  1. Serum pharmacodynamic biomarkers for chronic corticosteroid treatment of children

    Science.gov (United States)

    Hathout, Yetrib; Conklin, Laurie S.; Seol, Haeri; Gordish-Dressman, Heather; Brown, Kristy J.; Morgenroth, Lauren P.; Nagaraju, Kanneboyina; Heier, Christopher R.; Damsker, Jesse M.; van den Anker, John N.; Henricson, Erik; Clemens, Paula R.; Mah, Jean K.; McDonald, Craig; Hoffman, Eric P.

    2016-01-01

    Corticosteroids are extensively used in pediatrics, yet the burden of side effects is significant. Availability of a simple, fast, and reliable biochemical read out of steroidal drug pharmacodynamics could enable a rapid and objective assessment of safety and efficacy of corticosteroids and aid development of corticosteroid replacement drugs. To identify potential corticosteroid responsive biomarkers we performed proteome profiling of serum samples from DMD and IBD patients with and without corticosteroid treatment using SOMAscan aptamer panel testing 1,129 proteins in FGG). These are candidate biomarkers for anti-inflammatory efficacy of corticosteroids. Known safety concerns were validated, including elevated non-fasting insulin (insulin resistance), and elevated angiotensinogen (salt retention). These were extended by new candidates for metabolism disturbances (leptin, afamin), stunting of growth (growth hormone binding protein), and connective tissue remodeling (MMP3). Significant suppression of multiple adrenal steroid hormones was also seen in treated children (reductions of 17-hydroxyprogesterone, corticosterone, 11-deoxycortisol and testosterone). A panel of new pharmacodynamic biomarkers for corticosteroids in children was defined. Future studies will need to bridge specific biomarkers to mechanism of drug action, and specific clinical outcomes. PMID:27530235

  2. [Postnatal corticosteroids in preterm infants with immature lung disease].

    Science.gov (United States)

    Hinriksdottir, Erna; Brynjarsson, Hrolfur; Thorkelsson, Thordur

    2016-05-01

    Corticosteroids have been used in preterm infants with immature lungs to decrease their need for supplemental oxygen and mechanical ventilation. Whether the benefits of the treatment outweigh possible adverse effects remains controversial. The main objective of the study was to evaluate the effects of intravenous and inhalation corticosteroids on preterm infants' need for supplemental oxygen and mechanical ventilation and potential adverse effects. This was a retrospective cohort study on preterm infants at the Neonatal Intensive Care Unit of Children's Hospital Iceland, born between 2000-2014 and treated with intravenous (n=28) or inhalation (n=30) corticosteroids for immature lung disease. For each infant receiving steriods one infant who did not receive steriods was selected as control, matched on gestational age. There was a significant decrease in the need for supplemental oxygen following intravenous and inhalation corticosteroids administration, and a significant decrease in the need for mechanical ventilation following intravenous corticosteroids administration, but not in controls. Infants receiving intravenous corticosteroids gained significantly less weight than controls during treatment, but no significant difference in weight between groups was found at 35 weeks postmenstrual age, or in other possible adverse effects such as the prevalence of cerebral palsy. Intravenous and inhalation corticosteroids decrease the need for supplemental oxygen in preterm infants with immature lung disease and intravenous steriods facilitate earlier weaning from mechanical ventilation, without significant adverse effects. Therefore, it seems justifiable in selected cases to use corticosteroids in treatment of preterm infants with severe immature lung disease. Corticosteroids, preterm infants, chronic lung disease, mechanical ventilation. Correspondence: Thorður Thorkelsson, thordth@landspitali.is.

  3. PCP prophylaxis with use of corticosteroids by neurologists.

    Science.gov (United States)

    Kelly, Dearbhla M; Cronin, Simon

    2014-04-01

    Pneumocystis jirovecii pneumonia (PCP) is increasingly reported in patients without HIV. Corticosteroids are a major risk factor, with up to 90% of patients receiving corticosteroid treatment prior to the development of PCP. In view of this, many specialties now prescribe PCP prophylaxis to patients receiving prolonged or high-dose glucocorticoid regimens. Neurologists frequently prescribe corticosteroids but may not be as aware of the risk for PCP. Here, we review the evidence for routine PCP prophylaxis among regular glucocorticoid users and ask what guidance there is on the subject for neurologists.

  4. On the determination of reducing corticosteroids

    Directory of Open Access Journals (Sweden)

    Luiz Augusto de Abreu

    1955-12-01

    Full Text Available 1. The authors preconize the use of Folin-Ciocalteu's reagent in the colorimetric determination of reducing cortcosteroids. 2. The reaction follows Beer's law in the range 0-50 μg of 11-desoxycorticosterone. 3. Determinations made in human urine and adrenal glands of rats and guinea pigs are comparable with results obtained by other methods.Os autores preconizam o reagente de Folin-Ciocalteu na determinação colorimétrica dos corticosteroides redutores. A reação segue a lei de Beer na faixa de 0 a 50 μg de 11-desoxycorticosterona. A excreção urinária de corticosteroides redutores, em 24 horas, de indivíduos normais variou de 0.83 mg a 2.72 mg com a média de 1.69 mg, sem hidrólise prévia pela β glicuronidase. A intensidade da reação permite efetuar a dosagem em quantidades de urina sensìvelmente menores às usadas por outros métodos baseados nas propriedades redutoras dos corticosteróides. Os resultados, obtidos com suprarrenais de ratos, variaram de 16.3 mg a 50.8 mg de corticosteróides redutores por 100 g de glândula, com uma média de 32.5 mg, fazendo-se as determinações com as duas glândulas em cada animal. A taxa média observada nas suprarrenais de cobaias foi 22.9 mg de corticosteróides redutores por 100 g de glândula, com uma variação individual de 12.6 a 33.2 mg, fazendo-se as determinações sòmente com uma glândula. Os resultados obtidos são comparáveis aos descritos na literatura.

  5. Enhancing normal labour by adopting antenatal physiotherapy: a prospective study

    Directory of Open Access Journals (Sweden)

    Rooplekha Chauhan

    2016-08-01

    Conclusions: This highlights the very need for physiotherapy to be inculcated into the curriculum during antenatal period with conducive maternal and foetal outcome as it inflates the chances of normal deliveries and abate the rates of cesarean section and subsequent, which is the dire need of the day. [Int J Reprod Contracept Obstet Gynecol 2016; 5(8.000: 2672-2676

  6. Knowledge and perceptions of antenatal services need and delivery ...

    African Journals Online (AJOL)

    access health services for disease control, a study was conducted to assess knowledge, ... and other essential service supplies, existence of user-fees in health facilities, and pregnant ... In the area of antenatal care (ANC) services, medical and ... The government .... making some women to miss IPTp in the recommended.

  7. Antenatal MR diagnosis of urinary hydrometrocolpos due to urogenital sinus

    Energy Technology Data Exchange (ETDEWEB)

    Subramanian, Subramanian; Sharma, Raju; Gamanagatti, Shivanand [All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi (India); Agarwala, Sandeep [All India Institute of Medical Sciences, Department of Pediatric Surgery, New Delhi (India); Gupta, Prerna; Kumar, Sunesh [All India Institute of Medical Sciences, Department of Obstetrics and Gynaecology, New Delhi (India)

    2006-10-15

    Hydrometrocolpos is cystic dilatation of the vagina and uterus due to congenital vaginal obstruction. It may be secretory or urinary in character and manifests in the neonatal period with abdominal distension. Urinary hydrometrocolpos occurs in patients with urogenital sinus or cloacal anomaly. A rare case of antenatal MR diagnosis of urinary hydrometrocolpos due to urogenital sinus is presented. (orig.)

  8. Renal scintigraphy in infants with antenatally diagnosed renal pelvis dilatation

    Directory of Open Access Journals (Sweden)

    Ajdinović Boris

    2008-01-01

    Full Text Available Background/Aim. Ureteropelvic junction obstruction and vesicoureteral reflux are the most frequent entities identified on the basis of antenatal hydronephrosis. The aim of this study was to determine the incidence and pattern of abnormal renal scintigraphy findings in postnatal investigation of children with antenatal hydronephrosis. Methods. Twenty four infants (19 boys and five girls presented with antenatal hydronephrosis and mild to moderate hydronephrosis on ultrasound in newborn period were referred for renal scintigraphy. Ten patients with vesicoureteral reflux documented on micturating cystoureterography underwent 99mTc-DMSA renal scintigraphy and 14 patients were subjected to 99mTc-DTPA scintigraphy. Results. Anteroposterior pelvic diameter on ultrasound ranged from 11 to 24 mm. Renal DMSA scans identified congenital scars in two boys with bilateral reflux of grade V and unilateral reflux of grade III. Relative kidney uptake (RKU less than 40% was found in three, and poor kidney function (RKU less than 10% in two patients. Significant obstruction was shown on DTPA diuretic renal scintigraphy in 6/14 patients. Some slowing in dranaige (T1/2 greater than 10 minutes with no reduction in differential renal function was identified in three patients. Differential renal function less than 10% was obtained in one case. Conclusion. A high percent of abnormal renal scintigraphy findings was obtained. Renal scintigraphy was useful in determination of underlying cause of antenatally detected hydronephrosis.

  9. Variables influencing delay in antenatal clinic attendance among ...

    African Journals Online (AJOL)

    A delay in deciding to seek antenatal care is predominant among pregnant teenagers in ... to the Lesotho Population Data Sheet of 2000, the doctor-patient ratio for this ... on health promotion in reproductive health, especially birth preparedness, and ... rates of teenage pregnancies in Lesotho and the consequences thereof.

  10. The quality of care in an antenatal clinic in Kenya.

    Science.gov (United States)

    Malone, M I

    1980-02-01

    As part of an operations research project aimed at improving outpatient services in Kenya, the quality of care in Kiambu District Hospital's antenatal clinic was monitored in 1974-76 with particular emphasis on the identification of high risk women. Of the 270 patients studied, 57 (21%) were considered by midwives to be at no risk in terms of their pregnancy and 213 (79%) were considered at risk. 46% of the care observed in this study was considered adequate by the audit method; however, an implicit judgement assessment of the same care rated only 19% as adequate. Since the evaluators were familiar with the working conditions and capabilities of the staff, these low performance statistics suggest that the quality of care being provided in antenatal clinics is a serious problem. Dramatic improvements can be recorded if more attention is given by midwives to obtaining a medical and obstetric history and using an antenatal card. There is a need for clearly defined criteria and instructions for categorizing and managing high and low risk groups of pregnant women. In-service training and clinical meetings are essential to ensure that midwives can interpret abnormal findings and estimate the fundal height of the uterus. Although antenatal cards that guide midwives in the categorization of risk factors are available in Kenya, they are frequently out of stock and replaced with hastily developed, inadequate substitute forms.

  11. Knowledge, attitude and practice study regarding anemia in antenatal women

    Directory of Open Access Journals (Sweden)

    Raksha M

    2016-07-01

    Conclusions: Assessments of knowledge and practice and health education are essential step towards prevention of anaemia in pregnancy. Educating antenatal women about the importance of diet and implementing this into practice will help in the prevention of anemia. [Int J Reprod Contracept Obstet Gynecol 2016; 5(7.000: 2101-2103

  12. Severe antenatally diagnosed renal disorders: background, prognosis and practical approach.

    Science.gov (United States)

    Aulbert, Wiebke; Kemper, Markus J

    2016-04-01

    Nowadays most renal disorders, especially urinary tract malformations and renal cystic disease, are diagnosed antenatally. In cases of severe bilateral disease, intrauterine renal dysfunction may lead to renal oligohydramnios (ROH), resulting in pulmonary hypoplasia which affects perinatal mortality and morbidity as well as the long-term outcome. However, some infants may only have mild pulmonary and renal disease, and advances in postnatal and dialysis treatment have resulted in improved short- and long-term outcome even in those infants with severe ROH. Here, we review the current state of knowledge and clinical experience of patients presenting antenatally with severe bilateral renal disorders and ROH. By addressing underlying mechanisms, intrauterine tools of diagnosis and treatment as well as published outcome data, we hope to improve antenatal counselling and postnatal care. KEY SUMMARY POINTS: 1. Nowadays most renal disorders are diagnosed antenatally, especially urinary tract malformations and renal cystic disease. 2. Severe kidney dysfunction may lead to renal oligohydramnios, which can cause pulmonary hypoplasia and is a risk factor of perinatal mortality and postnatal renal outcome. However, as considerable clinical heterogeneity is present, outcome predictions need to be treated with caution. 3. Advances in postnatal and dialysis treatment have resulted in improved short- and long-term outcomes even in infants with severe renal oligohydramnios. 4. A multidisciplinary approach with specialist input is required when counselling a family with an ROH-affected fetus as the decision-making process is very challenging.

  13. The antenatal prevention ofcongenital syphilis in a peri-urban ...

    African Journals Online (AJOL)

    referred from the antenatal clinic to a separate sexually ... may be cost-effective ar an incidence as low as 5 per. 100 000.I ... A retrospective analysis of the records of Khayelirsha patients presenting ... central laboratory at GSH for a venereal disease research ... the delivery registers of the respective labour wards. Where the ...

  14. Prevalence and factors associated with late antenatal care visit ...

    African Journals Online (AJOL)

    Flora

    Background: Adequate utilization of antenatal health care services is associated ... Using the formula n=z2p (100−p)/e2, marginal error(e) of 4 %, z at 95 % confidence interval of 1.96, ... cleaning and generation of frequency distribution tables.

  15. Meckel-Gruber syndrome: Antenatal diagnosis and ethical perspectives.

    Science.gov (United States)

    Mohamed, Sarar; Ibrahim, Fatima; Kamil, Kameel; Satti, Satti A

    2012-01-01

    Meckel-Gruber syndrome (MGS) is an autosomal recessive disorder characterized by occipital encephalocele, polycystic kidneys and variable other congenital malformations. We report on a Sudanese patient with MGS diagnosed by antenatal ultrasound scan. Pregnancy was terminated at 25 weeks of gestation.

  16. Fluticasone furoate: A new intranasal corticosteroid

    Directory of Open Access Journals (Sweden)

    R Kumar

    2012-01-01

    Full Text Available Intranasal corticosteroids are recommended as one of the first-line therapies for the treatment of allergic rhinitis (AR, especially when associated with nasal congestion and recurrent symptoms. Fluticasone furoate is a novel enhanced-affinity glucocorticoid for the treatment of AR approved by the Food and Drug Administration in 2007 and recently introduced in India. Fluticasone furoate nasal spray is indicated for the treatment of the symptoms of seasonal and perennial AR in patients aged two years and older. This review summarizes the clinical data on fluticasone furoate nasal spray and discusses its role in the management of AR. Important attributes of fluticasone furoate include low systemic bioavailability (<0.5%, 24-h symptom relief with once-daily dosing, comprehensive coverage of both nasal and ocular symptoms, safety and tolerability with daily use, and availability in a side-actuated device that makes medication delivery simple and consistent. With these properties, fluticasone furoate nasal spray has the potential to enhance patient satisfaction and compliance, thus making it a good choice amongst available intranasal steroids.

  17. Early interventions in asthma with inhaled corticosteroids.

    Science.gov (United States)

    Laitinen, L A; Altraja, A; Karjalainen, E M; Laitinen, A

    2000-02-01

    We have earlier shown epithelial damage in the airway mucosa in patients with asthma. Later other structural changes have been recognized in asthma, such as deposition of collagen and tenascin in the subepithelial basement membrane and changes in the laminin subchain composition. These processes are modified by an inflammatory process in the airways. Both the United States National Institutes of Health and the British Thoracic Society guidelines on the management of asthma emphasize the need for early use of anti-inflammatory drugs. Many clinical studies that used airway biopsy specimens have shown a decrease in airway inflammatory cell numbers after inhaled corticosteroid therapy. However, there is very little information on the effects of asthma medication on the structural components of the airways. Both the synthesis and degradation of many extracellular matrix components may be affected by the disease process and the drugs resulting in altered remodeling and gene expression in the airways. Because there are only a few studies that try to identify early changes in asthma, it is not known whether the anti-inflammatory treatment of asthma proposed by the guidelines is started early enough.

  18. Radiolytic degradation scheme for 60Co-irradiated corticosteroids

    Energy Technology Data Exchange (ETDEWEB)

    Kane, M.P.; Tsuji, K.

    1983-01-01

    The cobalt 60 radiolytic degradation products have been identified in the following corticosteroids: cortisone, cortisone acetate, hydrocortisone, hydrocortisone acetate, hydrocortisone sodium succinate, isoflupredone acetate, methylprednisolone, methylprednisolone acetate, prednisolone, prednisolone acetate, and prednisone. Two major types of degradation processes have been identified: loss of the corticoid side chain on the D-ring to produce the C-17 ketone and conversion of the C-11 alcohol, if present, to the C-11 ketone. Minor degradation products derived from other changes affecting the side chain are also identified in several corticosteroids. These compounds are frequently associated in corticosteroids as process impurities or degradation compounds. No new radiolytic compounds unique to 60Co-irradiation have been found. The majority of corticosteroids have been shown to be stable to 60Co-irradiation. The rates of radiolytic degradation ranged from 0.2 to 1.4%/Mrad.

  19. Corticosteroids: Friends or foes of teleost fish reproduction?

    Science.gov (United States)

    Milla, S; Wang, N; Mandiki, S N M; Kestemont, P

    2009-07-01

    Reproduction in vertebrates is controlled by the Hypothalamus-Pituitary-Gonad axis and the main hormone actions have been extensively described. Still, despite the scattered information in fish, accumulating evidence strongly indicates that corticosteroids play essential roles in reproductive mechanisms. An integrative approach is important for understanding these implications. Animal husbandry and physiological studies at molecular to organismal levels have revealed that these corticosteroids are regulators of fish reproductive processes. But their involvements appear strongly contrasted. Indeed, for both sexes, corticosteroids present either deleterious or positive effects on fish reproduction. In this review, the authors will attempt to gather and clarify the available information about these physiological involvements. The authors will also suggest future ways to prospect corticosteroid roles in fish reproduction.

  20. Oxidant-induced corticosteroid unresponsiveness in human bronchial epithelial cells

    NARCIS (Netherlands)

    Heijink, Irene; van Oosterhout, Antoon; Kliphuis, Nathalie; Jonker, Marnix; Hoffmann, Roland; Telenga, Eef; Klooster, Karin; Slebos, Dirk-Jan; ten Hacken, Nick; Postma, Dirkje; van den Berge, Maarten

    2014-01-01

    Background We hypothesised that increased oxidative stress, as present in the airways of asthma and chronic obstructive pulmonary disease (COPD) patients, induces epithelial damage and reduces epithelial responsiveness to suppressive effects of corticosteroids on proinflammatory cytokine production

  1. Chlorhexidine monotherapy with adjunctive topical corticosteroids for acanthamoeba keratitis

    Directory of Open Access Journals (Sweden)

    Firoozeh Rahimi

    2015-01-01

    Conclusion: Chlorhexidine is effective for monotherapy in AK and could be a good choice for initiating treatment. After the initial response to anti-Acanthamoeba agents, corticosteroids can be used as adjunctive therapy depending on the clinical condition.

  2. Incidence of plantar fascia ruptures following corticosteroid injection.

    Science.gov (United States)

    Kim, Chul; Cashdollar, Michael R; Mendicino, Robert W; Catanzariti, Alan R; Fuge, LaDonna

    2010-12-01

    Plantar fasciitis is commonly treated with corticosteroid injections to decrease pain and inflammation. Therapeutic benefits often vary in terms of efficacy and duration. Rupture of the plantar fascia has been reported as a possible complication following corticosteroid injection. A retrospective chart review of 120 patients who received corticosteroid injection for plantar fasciitis was performed at the authors' institution to determine the incidence of plantar fascia rupture. The plantar fascia rupture was diagnosed clinically and confirmed with magnetic resonance imaging. Various factors were analyzed, including the number of injections, interval between injections, body mass index (BMI), and activity level. Four patients (2.4%) consequently experienced plantar fascia rupture following an average of 2.67 injections. The average BMI of these patients was 38.6 kg/m². The authors conclude that corticosteroid injection therapy appears to be a safe and effective form of nonoperative treatment with minimal complications and a relatively low incident of plantar fascia rupture.

  3. Oxidant-induced corticosteroid unresponsiveness in human bronchial epithelial cells

    NARCIS (Netherlands)

    Heijink, Irene; van Oosterhout, Antoon; Kliphuis, Nathalie; Jonker, Marnix; Hoffmann, Roland; Telenga, Eef; Klooster, Karin; Slebos, Dirk-Jan; ten Hacken, Nick; Postma, Dirkje; van den Berge, Maarten

    2014-01-01

    Background We hypothesised that increased oxidative stress, as present in the airways of asthma and chronic obstructive pulmonary disease (COPD) patients, induces epithelial damage and reduces epithelial responsiveness to suppressive effects of corticosteroids on proinflammatory cytokine production

  4. Lower Corticosteroid Skin Blanching Response Is Associated with Severe COPD

    NARCIS (Netherlands)

    Hoonhorst, Susan J. M.; ten Hacken, Nicolaas; Loi, Adele T. Lo Tam; Koenderman, Leo; Lammers, Jan Willem J.; Telenga, Eef D.; Boezen, Hendrika; van den Berge, Maarten; Postma, Dirkje S.

    2014-01-01

    Background: Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation caused by ongoing inflammatory and remodeling processes of the airways and lung tissue. Inflammation can be targeted by corticosteroids. However, airway inflammation is generally less responsive t

  5. Acute corticosteroid-induced rhabdomyolysis in a golf player

    African Journals Online (AJOL)

    management. The baseline creatine ... The diagnosis of acute steroid-induced rhabdomyolysis was based ... and muscle weakness was first reported by Cushing in 1932.2 ... Corticosteroid-induced myopathy is a disease that mainly causes.

  6. [Corticosteroid administration for acute respiratory distress syndrome : therapeutic option?].

    Science.gov (United States)

    Möhnle, P; Briegel, J

    2012-04-01

    Despite a number of clinical trials there is still controversy about the role of corticosteroid therapy in acute respiratory distress syndrome (ARDS). In addition recent meta-analyses differed markedly in the conclusions. This review is intended to provide a short practical guide for the clinician. Based on the available literature, high-dose and pre-emptive administration of corticosteroids is hazardous and not indicated. A low-dose corticosteroid regime given for 4 weeks may potentially be helpful and can be considered in acute or unresolved ARDS in less than 14 days after onset of ARDS, if a close infection surveillance program is available, if neuromuscular blockade can be avoided and if a stepwise dose reduction of corticosteroids is performed. The total daily dose at the beginning of treatment should not exceed 2 mg/kg body weight (BW) methylprednisolone.

  7. Safety of bronchodilators and corticosteroids for asthma during pregnancy

    DEFF Research Database (Denmark)

    Gregersen, Thorbjørn Lomholt; Ulrik, Charlotte Suppli

    2013-01-01

    the safety of add-on long-acting β2-agonists to inhaled corticosteroids. Inhaled corticosteroids are generally found to be safe, although further research is needed to investigate both the efficacy and safety of high dose therapy with inhaled corticosteroids. Studies have reported associations between......Asthma is a common medical condition complicating pregnancy with potentially serious effects on pregnancy outcome. The aim of this review is to provide an update on efficacy and safety of asthma medications, primarily bronchodilators and corticosteroids, used during pregnancy with focus...... stating otherwise appear to have, perhaps critical, methodological limitations. The safety of long-acting β2-agonists remains to be further investigated, and the few available studies have methodological limitations and, therefore, provide no definite answers, although a very recent study supports...

  8. Prednisone and Other Corticosteroids: Balance the Risks and Benefits

    Science.gov (United States)

    ... least amount of risk: Try lower doses or intermittent dosing. Newer forms of corticosteroids come in varying ... ways to minimize side effects. Eat a healthy diet and participate in activities that help you maintain ...

  9. The effects of corticosteroids and nonsteroidal anti-inflammatory ...

    African Journals Online (AJOL)

    conversion of arachidonic acid to prostaglandins by COX. Corticosteroids reduce the .... Zezos P, Kouklakis G, Saibil F. Inflammatory bowel disease and thromboembolism. World J ... The cardiovascular toxicity of selective and nonselective ...

  10. Systemic sclerosis with portal hypertensive ascites responded to corticosteroid treatment

    Institute of Scientific and Technical Information of China (English)

    LENG Xiao-mei; SUN Xue-feng; ZHANG Xuan; ZHANG Wen; LI Meng-tao; ZENG Xiao-feng

    2012-01-01

    We describe a case of systemic sclerosis (SSc) complicated with portal hypertensive ascites which did not improve with diuretics and ascitic drainage.When corticosteroid added,her ascites diminished dramatically.Though portal hypertension can be imputed to other causes,such as polycystic liver in this case,it can occur in limited SSc with positive anti-centromere antibody and respond to corticosteroid treatment.

  11. Corticosteroid treatment increases parasite numbers in murine giardiasis.

    OpenAIRE

    Nair, K V; Gillon, J.; Ferguson, A

    1981-01-01

    Corticosteroid therapy is known to be hazardous in patients with occult infection but the mechanism by which the host parasite relationship is altered by steroids is not known.We have used an intestinal protozoal parasite, Giardia muris, to examine the effects of corticosteroids on the number of parasites in the intestine in the course of a primary infection. A single injection of cortisone acetate, subcutaneously, one day before oral inoculation of CBA mice with 1000 cysts of Giardia muris, ...

  12. Prenatal corticosteroid exposure alters early developmental seizures and behavior

    OpenAIRE

    Velíšek, Libor

    2011-01-01

    In humans, corticosteroids are often administered prenatally to improve lung development in preterm neonates. Studies in exposed children as well as in children, whose mothers experienced significant stress during pregnancy indicate behavioral problems and possible increased occurrence of epileptic spasms. This study investigated whether prenatal corticosteroid exposure alters early postnatal seizure susceptibility and behaviors. On gestational day 15, pregnant rats were injected i.p. with hy...

  13. Patch testing with corticosteroid mixes in Europe. A multicentre study of the EECDRG

    DEFF Research Database (Denmark)

    Isaksson, M; Andersen, Klaus Ejner; Brandão, F M;

    2000-01-01

    This study investigated whether a corticosteroid mix containing tixocortol pivalate, budesonide, and hydrocortisone-17-butyrate could detect contact allergy to corticosteroids. 2 corticosteroid mixes, 1 with a high (mix I) and 1 with a low (mix II) concentration and the 3 individual constituents...... allergy to corticosteroid markers was missed....

  14. Intratympanic corticosteroid for sudden hearing loss: does it really work?

    Science.gov (United States)

    Barreto, Monique Antunes de Souza Chelminski; Ledesma, Aleluia Lima Losno; de Oliveira, Carlos Augusto Costa Pires; Bahmad, Fayez

    2016-01-01

    Sudden deafness is characterized by an abrupt hearing loss of at least 30dB in three sequential frequencies in the standard pure tone audiogram over three days or less. Treatment is based on its etiology, and oral corticosteroids are widely used. Intratympanic corticosteroids are included as primary or secondary treatment when there is no improvement with the use of oral corticosteroids. To determine the effectiveness of therapy with intratympanic steroids in sudden deafness. A systematic review was performed of publications on the topic in the databases of PubMed/MEDLINE, with the keywords: sudden deafness, sudden hearing loss, and corticosteroids. Thirty scientific studies were analyzed. As to the objectives of the study analyzed, 76.7% sought to evaluate the use of intratympanic therapy salvage after failure to conventional treatment, and intratympanic therapy was used as the primary treatment 23.3% of the studies. Intratympanic corticosteroid therapy is prescribed primarily when there is failure of conventional therapy and when it is limited to use systemic corticosteroids, such as the diabetic patient. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  15. Intratympanic corticosteroid for sudden hearing loss: does it really work?

    Directory of Open Access Journals (Sweden)

    Monique Antunes de Souza Chelminski Barreto

    Full Text Available ABSTRACT INTRODUCTION: Sudden deafness is characterized by an abrupt hearing loss of at least 30 dB in three sequential frequencies in the standard pure tone audiogram over three days or less. Treatment is based on its etiology, and oral corticosteroids are widely used. Intratympanic corticosteroids are included as primary or secondary treatment when there is no improvement with the use of oral corticosteroids. OBJECTIVE: To determine the effectiveness of therapy with intratympanic steroids in sudden deafness. METHODS: A systematic review was performed of publications on the topic in the databases of PubMed/MEDLINE, with the keywords: sudden deafness, sudden hearing loss, and corticosteroids. RESULTS: Thirty scientific studies were analyzed. As to the objectives of the study analyzed, 76.7% sought to evaluate the use of intratympanic therapy salvage after failure to conventional treatment, and intratympanic therapy was used as the primary treatment 23.3% of the studies. CONCLUSION: Intratympanic corticosteroid therapy is prescribed primarily when there is failure of conventional therapy and when it is limited to use systemic corticosteroids, such as the diabetic patient.

  16. Misuse of topical corticosteroids: A clinical study of adverse effects

    Directory of Open Access Journals (Sweden)

    Vivek Kumar Dey

    2014-01-01

    Full Text Available Background: Misuse of topical corticosteroids is a widespread phenomenon among young people in India, especially women. The practice is associated with significant adverse effects and poor awareness of these effects among the general public. Aim: This study was conducted to examine the misuse and adverse effects of topical corticosteroids among the people in Bastar region in Chhattisgarh state of India. Materials and Methods: Data collected from patients presenting with at least one of the adverse effects of topical corticosteroids as the chief complaint, from November 2010 to October 2011. Results: Out of the 6723 new patients, 379 (5.63% had presented with misuse and adverse effects of topical corticosteroids, of whom 78.89% were females. More than 65% of the patients were in the age group 10-29 years. The main reason for using the topical corticosteroids was to lighten skin colour and treat melasma and suntan. Acne (37.99% and telangiectasia (18.99% were the most common adverse effects noted. Conclusions: Misuse of topical corticosteroids has a huge impact on dermatological practice, leading to a significant proportion of visits to the dermatologist. This hydra-headed problem needs multi-dimensional interventions, involving educational, legal and managerial approaches with cooperation from different sectors of society.

  17. Corticosteroids for the management of severe intracranial hypertension in meningoencephalitis caused by Cryptococcus gattii: A case report and review.

    Science.gov (United States)

    Maciel, R-A; Ferreira, L-S; Wirth, F; Rosa, P-D; Aves, M; Turra, E; Goldani, L-Z

    2017-03-01

    Immune reconstitution inflammatory syndrome in meningitis caused by Cryptococcus gattii in immunocompetent patients after initiation of antifungal therapy appears to be the result of paradoxical antifungal treatment-induced clinical deterioration due to improved local immune responses to cryptococcal organisms. Recent anecdotal reports have suggested a favorable clinical response to corticosteroids in select patients with C. gattii central nervous system (CNS) infections. In this report, we describe a 65-year-old patient with meningoencephalitis caused by C. gattii who developed persistent intracranial hypertension and was successfully managed with antifungal therapy, repeated lumbar puncture and corticosteroids. Our observations suggest a possible benefit of dexamethasone in the management of select cases of C. gattii CNS infection with intracranial hypertension. Further studies are necessary to evaluate the long-term use of steroids in select patients with C. gattii with intracranial hypertension. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  18. The expectations of pregnant women regarding antenatal care

    Directory of Open Access Journals (Sweden)

    JM Mathibe-Neke

    2008-09-01

    Full Text Available From a feminist perspective, research on childbirth and women’s health is a means to a positive change that is conducted in partnership with women for their benefit. A patient-led National Health System (NHS (Hillan, 1999 also calls for consultation with patients and the wider public for shaping the current and future health services. This study was aimed at exploring and describing the expectations that pregnant women have regarding antenatal care service by the midwife practitioner. In-depth interviews were conducted in an antenatal unit of an Academic Hospital in Gauteng Povince. Data saturation was reached with a sample of eighteen pregnant women who were conveniently selected. Data analysis ran concurrently with data collection. A manual content analysis as described by Tesch was used. Lincoln and Guba’s method of ensuring trustworthiness was adopted (Lincoln & Guba, 1985:328

  19. Determinants of the number of antenatal visits in a metropolitan region

    Directory of Open Access Journals (Sweden)

    Beeckman Katrien

    2010-09-01

    Full Text Available Abstract Background Antenatal care has a positive effect on pregnancy, both clinically and psychologically, but consensus about the optimal number of antenatal visits is lacking. This study aims to provide insight into the dynamics of the number of antenatal visits a woman receives. Independent effects of predisposing, enabling and pregnancy-related determinants are examined. Methods Women were recruited in nine clinical centres in the Brussels Metropolitan region. Antenatal care use was measured prospectively. A Poisson regression model was applied to measure the independent effect of individual determinants on the number of antenatal visits. Results Data on antenatal care trajectories in 333 women were collected. The multivariate analyses showed that women with a Maghreb or Turkish origin had 14% fewer visits compared with European (EU15 women. More highly educated women had 22% more visits compared with those with a low education. Women with a high income had 14% more antenatal visits compared with those with a low income. Fewer antenatal visits were observed in multiparae (15%, women initiating care after 14 weeks of gestation (31%, women without medical risks during the pregnancy (12% and in women with a continuity of care index of 50% or more (12%. More visits were observed in delivering after week 37 (22% increase. Conclusions Predisposing and enabling factors have to be considered when antenatal care programmes are evaluated in a metropolitan area. Variations in the number of antenatal visits show that socially vulnerable women are more at risk of having fewer visits.

  20. Determinants of the number of antenatal visits in a metropolitan region.

    Science.gov (United States)

    Beeckman, Katrien; Louckx, Fred; Putman, Koen

    2010-09-01

    Antenatal care has a positive effect on pregnancy, both clinically and psychologically, but consensus about the optimal number of antenatal visits is lacking. This study aims to provide insight into the dynamics of the number of antenatal visits a woman receives. Independent effects of predisposing, enabling and pregnancy-related determinants are examined. Women were recruited in nine clinical centres in the Brussels Metropolitan region. Antenatal care use was measured prospectively. A Poisson regression model was applied to measure the independent effect of individual determinants on the number of antenatal visits. Data on antenatal care trajectories in 333 women were collected. The multivariate analyses showed that women with a Maghreb or Turkish origin had 14% fewer visits compared with European (EU15) women. More highly educated women had 22% more visits compared with those with a low education. Women with a high income had 14% more antenatal visits compared with those with a low income. Fewer antenatal visits were observed in multiparae (15%), women initiating care after 14 weeks of gestation (31%), women without medical risks during the pregnancy (12%) and in women with a continuity of care index of 50% or more (12%). More visits were observed in delivering after week 37 (22% increase). Predisposing and enabling factors have to be considered when antenatal care programmes are evaluated in a metropolitan area. Variations in the number of antenatal visits show that socially vulnerable women are more at risk of having fewer visits.

  1. Antenatal diagnosis of Patau syndrome with previous anomalous baby

    OpenAIRE

    Keerthi Kocherla; Vasantha Kocherla

    2014-01-01

    Patau syndrome is the least common and most severe of the viable autosomal trisomies with median survival of fewer than 3 days was first identified as a cytogenetic syndrome in 1960. Patau syndrome is caused by an extra copy of chromosome 13. In this case report, we present antenatal imaging findings and gross foetal specimen correlation of foetus with Patau syndrome confirmed by karyotyping in third gravida who had significant previous obstetric history of gastrochisis in monochorionic and...

  2. The expectations of pregnant women regarding antenatal care

    OpenAIRE

    JM Mathibe-Neke

    2008-01-01

    From a feminist perspective, research on childbirth and women’s health is a means to a positive change that is conducted in partnership with women for their benefit. A patient-led National Health System (NHS) (Hillan, 1999) also calls for consultation with patients and the wider public for shaping the current and future health services. This study was aimed at exploring and describing the expectations that pregnant women have regarding antenatal care service by the midwife practitioner. In-de...

  3. Antenatal diagnosis of Patau syndrome with previous anomalous baby

    OpenAIRE

    Keerthi Kocherla; Vasantha Kocherla

    2014-01-01

    Patau syndrome is the least common and most severe of the viable autosomal trisomies with median survival of fewer than 3 days was first identified as a cytogenetic syndrome in 1960. Patau syndrome is caused by an extra copy of chromosome 13. In this case report, we present antenatal imaging findings and gross foetal specimen correlation of foetus with Patau syndrome confirmed by karyotyping in third gravida who had significant previous obstetric history of gastrochisis in monochorionic and...

  4. Personalized Antenatal Consultations for Preterm Labor: Responding to Mothers' Expectations.

    Science.gov (United States)

    Gaucher, Nathalie; Nadeau, Sophie; Barbier, Alexandre; Janvier, Annie; Payot, Antoine

    2016-11-01

    To explore prospective mothers' perspectives regarding antenatal consultations by neonatology teams for threatened preterm delivery. In a prospective multicenter study, women at risk of preterm delivery between 26 and 32 weeks of gestational age were surveyed during the 72 hours following their antenatal consultation. The questionnaire used was developed and validated during a single-center study. Over 18 months, 229 mothers completed the survey (73% response rate), at a median gestational age of 30 weeks. Spouses/partners were present for 49% of consultations. Most women (90%) reported a positive experience. They found it important to discuss the outcomes of prematurity (96%), but 39% of them reported receiving too much information. Women wanted their spouse/partner to be present (71%) and wished to discuss parental concerns: their roles as mother of a premature baby (82%), their integration in their baby's care (83%), and a better understanding of the neonatal intensive care unit (NICU) environment, including antenatal NICU visits (69%). The majority (56%) wanted a follow-up consultation: this was less likely if a NICU visit had been offered (P child-centered information. Although clinicians follow these guidelines, mothers want personalized information focusing on their individual concerns and questions, such as what they can do for their baby, how NICUs work, and the integration of their family. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Dimensions of quality of antenatal care service at Suez, Egypt

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    Hanan Abbas Abdo Abdel Rahman El Gammal

    2014-01-01

    Full Text Available Introduction: The 5 th millennium development goal aims at reducing maternal mortality by 75% by the year 2015. According to the World Health Organization, there was an estimated 358,000 maternal deaths globally in 2008. Developing countries accounted for 99% of these deaths of which three-fifths occurred in Sub-Saharan Africa. In primary health care (PHC, quality of antenatal care is fundamental and critically affects service continuity. Nevertheless, medical research ignores the issue and it is lacking scientific inquiry, particularly in Egypt. Aim of the Study: The aim of the following study is to assess the quality of antenatal care in urban Suez Governorate, Egypt. Materials and Methods: A cross-sectional primary health care center (PHCC based study conducted at five PHCC in urban Suez, Egypt. The total sample size collected from clients, physicians and medical records. Parameters assessed auditing of medical records, assessing provider and pregnant women satisfaction. Results: Nearly 97% of respondents were satisfied about the quality of antenatal care, while provider′s satisfaction was 61% and for file, auditing was 76.5 ° 5.6. Conclusion: The present study shows that client satisfaction, physicians′ satisfaction and auditing of medical record represent an idea about opportunities for improvement.

  6. Antenatal screening and the gendering of genetic responsibility

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    Reed Kate

    2007-09-01

    Full Text Available Abstract Background The objective of this study is to explore men's and women's perceptions of antenatal blood screening. The study will assess the impact of these perceptions on decision-making regarding diagnostic testing and selective abortion, and on parental feelings of genetic responsibility. By exploring gender and antenatal screening in this way, the research aims to contribute to our understanding of lay perceptions of genetic screening and increase our knowledge of the decision-making process in screening. Research design This qualitative study will be based on semi-structured interviews with twenty pregnant women and twenty male partners in the post-industrial city of Sheffield, UK. All interviews will be taped, transcribed and analysed thematically using NVIVO, a qualitative software package. Discussion The findings of this study have relevance to existing debates on the social and ethical implications of reproductive genetics. A better understanding of male and female perceptions of the screening process could improve guidance and practice in antenatal screening and genetic counselling. It will also inform and contribute to the development of theory on gender and genetic screening.

  7. Treatment of chronic rhinosinusitis with pressure-pulsed corticosteroid inhalation.

    Science.gov (United States)

    Goektas, Oender; Lau, Larissa; Olze, Heidi

    2013-08-01

    Chronic rhinosinusitis may cause olfactory dysfunction and affects quality of life in patients. In a prospective study we investigated the effect of topical application of corticosteroids through pressure-pulsed inhalation as treatment option of chronic rhinosinusitis with olfactory disorder. Patients with sinonasal olfactory disorder according to the European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) were allocated to the new nasal inhalation therapy or a systemic corticosteroid therapy, each receiving a corticosteroid course of 12 days. 18 patients received topical corticosteroid pressure-pulsed inhalation (AMSA, Schumacher, Dausenau) and 15 systemic corticosteroid. Olfactory function was measured before and after treatment using the Threshold Discrimination Identification score (TDI score) and visual analogue scales. Lund Mackay score (LMS) was measured before starting treatment. Olfactory function (OF) increased from 17.5 ± 6.4 to 21 ± 7.9 TDI points (p treatment after 2 months. In the follow-up period of 6 months, the mean TDI score dropped to 20.0 ± 9.2 points (p = 0.01). There was no correlation between LMS and TDI. Treatment of chronic rhinosinusitis with pressure-pulsed inhalation was demonstrated to be effective. Multicenter investigations with large participant numbers are needed.

  8. High dose corticosteroids in severe leptospirosis: a systematic review.

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    Rodrigo, Chaturaka; Lakshitha de Silva, Nipun; Goonaratne, Ravindi; Samarasekara, Keshinie; Wijesinghe, Indika; Parththipan, B; Rajapakse, Senaka

    2014-12-01

    The role of corticosteroids in the treatment of severe leptospirosis is unclear. The rationale for their use is that, in severe leptospirosis, there is a severe immunological response that is harmful to the host resulting in multi-organ dysfunction, which is potentially offset by the nonspecific immunosuppression of high dose steroids. We conducted a systematic review of studies that have assessed the use of high dose corticosteroids in patients with severe leptospirosis by searching MEDLINE and Scopus SciVerse without any language or time restrictions. We identified five studies, including one open randomized clinical trial, which had assessed the use of high dose steroids in severe leptospirosis. Four studies demonstrated a benefit of corticosteroids in treating severe disease with pulmonary involvement when administered early in the course of the disease, but these studies had several methodological constraints as highlighted in the text. Only the randomized controlled trial study showed that corticosteroids are ineffective and may increase the risk of nosocomial infections. There is no robust evidence to suggest that high dose corticosteroids are effective in severe leptospirosis, and a well-designed randomized clinical trial is needed to resolve this.

  9. T lymphocyte insensitivity to corticosteroids in chronic obstructive pulmonary disease

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    Kaur Manminder

    2012-03-01

    Full Text Available Abstract Background There are increased numbers of activated lymphocytes in the lungs of chronic obstructive pulmonary disease (COPD patients. The clinical benefits of corticosteroids in COPD patients are limited. Our hypothesis is that lymphocytes play a role in this corticosteroid insensitivity. Objectives To investigate the effects of the corticosteroid dexamethasone on lung lymphocyte cytokine production from patients with COPD compared to controls. Methods Cultured airway lymphocytes obtained by bronchoscopy from healthy non-smokers (HNS, smokers (S and COPD patients were stimulated with phytohaemagglutinin (PHA & phorbol myristate acetate (PMA, +/- dexamethasone. Supernatants were assayed for interleukin (IL-2 and interferon (IFNγ. Immunofluoresence was used to analyse changes in CD8 glucocorticoid receptor (GRα and GRβ expression. Results The inhibition of PHA/PMA stimulated IFNγ production by dexamethasone was reduced in COPD patients compared to HNS (p p Conclusions IFNγ production from COPD airway lymphocytes is corticosteroid insensitive. This phenomenon may be important in the poor clinical response often observed with corticosteroids.

  10. Analysis of Antenatal Care and its Related Factors among Married Chinese Women

    Institute of Scientific and Technical Information of China (English)

    Guo-qing MI; Xi-kuan CHEN; Er-Sheng Gao

    2004-01-01

    Objective To explore the related factors of antenatal care Methods The data derived from National Demography and Reproductive Health Survey in 1997 conducted by National Population and Family Planning Commission. 11 892 women who had given birth to at least one survival child were involved in this study. SAS software was used in multivariate analysis.Results The average rate of general antenatal care is 57.3% and has increased dramatically in the recent 30 years. The major reason why most subjects didn't have antenatal care was lacking the recognition of the importance of antenatal care. The antenatal care was associated with residence in rural area or urban area, age, educational level, parity of the last birth, local average income, distance between home and township in rural area and so on.Conclusion Women of childbearing age need to improve their health knowledge; the government should increase the availability of antenatal care.

  11. Repeat-until-success quantum repeaters

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    Bruschi, David Edward; Barlow, Thomas M.; Razavi, Mohsen; Beige, Almut

    2014-09-01

    We propose a repeat-until-success protocol to improve the performance of probabilistic quantum repeaters. Conventionally, these rely on passive static linear-optics elements and photodetectors to perform Bell-state measurements (BSMs) with a maximum success rate of 50%. This is a strong impediment for entanglement swapping between distant quantum memories. Every time a BSM fails, entanglement needs to be redistributed between the corresponding memories in the repeater link. The key ingredients of our scheme are repeatable BSMs. Under ideal conditions, these turn probabilistic quantum repeaters into deterministic ones. Under realistic conditions, our protocol too might fail. However, using additional threshold detectors now allows us to improve the entanglement generation rate by almost orders of magnitude, at a nominal distance of 1000 km, compared to schemes that rely on conventional BSMs. This improvement is sufficient to make the performance of our scheme comparable to the expected performance of some deterministic quantum repeaters.

  12. Can intramuscular corticosteroid injection cause nonarteritic anterior ischemic optic neuropathy?

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    Bakbak B

    2013-03-01

    Full Text Available Berker Bakbak, Banu Turgut Ozturk, Sansal Gedik, Bengu Ekinci Koktekir, Saban Gonul Selcuk University Medical Faculty, Department of Ophthalmology, Konya, Turkey Abstract: A 56-year-old man noted a sudden decrease of vision in his right eye 4 hours after intramuscular triamcinolone acetonide (TA injection. A diagnosis of unilateral nonarteritic anterior ischemic optic neuropathy (NAION was made, and the patient was counseled to discontinue using TA. Examination for possible risk factors revealed controlled hypertension. Final visual acuity was finger counting at 1 m, and the optic disc was pale in his right eye. This is the first reported case of unilateral NAION that has occurred in a patient after intramuscular corticosteroid injection. Although a cause-and-effect relationship is difficult to prove, the short duration between the TA injection and the NAION is noteworthy. The history of corticosteroid injection should be questioned in cases with predisposing conditions such as hypertension. Keywords: ischemic optic neuropathy, corticosteroids, optic disc edema

  13. Treatment of coccidioidomycosis-associated eosinophilic pneumonia with corticosteroids

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    Raz Y

    2012-03-01

    Full Text Available Pulmonary coccidioidomycosis is a common cause of community-acquired pneumonia in endemic areas of the southwestern United States. The clinical spectrum of this disease ranges from an asymptomatic presentation to severe disease with ARDS and hypoxemic respiratory failure. Despite evidence supporting the use of corticosteroids for severe pulmonary disease in other fungal infections, there is currently no established role for this therapy in coccidioidomycosis infections. Peripheral eosinophilia is a common feature of coccidioidomycosis; however, pulmonary eosinophilia is rarely reported. In the setting of pulmonary eosinophilia of other etiologies, corticosteroid therapy has been demonstrated to have a role in reducing the inflammatory response and leading to a more rapid resolution of hypoxemic respiratory failure. We report a case of a patient with primary pulmonary coccidioidomycosis complicated by severe pulmonary eosinophilia that demonstrated rapid improvement after the initiation of corticosteroid therapy.

  14. Corticosteroids in the treatment of dengue shock syndrome

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    Rajapakse S

    2014-05-01

    Full Text Available Senaka Rajapakse,1 Chaturaka Rodrigo,1 Sachith Maduranga,1 Anoja Chamarie Rajapakse21Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka; 2Kings Mill Hospital, Sherwood Forest NHS Foundation Trust, Sutton-in-Ashfield, Nottinghamshire, UKAbstract: Dengue infection causes significant morbidity and mortality in over 100 countries worldwide, and its incidence is on the rise. The pathophysiological basis for the development of severe dengue, characterized by plasma leakage and the “shock syndrome” are poorly understood. No specific treatment or vaccine is available, and careful monitoring and judicious administration of fluids forms the mainstay of management at present. It is postulated that vascular endothelial dysfunction, induced by cytokine and chemical mediators, is an important mechanism of plasma leakage. Although corticosteroids are potent modulators of the immune system, their role in pharmacological doses in modulating the purported immunological effects that take place in severe dengue has been a subject of controversy. The key evidence related to the role of corticosteroids for various manifestations of dengue are reviewed here. In summary, there is currently no high-quality evidence supporting the beneficial effects of corticosteroids for treatment of shock, prevention of serious complications, or increasing platelet counts. Non-randomized trials of corticosteroids given as rescue medication for severe shock have shown possible benefit. Nonetheless, the evidence base is small, and good-quality trials are lacking. We reiterate the need for well-designed and adequately powered randomized controlled trials of corticosteroids for the treatment of dengue shock.Keywords: dengue, dengue shock, shock, corticosteroids, vascular leak, thrombocytopenia

  15. Lower corticosteroid skin blanching response is associated with severe COPD.

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    Susan J M Hoonhorst

    Full Text Available BACKGROUND: Chronic obstructive pulmonary disease (COPD is characterized by chronic airflow limitation caused by ongoing inflammatory and remodeling processes of the airways and lung tissue. Inflammation can be targeted by corticosteroids. However, airway inflammation is generally less responsive to steroids in COPD than in asthma. The underlying mechanisms are yet unclear. This study aimed to assess whether skin corticosteroid insensitivity is associated with COPD and COPD severity using the corticosteroid skin blanching test. METHODS: COPD patients GOLD stage I-IV (n = 27, 24, 22, and 16 respectively and healthy never-smokers and smokers (n = 28 and 56 respectively were included. Corticosteroid sensitivity was assessed by the corticosteroid skin blanching test. Budesonide was applied in 8 logarithmically increasing concentrations (0-100 μg/ml on subject's forearm. Assessment of blanching was performed after 7 hours using a 7-point scale (normal skin to intense blanching. All subjects performed spirometry and body plethysmography. RESULTS: Both GOLD III and GOLD IV COPD patients showed significantly lower skin blanching responses than healthy never-smokers and smokers, GOLD I, and GOLD II patients. Their area under the dose-response curve values of the skin blanching response were 586 and 243 vs. 1560, 1154, 1380, and 1309 respectively, p<0.05. Lower FEV1 levels and higher RV/TLC ratios were significantly associated with lower skin blanching responses (p = 0.001 and p = 0.004 respectively. GOLD stage I, II, III and IV patients had similar age and packyears. CONCLUSIONS: In this study, severe and very severe COPD patients had lower skin corticosteroid sensitivity than mild and moderate COPD patients and non-COPD controls with comparable age and packyears. Our findings together suggest that the reduced skin blanching response fits with a subgroup of COPD patients that has an early-onset COPD phenotype.

  16. The effects of oral and topical corticosteroid in rabbit corneas.

    Science.gov (United States)

    Araki-Sasaki, Kaoru; Katsuta, Osamu; Mano, Hidetoshi; Nagano, Takashi; Nakamura, Masatsugu

    2016-09-05

    To determine the most effective route of administration of corticosteroids in the treatment of ocular surface disease, by characterizing the difference between oral prednisolone and topical dexamethasone administration using an animal model. Pharmacokinetic analyses determined the corticosteroid concentrations in the normal ocular tissues of rabbits after oral or topical administration of corticosteroids using LC-MS/MS. In wound healing analyses, the area of the epithelial defect created by keratectomy using a 6-mm trephine was calculated with an image analyzer using an orally or topically steroid-administrated animal model. The average size of basal epithelial cells, the frequency of mitotic basal epithelial cells, the number of squamous cells, and the number of hypertrophic stromal fibroblasts were determined in the enucleated corneal tissues after wound closure. By slit lamp examination, no remarkable differences were observed between orally and topically administered groups. Pharmacokinetic analyses showed that the distribution of dexamethasone after topical administration was superior to that after oral administration in the cornea. In contrast, both concentrations of corticosteroid applied topically and orally were similar with regards to AUCs (area under the concentration-time curve) in the conjunctiva. Although the healing rate was slower in the topical group, all corneas were almost healed within 96 h in the wound healing analysis. According to the histological analyses of epithelial cells, the average basal cell size was larger, the frequency of mitotic basal cells was greater, and the number of squamous epithelial cell layers was lower in the topically administered group although all of these differences were with no statistical significance. However, the number of hypertrophic stromal fibroblasts in the topically administered group was significantly lower than that in the orally administered group. There are different distributions and effects between

  17. Effectiveness of corticosteroid injections in adhesive capsulitis of shoulder

    Science.gov (United States)

    Wang, Wei; Shi, Mingmin; Zhou, Chenhe; Shi, Zhongli; Cai, Xunzi; Lin, Tiao; Yan, Shigui

    2017-01-01

    Abstract Background: Primary adhesive capsulitis is mainly characterized by spontaneous chronic shoulder pain and the gradual loss of shoulder motion. The main treatment for adhesive capsulitis is a trial of conservative therapies, including analgesia, exercise, physiotherapy, oral nonsteroidal anti-inflammation drugs, and intra-articular corticosteroid injections. Previously, it was reported that intra-articular corticosteroid lead to fast pain relief and improvement of range of motion (ROM). The objective of this study was to determine whether corticosteroid injections would lead to better pain relief and greater improvement in ROM. Methods: We searched PubMed, Medline, and the Cochrane library. We included 5 articles of the 1166 articles identified. Totally injection group included 115 patients and placebo group included 110 patients. We calculated the weighted mean differences to evaluate the pain relief as the primary outcome. We determined the ROM as the secondary outcome. Study quality was evaluated using the 12-item scale. We also used the criteria of the Grading of Recommendations Assessment, Development and Evaluation to evaluate the quality of evidence. Results: In total, 5 studies were included, 4 of which were randomized clinical trials, with a sample size of 225 patients with adhesive capsulitis of the shoulders. The overall pooled data demonstrated that, compared with placebo as control treatment, intra-articular corticosteroid injections were more effective in reducing the pain score at 0 to 8 weeks, but there was no difference between the injection group and the control group at 9 to 24 weeks. Improvement of ROM in the injection group was greater than that of the control group both at 0 to 8 and 9 to 24 weeks. Conclusions: Intra-articular corticosteroid injections were more effective in pain relief in the short term, but this pain relief did not sustain in the long term. Intra-articular corticosteroid injection resulted in greater improvement in

  18. Prevalence of Antenatal Depression and Associated Risk Factors among Pregnant Women Attending Antenatal Clinics in Abeokuta North Local Government Area, Nigeria.

    Science.gov (United States)

    Thompson, Okechukwu; Ajayi, IkeOluwapo

    2016-01-01

    Objective. The prevalence of antenatal depression (AD) and associated risk factors among pregnant women attending antenatal clinics in Abeokuta North Local Government Area, Nigeria, was determined. Methods. A descriptive cross-sectional survey was conducted, interviewing 314 pregnant women selected by multistage sampling technique from among those attending antenatal clinics. Information was collected using structured questionnaire and a screening tool, Edinburgh Postnatal Depression Scale (EPDS), to assess probable depression. Results. The prevalence of antenatal depression was 24.5%. There were significant associations between antenatal depression and attending public health facility (P = 0.000), young maternal age (P = 0.012), single marital status (P = 0.010), not having formal education (P = 0.022), large family size (P = 0.029), planned pregnancy (P = 0.014), coexisting medical conditions (P = 0.034), history of previous caesarian section (P = 0.032), drinking alcohol during pregnancy (P = 0.004), and gender based abuse (P = 0.001). On health seeking behaviour for antenatal depression among depressed pregnant women, most, 68.9%, consulted their husbands about their symptoms; 57.3% took the decision to get treatment from doctors, and 52% sought prayer in the church. Conclusion. Antenatal depression is prevalent in this study population. Interventions to address its risk factors should be carried out and physicians should suspect depression in pregnant women reporting alcohol use and gender abuse.

  19. Quality of antenatal care provided by nurse midwives in an Urban health centre with regard to low-risk antenatal mothers

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    Ruby Angeline Pricilla

    2017-01-01

    Full Text Available Background:India contributes to 19% of the global maternal deaths. Good quality antenatal care can prevent maternal deaths by early detection of complications and maintaining maternal health. There are few studies documenting quality of antenatal care in India. This study aimed to document the antenatal services provided by nurse midwives to low-risk pregnant mothers from an urban population. Aims: The primary objective was to describe the quality of the antenatal care provided by nurse midwives of an urban health centre with regard to low-risk mothers. The secondary objective was to document the maternal and early neonatal outcomes of the enrolled mothers during the period of study. Methods: This prospective cohort study was done on 200 pregnant women who had antenatal care by nurse midwives between April 2014 and November 2014. The quality of care was assessed by a checklist adapted from World Health Organization (WHO. Results: We report that the quality of antenatal care for all domains was above 90% except for the health education domain, which was poor with regard to breastfeeding and family planning in the enrolled 200 pregnant women. Conclusion: Our study concluded that trained nurse midwives when regularly monitored, audited and linked with reliable referral facilities can deliver good quality antenatal care.

  20. Perioperative corticosteroids for preventing complications following facial plastic surgery

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    Edina Mariko Koga da Silva

    Full Text Available BACKGROUND:Early recovery is an important factor for people undergoing facial plastic. However, the normal inflammatory processes that are a consequence of surgery commonly cause oedema (swelling and ecchymosis (bruising, which are undesirable complications. Severe oedema and ecchymosis delay full recovery, and may make patients dissatisfied with procedures. Perioperative corticosteroids have been used in facial plastic surgery with the aim of preventing oedema and ecchymosis.OBJECTIVES:To determine the effects, including safety, of perioperative administration of corticosteroids for preventing complications following facial plastic surgery in adults.METHODS:Search strategy: In January 2014, we searched the following electronic databases: the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL (The Cochrane Library; Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations; Ovid Embase; EBSCO CINAHL; and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS. There were no restrictions on the basis of date or language of publication. Selection criteria: We included RCTs that compared the administration of perioperative systemic corticosteroids with another intervention, no intervention or placebo in facial plastic surgery. ata collection and analysis: Two review authors independently screened the trials for inclusion in the review, appraised trial quality and extracted data.MAIN RESULTS: We included 10 trials, with a total of 422 participants, that addressed two of the outcomes of interest to this review: swelling (oedema and bruising (ecchymosis. Nine studies on rhinoplasty used a variety of different types, and doses, of corticosteroids. Overall, the results of the included studies showed that there is some evidence that perioperative administration of corticosteroids decreases formation of oedema over the first two postoperative days. Meta-analysis was only

  1. The expectations of pregnant women regarding antenatal care.

    Science.gov (United States)

    Mathibe-Neke, J M

    2008-09-01

    From a feminist perspective, research on childbirth and women's health is a means to a positive change that is conducted in partnership with women for their benefit. A patient-led National Health System (NHS) (Hillan, 1999) also calls for consultation with patients and the wider public for shaping the current and future health services. This study was aimed at exploring and describing the expectations that pregnant women have regarding antenatal care service by the midwife practitioner. In-depth interviews were conducted in an antenatal unit of an Academic Hospital in Gauteng Povince. Data saturation was reached with a sample of eighteen pregnant women who were conveniently selected. Data analysis ran concurrently with data collection. A manual content analysis as described by Tesch was used. Lincoln and Guba's method of ensuring trustworthiness was adopted (Lincoln & Guba, 1985:328) Literature was undertaken to compare the findings of this study with those of other previous studies. Women displayed several common expectations that led to the saturation of data. It also became apparent from the findings that each woman had varied expectations. There were also some commonalities within the women's expectations. Health care, as the major expectation and a basic human right, appeared to be basically fulfilled, with the exception of interactional characteristics such as the communication of information, guidance, involvement, the understanding and explanation of aspects, freedom of choice, punctuality, individualized care and continuity of care. The conclusions that were reached let to recommendations for nursing practice, education, research and the formulation of guidelines for the midwife practitioner for the implementation of effective antenatal care, based on the identified expectations.

  2. Prematuridad extrema y uso materno de corticoides antenatal

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    Ramón Acosta Díaz

    2000-12-01

    Full Text Available Con el objetivo de evaluar el uso de corticoides antenatal en las madres con amenaza de parto pretérmino y el efecto sobre los recién nacidos prematuros extremos, se realizó un estudio prospectivo, longitudinal, y analítico entre todos los niños nacidos vivos con edad gestacional menor de 31 semanas y peso inferior a 1 500 g, ocurridos en el Hospital Ginecoobstétrico Provincial Docente "Justo Legón Padilla" de Pinar del Río, desde enero de 1997 hasta julio de 1998. Se estudiaron los 53 niños con estas características. Los datos que se obtuvieron se depositaron en base de datos; para el procesamiento estadístico, se aplicó la prueba de chi cuadrado, con un nivel de significación de p In order to evaluate the antenatal use of adrenal cortex hormones in mothers with preterm delivery threat and its effect on extreme premature infants, it was conducted a prospective, longitudinal and analytical study among the live births with gestational age under 31 weeks and a weight lower than 1 500 g registered at "Justo Legón Padilla" Provincial Gynecoobstetric Teaching Hospital, in Pinar del Río, from January, 1997, to July, 1998. 53 children with these characteristics were studied. The collected data were entered in databases. The chi square test with a level of significance of p<0.05 was used for the statistical processing. Steroids were administered to 32 mothers. A statistically significant reduction of the hyaline membrane disease, the use of ventilation, the complications and mortality was observed with the antenatal use of maternal adrenal cortex hormones. There were no statistically significant differences between the study and the control group as regards sex, mean gestational age (29.0/28.9 weeks and weights (1207.9/1180.0 g.

  3. Antenatal testing for cystic fibrosis in Cuba, 1988-2011.

    Science.gov (United States)

    Collazo, Teresa; López, Ixchel; Clark, Yulia; Piloto, Yaixa; González, Laura; Gómez, Manuel; García, Marileivis; Reyes, Lidice; Rodríguez, Fidel

    2014-01-01

    INTRODUCTION Cystic fibrosis is a multisystem autosomal recessive disease with wide variability in clinical severity. It is incurable and characterized by elevated and premature mortality, as well as poor quality of life. Its frequency, lethality and devastating impact on both the physical and psychological wellbeing of patients and their families, make it a serious health problem. Its frequency in Cuba is 1 in 9862 live births, where marked molecular heterogeneity of the CFTR gene makes molecular diagnosis difficult. Six mutations have been identified that together enable molecular characterization of only 55.5% of cystic fibrosis chromosomes. This paper presents national results of antenatal diagnostic testing, using direct and indirect methods, for detection of cystic fibrosis. OBJECTIVE Characterize the Cuban public health system's experience with antenatal molecular testing for cystic fibrosis from 1988 through 2011. METHODS A retrospective descriptive study was conducted with results of antenatal diagnostic testing of amniotic fluid, performed nationwide from 1988 through 2011, for 108 fetuses of couples with some risk of having children affected by cystic fibrosis, who requested testing. Polymerase chain reaction detected mutations p.F508del, p.G542X, p.R1162X, p.R334W, p.R553X and c.3120+1G>A, and markers XV2C and KM19. Data were analyzed using absolute frequencies and percentages, and presented in tables. RESULTS For 93 cases (86.1%), testing for cystic fibrosis was done using direct analysis of mutations p.F508del, p.G542X, p.R1162X, p.R334W, p.R553X and c.3120+1G>A; five cases (4.6%) were tested indirectly using markers XV2C/Taq I and KM19/Pst I; and 10 (9.3%) were tested using a combination of the two methods. A total of 72 diagnoses (66.7% of studies done) were concluded, of which there were 20 healthy fetuses, 16 affected, 27 carrier, and 9 who were either healthy or carriers of an unknown mutation. CONCLUSIONS Direct or indirect molecular study was

  4. Determinants of folic acid knowledge and use among antenatal women.

    LENUS (Irish Health Repository)

    McDonnell, R

    1999-06-01

    Although recommendations on folic acid use were issued by health authorities in a number of countries in the early 1990s, uptake of peri-conceptional folic acid is still disappointingly low. Regardless of food fortification policies, folic acid promotion will probably be required in most countries to optimize folate levels among women of child-bearing age. The aim of this study was to examine folic acid knowledge and use, and their determinants among antenatal women in the east of Ireland in 1997.

  5. Antenatal diagnosis of Patau syndrome with previous anomalous baby

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    Keerthi Kocherla

    2014-06-01

    Full Text Available Patau syndrome is the least common and most severe of the viable autosomal trisomies with median survival of fewer than 3 days was first identified as a cytogenetic syndrome in 1960. Patau syndrome is caused by an extra copy of chromosome 13. In this case report, we present antenatal imaging findings and gross foetal specimen correlation of foetus with Patau syndrome confirmed by karyotyping in third gravida who had significant previous obstetric history of gastrochisis in monochorionic and monoamniotic twins who died at 14 weeks of gestation. [Int J Res Med Sci 2014; 2(3.000: 1172-1175

  6. Timing of antenatal care for adolescent and adult pregnant women in south-eastern Tanzania

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    Gross Karin

    2012-03-01

    Full Text Available Abstract Background Early and frequent antenatal care attendance during pregnancy is important to identify and mitigate risk factors in pregnancy and to encourage women to have a skilled attendant at childbirth. However, many pregnant women in sub-Saharan Africa start antenatal care attendance late, particularly adolescent pregnant women. Therefore they do not fully benefit from its preventive and curative services. This study assesses the timing of adult and adolescent pregnant women's first antenatal care visit and identifies factors influencing early and late attendance. Methods The study was conducted in the Ulanga and Kilombero rural Demographic Surveillance area in south-eastern Tanzania in 2008. Qualitative exploratory studies informed the design of a structured questionnaire. A total of 440 women who attended antenatal care participated in exit interviews. Socio-demographic, social, perception- and service related factors were analysed for associations with timing of antenatal care initiation using regression analysis. Results The majority of pregnant women initiated antenatal care attendance with an average of 5 gestational months. Belonging to the Sukuma ethnic group compared to other ethnic groups such as the Pogoro, Mhehe, Mgindo and others, perceived poor quality of care, late recognition of pregnancy and not being supported by the husband or partner were identified as factors associated with a later antenatal care enrolment (p Conclusions Factors including poor quality of care, lack of awareness about the health benefit of antenatal care, late recognition of pregnancy, and social and economic factors may influence timing of antenatal care. Community-based interventions are needed that involve men, and need to be combined with interventions that target improving the quality, content and outreach of antenatal care services to enhance early antenatal care enrolment among pregnant women.

  7. EFFECTS OF CORTICOSTEROIDS ON BRONCHODILATOR ACTION IN CHRONIC OBSTRUCTIVE LUNG-DISEASE

    NARCIS (Netherlands)

    WEMPE, JB; POSTMA, DS; BREEDERVELD, N; KORT, E; VANDERMARK, TW; KOETER, GH

    1992-01-01

    Background Short term treatment corticosteroids does not usually reduce airflow limitation and airway responsiveness in patients with chronic obstructive lung disease. We investigated whether corticosteroids modulate the effects of inhaled salbutamol and ipratropium bromide. Methods Ten non-allergic

  8. Corticosteroid effects on glutamatergic transmission and fear memory

    NARCIS (Netherlands)

    Xiong, Hui

    2016-01-01

    In our daily life we are regularly exposed to situations which we experience as stressful. In response to these events our body increases the release of corticosteroid hormones from the adrenal glands. These hormones promote behavioural adaptation to stressful experiences by enhancing the storage of

  9. Corticosteroid therapy in Henoch-Schönlein gastritis

    Directory of Open Access Journals (Sweden)

    Pavlović Momčilo

    2007-01-01

    Full Text Available Introduction. Henoch-Schönlein purpura (HSP is the most common vascular disease of childhood. It is a multisystem disease most commonly affecting the skin, joints, gastrointestinal tract, and kidneys, but other organs may be affected, too. Gastrointestinal involvement occurs in approximately 65-90% of patients, ranging from mild symptoms such as abdominal pain, nausea, and vomiting, to more severe manifestations such as gastrointestinal bleeding and intussusception. In most cases, HSP spontaneously resolves without treatment. The use of corticosteroids is controversial and usually reserved for severe systemic manifestations. Some authors suggest that the abdominal pain and gastrointestinal hemorrhage of HSP may respond to steroids, with some suggesting that there is a benefit in their use and describing a regimen. Case outline. This is a case report of HSP in a fourteen year-old boy with abdominal pain and hematemesis. Upper endoscopy showed an edematous and erythematous change in the body of the stomach and purpuric lesions in the duodenum, while multiple erosions were found in the antral area. Parenteral corticosteroid therapy with gastric acid secretion inhibitor administration led to regression of gastrointestinal symptoms on the seventh day, with relapses on the fourth and sixth day. Peroral administration of corticosteroids and gradual decrease of daily doses started on the eighth day of abdominal symptoms. New purpuric skin rashes appeared during six weeks. Conclusion. Corticosteroid therapy with gastric acid secretion inhibitors showed a positive effect in our patient with a severe form of HSP accompanied by abdominal pain and gastrointestinal hemorrhage. .

  10. The interplay between rapid and slow corticosteroid actions in brain

    NARCIS (Netherlands)

    Joëls, M.; Pasricha, N.; Karst, H.

    2013-01-01

    Stress causes the release of many transmitters and hormones, including corticosteroids. These molecules enter the brain and exert their effects through the mineralo- and glucocorticoid receptor. The former receptor plays an important role in neuronal stability. However, it also mediates rapid non-ge

  11. Inhaled corticosteroids stabilize constrictive bronchiolitis after hematopoietic stem cell transplantation.

    Science.gov (United States)

    Bashoura, L; Gupta, S; Jain, A; Couriel, D R; Komanduri, K V; Eapen, G A; Safdar, A; Broglio, K R; Adachi, R; Dickey, B F

    2008-01-01

    Post transplantation constrictive bronchiolitis (PTCB) is the most common pulmonary complication among long-term survivors of allogeneic hematopoietic stem cell transplantation (HSCT). It is a late manifestation of GVHD. Its treatment with high-dose systemic corticosteroids and other immunosuppressive regimens is associated with multiple side effects. Topical corticosteroids are used for the treatment of other manifestations of GVHD to minimize these side effects. We conducted a retrospective analysis of a series of adult patients to evaluate the efficacy of high-dose inhaled corticosteroids in the treatment of PTCB. Seventeen patients with new-onset airflow obstruction were diagnosed with PTCB. Their forced expiratory volume in 1 s (FEV1) declined from a median of 84% (range, 56-119) before HSCT to 53% (26-82) after HSCT. All patients received inhaled fluticasone propionate 500-940 microg two times daily. Symptoms of airway obstruction improved and FEV1 stabilized 3-6 months after treatment. We conclude that high-dose inhaled corticosteroids may be effective in the treatment of PTCB and propose a plausible mechanism of its action. A prospective evaluation of its efficacy is warranted.

  12. Fulminant Amebic Colitis after Corticosteroid Therapy: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Debbie-Ann Shirley

    2016-07-01

    Full Text Available Amebic colitis, caused by intestinal infection with the parasite, Entamoeba histolytica, is a common cause of diarrhea worldwide. Fulminant amebic colitis is the most devastating complication of this infection, associated with both high mortality and morbidity. We conducted a review of the English literature to describe cases of fulminant amebic colitis associated with exposure to corticosteroid medications in order to identify the risk factors for poor outcome and determine difficulties in diagnosis and treatment.Articles reporting severe and fulminant forms of amebic colitis between 1991 and 2016 were collected. 525 records were screened to identify 24 cases for qualitative analysis associated with corticosteroid use. Cases arose from areas of high endemicity or travel to such areas. Most cases (14 of 24, 58% were given corticosteroids for initially misdiagnosed colitis, mainly inflammatory bowel, resulting in rapid progression of disease. Nearly half of all cases underwent surgical intervention, and 25% of cases died, despite all patients eventually receiving treatment with metronidazole. The odds of death did not differ significantly by prior misdiagnosis, co-morbidities, bowel perforation or need for surgery.Infection with E. histolytica should be considered prior to the administration of corticosteroids, in particular for patients residing in endemic areas or those with appropriate travel history, especially prior to the diagnosis of inflammatory bowel disease. The development of preventative and treatment interventions are needed to improve outcomes of fulminant disease.

  13. Risks of pneumonia in patients with asthma taking inhaled corticosteroids

    DEFF Research Database (Denmark)

    O'Byrne, Paul M; Pedersen, Soren; Carlsson, Lars-Göran

    2011-01-01

    Rationale: Inhaled corticosteroids (ICS) are the mainstay of asthma treatment. Studies in chronic obstructive pulmonary disease reported increased rates of pneumonia with ICS. Concerns exist about an increased pneumonia risk in patients with asthma taking ICS. Objectives: To evaluate the risks...

  14. Treatment with inhaled corticosteroids in asthma is too often discontinued

    NARCIS (Netherlands)

    Breekveldt-Postma, Nancy S.; Koerselman, Jeroen; Erkens, Joelle A.; van der Molen, Thys; Lammers, Jan-Willem J.; Herings, Ron M. C.

    2008-01-01

    Purpose To study persistence with inhaled corticosteroids (ICS) and its determinants in asthma-patients. Methods From the PHARMO database, asthma-patients (age <35 years) with a first dispensing for ICS in 1999-2002 and >= 2 dispensings in the first year were included. Persistence during the first y

  15. Inhaled corticosteroids in chronic obstructive pulmonary disease : a review

    NARCIS (Netherlands)

    Telenga, Eef D.; Kerstjens, Huib A. M.; Postma, Dirkje S.; ten Hacken, Nick H.; van den Berge, Maarten

    2010-01-01

    Importance of the field: Chronic obstructive pulmonary disease (COPD) is a disease characterized by chronic airflow obstruction and a progressive lung function decline. Although widely used, the efficacy of inhaled corticosteroids (ICS) in the treatment of COPD remains a matter of debate. Areas cove

  16. [Inhaled corticosteroids in patients with COPD: maintain current guidelines

    NARCIS (Netherlands)

    Heijdra, Y.F.

    2007-01-01

    The use of inhaled corticosteroids (ICS) is one of the most controversial issues in COPD treatment. There is evidence that ICS with or without long-acting beta-2-adrenergics (LABA) reduce exacerbation rates and improve the health status of severe COPD patients. The effects on FEV1 are limited and th

  17. Drug interactions between inhaled corticosteroids and enzymatic inhibitors

    OpenAIRE

    Daveluy, Amélie; Raignoux, Cécile; Miremont-Salamé, Ghada; Girodet, Pierre-Olivier; Moore, Nicholas; Haramburu, Françoise; Molimard, Mathieu

    2009-01-01

    Drug interactions between inhaled corticosteroids and enzymatic inhibitors phone: +33-557-571561 (Daveluy, Amelie) (Daveluy, Amelie) Centre Regional de Pharmacovigilance, Hopital Pellegrin - 33076 - Bordeaux Cedex - FRANCE (Daveluy, Amelie) Unite 657, INSERM - Bordeaux - FRANCE (Daveluy, Amelie) Departement de Pharmacologie, CHU de Bordeaux - Bordeaux - FRANCE (Daveluy, Amelie) Centre Regional de Pharmacovigilance, Hopital Pellegrin - 33076...

  18. Vibrational spectra of corticosteroid hormones in the terahertz range

    Science.gov (United States)

    Cherkasova, O. P.; Nazarov, M. M.; Sapozhnikov, D. A.; Man'kova, A. A.; Fedulova, E. V.; Volodin, V. A.; Minaeva, V. A.; Minaev, B. F.; Baryshnikov, G. V.

    2010-11-01

    The terahertz time-domain and Raman spectra of corticosteroid hormones in the region of low-frequency infrared vibrations have been measured. On the ground of quantum chemical calculations of the frequencies and normal modes the assignments of vibrational bands in the THz-spectra are performed.

  19. Corticosteroid receptor dynamics : analysis by advanced fluorescence microscopy

    NARCIS (Netherlands)

    Groeneweg, Femke Lokke

    2014-01-01

    In this thesis I aimed to explore further finesses in the cellular dynamics of the two corticosteroid receptors, the MR and the GR, in both their membrane-associated and their nuclear subpopulations. Amongst others I quantified the dynamics of the receptors at the membrane (only MR) and at the chrom

  20. Fulminant Amebic Colitis after Corticosteroid Therapy: A Systematic Review

    Science.gov (United States)

    Shirley, Debbie-Ann; Moonah, Shannon

    2016-01-01

    Background Amebic colitis, caused by intestinal infection with the parasite, Entamoeba histolytica, is a common cause of diarrhea worldwide. Fulminant amebic colitis is the most devastating complication of this infection, associated with both high mortality and morbidity. We conducted a review of the English literature to describe cases of fulminant amebic colitis associated with exposure to corticosteroid medications in order to identify the risk factors for poor outcome and determine difficulties in diagnosis and treatment. Methodology and Principal Findings Articles reporting severe and fulminant forms of amebic colitis between 1991 and 2016 were collected. 525 records were screened to identify 24 cases for qualitative analysis associated with corticosteroid use. Cases arose from areas of high endemicity or travel to such areas. Most cases (14 of 24, 58%) were given corticosteroids for initially misdiagnosed colitis, mainly inflammatory bowel, resulting in rapid progression of disease. Nearly half of all cases underwent surgical intervention, and 25% of cases died, despite all patients eventually receiving treatment with metronidazole. The odds of death did not differ significantly by prior misdiagnosis, co-morbidities, bowel perforation or need for surgery. Conclusions and Significance Infection with E. histolytica should be considered prior to the administration of corticosteroids, in particular for patients residing in endemic areas or those with appropriate travel history, especially prior to the diagnosis of inflammatory bowel disease. The development of preventative and treatment interventions are needed to improve outcomes of fulminant disease. PMID:27467600

  1. Grizzly bear corticosteroid binding globulin: Cloning and serum protein expression.

    Science.gov (United States)

    Chow, Brian A; Hamilton, Jason; Alsop, Derek; Cattet, Marc R L; Stenhouse, Gordon; Vijayan, Mathilakath M

    2010-06-01

    Serum corticosteroid levels are routinely measured as markers of stress in wild animals. However, corticosteroid levels rise rapidly in response to the acute stress of capture and restraint for sampling, limiting its use as an indicator of chronic stress. We hypothesized that serum corticosteroid binding globulin (CBG), the primary transport protein for corticosteroids in circulation, may be a better marker of the stress status prior to capture in grizzly bears (Ursus arctos). To test this, a full-length CBG cDNA was cloned and sequenced from grizzly bear testis and polyclonal antibodies were generated for detection of this protein in bear sera. The deduced nucleotide and protein sequences were 1218 bp and 405 amino acids, respectively. Multiple sequence alignments showed that grizzly bear CBG (gbCBG) was 90% and 83% identical to the dog CBG nucleotide and amino acid sequences, respectively. The affinity purified rabbit gbCBG antiserum detected grizzly bear but not human CBG. There were no sex differences in serum total cortisol concentration, while CBG expression was significantly higher in adult females compared to males. Serum cortisol levels were significantly higher in bears captured by leg-hold snare compared to those captured by remote drug delivery from helicopter. However, serum CBG expression between these two groups did not differ significantly. Overall, serum CBG levels may be a better marker of chronic stress, especially because this protein is not modulated by the stress of capture and restraint in grizzly bears.

  2. Prevalence of and factors influencing sensitization to corticosteroids in a Danish patch test population

    DEFF Research Database (Denmark)

    Vind-Kezunovic, Dina; Johansen, Jeanne Duus; Carlsen, Berit Christina

    2011-01-01

    Corticosteroids are used to treat dermatoses, including allergic contact dermatitis, but can also cause contact allergy. The frequency of corticosteroid allergy varies between studies and is influenced by treatment traditions and availability.......Corticosteroids are used to treat dermatoses, including allergic contact dermatitis, but can also cause contact allergy. The frequency of corticosteroid allergy varies between studies and is influenced by treatment traditions and availability....

  3. Safety and Efficacy of Corticosteroids for the Treatment of Septic Shock: A Systematic Review and Meta-Analysis

    National Research Council Canada - National Science Library

    Wendy I. Sligl; Danny A. Milner; Sugantha Sundar; Wendy Mphatswe; Sumit R. Majumdar

    2009-01-01

    .... Adjunctive treatment with corticosteroids is common, but definitive data are lacking. We aimed to determine the efficacy and safety of corticosteroid therapy among patients with septic shock. Methods...

  4. The results of 15 years of consistent strategy in treating antenatally suspected pelvi-ureteric junction obstruction

    DEFF Research Database (Denmark)

    Thorup, Jørgen Mogens; Jokela, R; Cortes, Dina;

    2003-01-01

    To determine how to select patients for surgery among those with antenatally detected pelvi-ureteric junction (PUJ) obstruction.......To determine how to select patients for surgery among those with antenatally detected pelvi-ureteric junction (PUJ) obstruction....

  5. ADHD deficit as measured in adolescent boys with a continuous performance task is related to antenatal maternal anxiety

    NARCIS (Netherlands)

    Van Den Bergh, BRH; Mennes, M; Stevens, [No Value; Van Der Meere, J; Borger, N; Stiers, P; Marcoen, A; Lagae, L; Van den Berg, R.H.

    Antenatal maternal anxiety has been shown to be related to infant temperament, childhood disorders, and impulsivity in adolescence. This study prospectively investigated whether antenatal maternal anxiety is associated with performance on a continuous performance task. Sixty-four adolescents (mean

  6. Antenatal education in small classes may increase childbirth self-efficacy

    DEFF Research Database (Denmark)

    Brixval, Carina S; Axelsen, Solveig F; Thygesen, Lau C

    2016-01-01

    Antenatal education in small classes may increase childbirth self-efficacy. In this randomised trial we assessed the effect of a structured antenatal programme versus auditorium-based lectures on childbirth self-efficacy measured by three single items. We found that women in the intervention group...

  7. The effect of antenatal education in small classes on obstetric and psycho-social outcomes

    DEFF Research Database (Denmark)

    Brixval, Carina Sjöberg; Axelsen, Solveig Forberg; Andersen, Stig Krøger

    2014-01-01

    number of participants, may differ from the effect of other forms of antenatal education. The latest Cochrane review, assessed as up-to-date in 2007, concluded that the effect of antenatal education for childbirth or parenthood or both remains largely unknown. This systematic review and meta...

  8. Effect of daily antenatal iron supplementation on plasmodium infection in Kenyan women. A randomized clinical trial

    NARCIS (Netherlands)

    Mwangi, M.N.; Roth, J.M.; Smit, M.R.; Trijsburg, Laura; Mwangi, A.M.; Demir, A.Y.; Wielders, J.P.M.; Mens, P.F.; Verweij, J.J.; Cox, S.E.; Prentice, A.M.; Brouwer, I.D.; Savelkoul, H.F.J.; Andang'o, P.E.A.; Verhoef, J.C.M.

    2015-01-01

    Importance Anemia affects most pregnant African women and is predominantly due to iron deficiency, but antenatal iron supplementation has uncertain health benefits and can increase the malaria burden. Objective To measure the effect of antenatal iron supplementation on maternal Plasmodium infection

  9. Group-based antenatal birth and parent preparation for improving birth outcomes and parenting resources

    DEFF Research Database (Denmark)

    Koushede, Vibeke; Brixval, Carina Sjöberg; Axelsen, Solveig Forberg

    2013-01-01

    To examine the efficacy and cost-effectiveness of group based antenatal education for improving childbirth and parenting resources compared to auditorium based education.......To examine the efficacy and cost-effectiveness of group based antenatal education for improving childbirth and parenting resources compared to auditorium based education....

  10. Early Postnatal Blood Pressure in Preterm Infants : Effects of Chorioamnionitis and Timing of Antenatal Steroids

    NARCIS (Netherlands)

    Been, Jasper V.; Kornelisse, Rene F.; Rours, Ingrid G. I. J. G.; Passos, Valeria Lima; De Krijger, Ronald R.; Zimmermann, Luc J. I.

    2009-01-01

    Previous studies suggest postnatal blood pressure in preterm infants to be decreased by chorioamnionitis and increased by antenatal steroids (AS). We examined the adjusted effects of both antenatal modulators on postnatal blood pressure (BP), with separate effects reported for histologic chorioamnio

  11. Urinary tract infections at first antenatal check-up: a single centre prospective study

    Directory of Open Access Journals (Sweden)

    Saubhagya Kumar Jena

    2016-09-01

    Conclusions: ASB is more common during pregnancy even in first antenatal check-up. We suggest routine urine culture and sensitivity during first antenatal check-up to detect ASB and treat with proper antibiotic to prevent the complications and development of resistance. [Int J Reprod Contracept Obstet Gynecol 2016; 5(9.000: 3103-3106

  12. A nationwide population analysis of antenatal and perinatal complications among nurses and nonmedical working women

    Directory of Open Access Journals (Sweden)

    Chun-Che Huang

    2016-10-01

    Conclusion: Our nationwide population-based study revealed increased risks of antenatal and perinatal complications among nurses compared with those among nonmedical working women. The large-scale observation of the increased antenatal and perinatal complications draws attention to the health issues faced by nursing personnel who represent one of the most important workforces in the healthcare system.

  13. Effect of daily antenatal iron supplementation on plasmodium infection in Kenyan women. A randomized clinical trial

    NARCIS (Netherlands)

    Mwangi, M.N.; Roth, J.M.; Smit, M.R.; Trijsburg, Laura; Mwangi, A.M.; Demir, A.Y.; Wielders, J.P.M.; Mens, P.F.; Verweij, J.J.; Cox, S.E.; Prentice, A.M.; Brouwer, I.D.; Savelkoul, H.F.J.; Andang'o, P.E.A.; Verhoef, J.C.M.

    2015-01-01

    Importance Anemia affects most pregnant African women and is predominantly due to iron deficiency, but antenatal iron supplementation has uncertain health benefits and can increase the malaria burden. Objective To measure the effect of antenatal iron supplementation on maternal Plasmodium infection

  14. Faktor-Faktor yang Mempengaruhi Ibu Hamil dalam Melakukan Pemeriksaan Antenatal Care

    OpenAIRE

    Ritonga, Fatimah Jahra; Sitohang, Nur Asnah

    2016-01-01

    Pemeriksaan Antenatal Care adalah suatu program yang terencana berupa observasi, edukasi dan penanganan medik pada ibu hamil, untuk memperoleh suatu proses kehamilan dan persalinan yang aman dan memuaskan. Faktor-faktor yang mempengaruhi ibu hamil dalam melakukan pemeriksaan antenatal care adalah pengetahuan,pendidikan,umur,ekonomi,sumber informasi, letak geografis dan dukungan keluarga. Nur Asnah Sitohang

  15. Impact of antenatal depression on perinatal outcomes and postpartum depression in Korean women

    Directory of Open Access Journals (Sweden)

    Sae Kyung Choi

    2014-01-01

    Full Text Available Background: Maternal prenatal mental health has been shown to be associated with adverse consequences for the mother and the child. However, studies considering the effect of prenatal depressive symptoms are lacking. The aim of this study was to examine the influence of antenatal depressive symptoms on obstetric outcomes and to determine associations between antenatal and postpartum depressions. Materials and Methods: This was a prospective cohort study. The Edinburgh postnatal depression scale (EPDS questionnaire was completed by pregnant women receiving obstetrical care at Seoul St. Mary′s hospital in the third trimester of gestation. The electronic medical records were reviewed after delivery and perinatal outcomes were evaluated. The association between antenatal and postpartum depression was analyzed using the EPDS questionnaire, which was completed by the same women within 2 months of delivery. Results: Of the 467 participants, 26.34% (n = 123 had antenatal depressive symptoms, with EPDS scores of ≥10. There were no significant perinatal outcomes associated with antenatal depressive symptoms. During the postpartum period, 192 of the women in the initial study cohort were given the EPDS again as a follow-up. Of the 192 participants, 56 (29.17% scored >10. Spearman correlation coefficient between the antenatal and postpartum EPDS scores was 0.604, which was statistically significant (P < 0.001. Conclusion: Antenatal depression does not lead to unfavorable perinatal outcomes. However, screening for antenatal depression may be helpful to identify women at risk of postpartum depression.

  16. Study of compliance with a new, targeted antenatal D immunization prevention programme in Denmark

    DEFF Research Database (Denmark)

    Damkjaer, M B; Perslev, A; Clausen, F B

    2012-01-01

    A targeted routine antenatal anti-D prophylaxis programme was implemented in Denmark where anti-D immunoglobulin is given based on the result from noninvasive antenatal screening for fetal RHD. Our objective was to evaluate compliance with this new programme right after its initiation. Materials and...

  17. Antenatal renal pelvic dilatation; the long-term outlook

    Energy Technology Data Exchange (ETDEWEB)

    Duncan, K.A. [Royal Aberdeen Children' s Hospital and Aberdeen Maternity Hospital, Foresterhill, Aberdeen (United Kingdom)]. E-mail: k.duncan@nhs.net

    2007-02-15

    Aim: The purpose of this study was twofold: first to provide data for more accurate counselling of parents with regard to prognosis, and second, to ensure that by following a policy of selective micturating cystourethography (MCUG), significant pathology is not missed, in particular vesicoureteric reflux (VUR). (MCUG is only undertaken if the renal pelvic diameter (RPD) is {>=} 10 mm or if there is calyceal or ureteric dilatation.) Material and methods: Data were collected prospectively over a 6-year period. Pre and postnatal imaging findings were collected for all infants in whom a RPD of {>=} 5 mm was identified at any gestational age. The imaging records of all patients were reviewed in 2005 for evidence of pathology detected after re-presentation with symptoms. The age range at review varied from 2-8 years. Results: Complete data were available in 527 infants. The risk of significant pathology was related to the degree of antenatal renal pelvic dilatation varying from 6% for a RPD of 5 mm at 20 weeks gestation to 38% at 10mm. At 28-33 weeks gestation the risk varied from 5% at 5 mm to 15% at 10 mm. Subsequent imaging record review revealed only one patient with grade II VUR in the study population not picked up by our selective MCUG policy. Conclusion: The present study provides prognostic information that can be given to parents both antenatally and postnatally, and reassurance that a selective MCUG policy is appropriate.

  18. Antenatal Ultrasonographic Anteroposterior Renal Pelvis Diameter Measurement: Is It a Reliable Way of Defining Fetal Hydronephrosis?

    Directory of Open Access Journals (Sweden)

    Alamanda Kfoury Pereira

    2011-01-01

    Full Text Available Purpose. It was to quantify the intraobserver and interobserver variability of the sonographic measurements of renal pelvis and classify hydronephrosis severity. Methods. Two ultrasonographers evaluated 17 fetuses from 23 to 39 weeks of gestation. Renal pelvis APD were taken in 50 renal units. For intraobserver error, one of them performed three sequential measurements. The mean and standard deviation from the absolute and percentage differences between measurements were calculated. Bland-Altman plots were used to visually assess the relationship between the precision of repeated measurements. Hydronephrosis was classified as mild (5.0 to 9.9 mm, moderate (10.0 to 14.9 mm, or severe (≥15.0 mm. Interrater agreement were obtained using the Kappa index. Results. Absolute intraobserver variation in APD measurements was 5.2±3.5%. Interobserver variation of ultrasonographers was 9.3±9.7%. Neither intraobserver or interobserver error increased with increasing APD size. The overall percentage of agreement with the antenatal hydronephrosis diagnosis was 64%. Cohen's Kappa to hydronephrosis severity was 0.51 (95% CI, 0.33 to 0.69. Conclusion. Inter and intraobserver APD measurement errors were low in these group, but the agreement to hydronephrosis diagnosis and classification was fair. We suggest that standard and serial APD measurement can better define and evaluate fetal hydronephrosis.

  19. The effect of antenatal education in small classes on obstetric and psycho-social outcomes

    DEFF Research Database (Denmark)

    Brixval, Carina Sjöberg; Axelsen, Solveig Forberg; Lauemøller, Stine Glenstrup

    2015-01-01

    BACKGROUND: The aims of antenatal education are broad and encompass outcomes related to pregnancy, birth, and parenthood. Both form and content of antenatal education have changed over time without evidence of effects on relevant outcomes. The effect of antenatal education in groups......, with participation of a small number of participants, may differ from the effect of other forms of antenatal education due to, for example, group dynamic. The objective of this systematic review is to assess the effects of antenatal education in small groups on obstetric as well as psycho-social outcomes. METHODS......: Bibliographic databases (Medline, EMBASE, CENTRAL, CINAHL, Web of Science, and PsycINFO) were searched. We included randomized and quasi-randomized trials irrespective of language, publication year, publication type, and publication status. Only trials carried out in the Western world were considered...

  20. Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort.

    Directory of Open Access Journals (Sweden)

    Akbar K Waljee

    Full Text Available Corticosteroids are effective for the short-term treatment of inflammatory bowel disease (IBD. Long-term use, however, is associated with significant adverse effects. To define the: (1 frequency and duration of corticosteroid use, (2 frequency of escalation to corticosteroid-sparing therapy, (3 rate of complications related to corticosteroid use, (4 rate of appropriate bone density measurements (dual energy X-ray absorptiometry [DEXA] scans, and (5 factors associated with escalation and DEXA scans.Retrospective review of Veterans Health Administration (VHA data from 2002-2010.Of the 30,456 Veterans with IBD, 32% required at least one course of corticosteroids during the study time period, and 17% of the steroid users had a prolonged course. Among these patients, only 26.2% underwent escalation of therapy. Patients visiting a gastroenterology (GI physician were significantly more likely to receive corticosteroid-sparing medications. Factors associated with corticosteroid-sparing medications included younger age (OR = 0.96 per year,95%CI:0.95, 0.97, male gender (OR = 2.00,95%CI:1.16,3.46, GI visit during the corticosteroid evaluation period (OR = 8.01,95%CI:5.85,10.95 and the use of continuous corticosteroids vs. intermittent corticosteroids (OR = 2.28,95%CI:1.33,3.90. Rates of complications per 1000 person-years after IBD diagnosis were higher among corticosteroid users (venous thromboembolism [VTE] 9.0%; fragility fracture 2.6%; Infections 54.3 than non-corticosteroid users (VTE 4.9%; fragility fracture 1.9%; Infections 26.9. DEXA scan utilization rates among corticosteroid users were only 7.8%.Prolonged corticosteroid therapy for the treatment of IBD is common and is associated with significant harm to patients. Patients with prolonged use of corticosteroids for IBD should be referred to gastroenterology early and universal efforts to improve the delivery of high quality care should be undertaken.

  1. Early Initiation of Antenatal Care and Factors Associated with Early Antenatal Care Initiation at Health Facilities in Southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Mengesha Boko Geta

    2017-01-01

    Full Text Available Antenatal care (ANC is care given to pregnant mothers to timely identify and mitigate pregnancy related problems that can harm mother or fetus. Most of Ethiopian mothers present late for ANC. The aim of this paper was to assess determinants of early antenatal care initiation among pregnant women. Mothers attending Shebedino District Health Centers for ANC between January 12 and February 18, 2015, were invited to the study. Multistage sampling technique and structured questionnaire were used to collect data by trained data collectors. Univariate and bivariate analysis were conducted to study the association between explanatory and outcome variable. Out of 608 women, 132 [21.71%] had their first ANC within the recommended time [before or at 3 months]. Media access [AOR = 2.11 95% CI 1.00, 3.22], knowledge about the correct time of ANC booking [AOR = 4.49 95% CI 2.47, 6.16], and having been advised to book within 12 weeks [AOR = 4.14 95% CI 3.80, 5.21] were determinants of first-trimester booking. Health professionals and care providers should provide full information, advice, and appropriate care about early ANC for every eligible mother.

  2. Assessing the potential impact of extending antenatal steroids to the late preterm period.

    Science.gov (United States)

    Souter, Vivienne; Kauffman, Ellen; Marshall, Alice J; Katon, Jodie G

    2017-10-01

    In 2016, guidance statements were issued by the Society for Maternal-Fetal Medicine and the American Congress of Obstetricians and Gynecologists about extending antenatal steroid use to selected late preterm singleton pregnancies. We sought to review antenatal steroid use prior to the 2016 guidance statements and assess the potential impact of these. This cohort study used chart-abstracted data from singleton deliveries from Jan. 1, 2012, through March 31, 2016, at 12 centers participating in the Obstetrics Clinical Outcomes Assessment Program, a quality initiative in Washington State. Pregnancies with missing gestation at delivery, fetal anomalies, or antepartum demise were excluded. Antenatal steroid use prior to the 2016 guidance was evaluated based on the percentage of early preterm deliveries (23(+0)-33(+6) weeks) and the percentage of all pregnancies that received antenatal steroids. Newborn complication rates were calculated for late preterm deliveries (34+0(+0)-36(+6) weeks), grouped by whether they would be potentially eligible or ineligible for antenatal steroids based on the 2016 guidance statements. The opportunity for antenatal steroids was missed in 21.8% (226/1034) of early preterm deliveries and of all those who received antenatal steroids, 32.2% (614/1908) delivered at term. Of preterm deliveries, 74% (n = 2942) were in the late preterm period. In all, 80% (n = 2363) of late preterm deliveries were potentially eligible for antenatal steroids and 60% of these (n = 1411) delivered at 36 weeks. The rate of respiratory complications in newborns delivering at 34 and 35 weeks was higher in the group potentially eligible for late preterm antenatal steroids compared to those in the ineligible group. Of those delivering at 36 weeks, no differences were detected in prevalence of respiratory complications by potential eligibility for antenatal steroids; however, compared with the ineligible group, those potentially eligible had a lower risk of neonatal

  3. Antibody induction versus corticosteroid induction for liver transplant recipients

    DEFF Research Database (Denmark)

    Penninga, Luit; Wettergren, André; Wilson, Colin H

    2014-01-01

    BACKGROUND: Liver transplantation is an established treatment option for end-stage liver failure. To date, no consensus has been reached on the use of immunosuppressive T-cell specific antibody induction compared with corticosteroid induction of immunosuppression after liver transplantation....... OBJECTIVES: To assess the benefits and harms of T-cell specific antibody induction versus corticosteroid induction for prevention of acute rejection in liver transplant recipients. SEARCH METHODS: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register...... of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index Expanded, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 30 September 2013 together with reference checking, citation searching, contact with trial authors and pharmaceutical companies...

  4. System among the corticosteroids: specificity and molecular dynamics

    Science.gov (United States)

    Brookes, Jennifer C.; Galigniana, Mario D.; Harker, Anthony H.; Stoneham, A. Marshall; Vinson, Gavin P.

    2012-01-01

    Understanding how structural features determine specific biological activities has often proved elusive. With over 161 000 steroid structures described, an algorithm able to predict activity from structural attributes would provide manifest benefits. Molecular simulations of a range of 35 corticosteroids show striking correlations between conformational mobility and biological specificity. Thus steroid ring A is important for glucocorticoid action, and is rigid in the most specific (and potent) examples, such as dexamethasone. By contrast, ring C conformation is important for the mineralocorticoids, and is rigid in aldosterone. Other steroids that are less specific, or have mixed functions, or none at all, are more flexible. One unexpected example is 11-deoxycorticosterone, which the methods predict (and our activity studies confirm) is not only a specific mineralocorticoid, but also has significant glucocorticoid activity. These methods may guide the design of new corticosteroid agonists and antagonists. They will also have application in other examples of ligand–receptor interactions. PMID:21613285

  5. Intermittent inhaled corticosteroids in infants with episodic wheezing

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Hermansen, Mette Northman; Loland, Lotte

    2006-01-01

    secondary outcomes were the time to discontinuation due to persistent wheezing and safety, as evaluated by height and bone mineral density at the end of the study. RESULTS: We enrolled 411 infants and randomly assigned 294 to receive budesonide at a first episode of wheezing. The proportion of symptom...... not affected by treatment. CONCLUSIONS: Intermittent inhaled corticosteroid therapy had no effect on the progression from episodic to persistent wheezing and no short-term benefit during episodes of wheezing in the first three years of life. (ClinicalTrials.gov number, NCT00234390.).......BACKGROUND: We hypothesized that asthma is preceded by a stage of recurrent episodes of wheezing during the first years of life and that inhaled corticosteroid therapy during symptomatic episodes in this early phase may delay progression to persistent wheezing. METHODS: We assigned one...

  6. [Crusted scabies induced by topical corticosteroids: A case report].

    Science.gov (United States)

    Bilan, P; Colin-Gorski, A-M; Chapelon, E; Sigal, M-L; Mahé, E

    2015-12-01

    The frequency of scabies is increasing in France. Crusted (or Norwegian) scabies is a very contagious form of scabies because of the huge number of mites in the skin. It is observed in patients suffering from immunodepression, motor or sensory deficiency, or mental retardation. The clinical presentation, except for the classic manifestation of scabies, is characterized by crusted lesions. Treatment is not easy and requires hospitalization. Topical corticosteroids are frequently used for children's dermatological diseases. Their long-term and inappropriate application in an infested scabies child can induce crusted scabies. We report on a case of an 8-year-old boy who developed crusted scabies induced by topical corticosteroid application. We discuss the therapeutic aspects of this severe form of scabies.

  7. Minimizing side effects of systemic corticosteroids in children

    Directory of Open Access Journals (Sweden)

    Deshmukh C

    2007-01-01

    Full Text Available Corticosteroids are potent drugs used in management of various inflammatory and autoimmune disorders. The antiinflammatory effects of corticosteroids cannot however be separated from their metabolic effects. Children are more vulnerable to their side effects, particularly the effects on growth, immunity and adrenal suppression. It is essential for the treating physician to be aware of the side effects and the measures to be taken to minimize them. A side effect that is unique to children is growth suppression, which is helped by alternate day treatment. Administration of small doses of prednisolone (10-15 mg/day or < 0.5 mg/kg/day single dose on alternate days, does not slow growth velocity significantly. The potency of dexamethasone and betamethasone in suppressing growth is nearly 18 times higher than that of prednisolone. There is some evidence that the administration of growth hormone can reverse these changes.

  8. Amphiphilic polymeric micelle as pseudostationary phase in electrokinetic chromatography for analysis of eight corticosteroids in cosmetics.

    Science.gov (United States)

    Xu, Xiaojin; Ni, Xinjiong; Cao, Yuhua; Zhuo, Xiaolu; Yang, Xiaoxiao; Cao, Guangqun

    2014-03-01

    Amphiphilic polymeric micelle, as a novel pseudostationary phase in EKC was used to determine eight kinds of corticosteroids namely hydrocortisone, prednisolone, hydrocortisone acetate, prednisone, cortisone acetate, prednisolone acetate, dexamethasone, and triamcinolone acetonide in cosmetics. Amphiphilic random copolymer poly(methyl methacrylate-co-methacrylic acid) (P(MMA-co-MAA)) was micellizated via neutralization in alkaline aqueous solution. The influences of the molar ratio of monomer MMA to MAA, the concentration of polymer and pH on the polymeric micelle microstructure and EKC performances were investigated. As molar ratio of MMA to MAA in P(MMA-co-MAA) increased, both CMC and environmental polarity of the inner core in polymeric micelle decreased dramatically. With increasing monomer ratio, the size of polymeric micelles increased firstly, and then decreased, finally increased again. ζ potential of the micelle had a slight decline trend. As increment of polymer concentration, the size of the polymeric micelle increased steadily. By optimizing the monomer ratio, the polymer concentration, and pH of the running buffer, as well as operation conditions such as separation voltage and temperature, the eight analytes could be separated within 16.5 min using 7.5 mg/mL polymer with the monomer ratio of 7:3 dissolved in pH 9.2 borax buffer as the running buffer. The method has been used for analysis of corticosteroids in cosmetic samples with simple extraction; the recoveries for eight analytes were between 85.9 and 106%. This method was of accuracy, repeatability, pretreatment simplicity, and could be applied to the quality control of cosmetics. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  9. Neurosarcoidosis associated with hypersomnolence treated with corticosteroids and brain irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Rubinstein, I.; Gray, T.A.; Moldofsky, H.; Hoffstein, V.

    1988-07-01

    Narcoleptic features developed in a young man with CNS sarcoidosis. This was associated with a structural lesion in the hypothalamus as demonstrated on CT scans of the head. The diagnosis of narcolepsy was established by compatible clinical history and the Multiple Sleep Latency Test. Treatment with high-dose corticosteroids was ineffective, but when the low-dose, whole-brain irradiation was added, complete resolution of the narcoleptic features ensued.

  10. Crusted (Norwegian) Scabies Following Systemic and Topical Corticosteroid Therapy

    OpenAIRE

    Binić, Ivana; Janković, Aleksandar; Jovanović, Dragan; Ljubenović, Milanka

    2009-01-01

    It is a case study of a 62-yr-old female with crusted (Norwegian) scabies, which appeared during her treatment with systemic and topical corticosteroid therapy, under the diagnosis of erythroderma. In the same time, the patient had been suffered from hypothyoidism, and her skin changes were misdiagnosed, because it was thought that they are associated with her endocrine disorder. Suddenly, beside the erythema, her skin became hyperkeratotic, with widespread scaling over the trunk and limbs, a...

  11. THE PARADOXICAL EFFECT ON PNEUMONIA OF CHRONIC INHALED CORTICOSTEROIDS

    OpenAIRE

    Sibila, Oriol; Anzueto, Antonio; Restrepo, Marcos I.

    2013-01-01

    Community-acquired pneumonia (CAP) is the leading infectious cause of death in developed countries. Several studies have shown that the risk of pneumonia is increased in patients with Chronic Obstructive Pulmonary Disease (COPD) who are receiving chronic inhaled corticosteroids (ICS). The impact of ICS On pneumonia prognosis is controversial. Recent studies have shown that COPD patients with prior ICS use have less mortality after developing CAP as compared with patients with COPD without pri...

  12. Corticosteroid refractory radiation pneumonitis that remarkably responded to cyclosporin A

    Energy Technology Data Exchange (ETDEWEB)

    Muraoka, Tomie; Bandoh, Shuji; Fujita, Jiro; Horiike, Atsushi; Ishii, Tomoya; Tojo, Yasunori; Kubo, Akihito; Ishida, Toshihiko [Kagawa Medical Univ., Miki (Japan)

    2002-09-01

    Radiation therapy is commonly used for the treatment of lung cancer. However, radiation pneumonitis frequently occurs as a complication of the radiation therapy. Although corticosteroids are widely used for the treatment of radiation pneumonitis, they are not always effective. In this report, we used cycosporin A in the treatment of a patient suffering from steroid-refractory radiation pneumonitis. To our knowledge, this is the first report in which cyclosporin A was successfully used in the treatment of radiation pneumonitis. (author)

  13. Autosomal Recessive Polycystic Kidney Disease: Antenatal Diagnosis and Histopathological Correlation

    Directory of Open Access Journals (Sweden)

    Dayananda Kumar Rajanna

    2013-01-01

    Full Text Available Autosomal recessive polycystic kidney disease (ARPKD is one of the most common inheritable disease manifesting in infancy and childhood with a frequency of 1:6,000 to 1:55,000 births. The patient in her second trimester presented with a history of amenorrhea. Ultrasound examination revealed bilateral, enlarged, hyperechogenic kidneys, placentomegaly, and severe oligohydramnios. The pregnancy was terminated. An autopsy was performed on the fetus. Both the kidneys were found to be enlarged and the cut surface showed numerous cysts. The liver sections showed changes due to fibrosis. The final diagnosis of autosomal recessive polycystic kidney disease was made based on these findings. In this article, we correlate the ante-natal ultrasound and histopathological findings in autosomal recessive polycystic kidney disease.

  14. Approaches to the management of antenatally diagnosed congenital tumours

    Energy Technology Data Exchange (ETDEWEB)

    Mahony, Rhona; McParland, Peter [National Maternity Hospital, Department of Fetal and Maternal Medicine, Dublin (Ireland)

    2009-11-15

    Congenital fetal tumours are rare, but current imaging modalities including US and MRI facilitate antenatal diagnosis and investigation, allowing a presumptive diagnosis and management strategy. Although the prevalence of fetal tumours is difficult to ascertain, an incidence of 7.2 per 100,000 live births has previously been reported, with the incidence of neonatal malignancy estimated at 36.5 per million births. Teratomas and neuroblastomas are the most common solid tumours described. Tumours may be very large or associated with severe hydrops leading to significant dystocia with the potential for difficult vaginal or caesarean delivery. Once the diagnosis of a fetal tumour is made, optimal management incorporates a multidisciplinary approach including obstetrician, neonatologist, paediatric surgeon and paediatric oncologist so that counselling is appropriate and a clear management plan is in place for parents. (orig.)

  15. Health education during antenatal care: the need for more

    Directory of Open Access Journals (Sweden)

    Al-Ateeq MA

    2015-02-01

    Full Text Available Mohammed A Al-Ateeq,1 Amal A Al-Rusaiess21College of Medicine, King Saud Bin Abdul-Aziz University for Health Sciences, 2Department of Family Medicine and Primary Health Care, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia Abstract: The aim of health education during ante natal is to provide advice, education, ­reassurance and support, to address and treat the minor problems of pregnancy, and to provide effective screening during the pregnancy. Exploring current practices in this regard revealed the need for more organized educational activities to ensure high quality and clients satisfaction. Keywords: antenatal care, health education, pregnant women, postpartum, misconceptions

  16. Extrafine inhaled corticosteroid therapy in the control of asthma

    Directory of Open Access Journals (Sweden)

    Ivancsó I

    2013-06-01

    Full Text Available István Ivancsó, Renáta Böcskei, Veronika Müller, Lilla Tamási Department of Pulmonology, Semmelweis University, Budapest, Hungary Abstract: Small airways disease plays an important role in the pathogenesis of asthma, but assessment of small airways impairment is not easy in everyday clinical practice. The small airways can be examined by several invasive and noninvasive methods, most of which can at present be used only in the experimental setting. Inhalers providing extrafine inhaled corticosteroid particle sizes may achieve sufficient deposition in the peripheral airways. Many studies have reported the beneficial effects of extrafine inhaled corticosteroids on inflammation, ie, on dysfunction in both the central and distal airways in asthmatics, and there are some data on asthma phenotypes in which the small airways seem to be affected more than in other phenotypes, including nocturnal asthma, severe steroid-dependent or difficult-to-treat asthma, asthma complicated by smoking, elderly asthmatic patients and/or patients with fixed airflow obstruction, and asthmatic children. The relevant randomized controlled clinical trials indicate that the efficacy of extrafine and nonextrafine inhaled corticosteroid formulations is similar in terms of primary endpoints, but there are certain clinically important endpoints for which the extrafine formulations show additional benefits. Keywords: small airways, inflammation, dysfunction, noninvasive evaluation methods, peripheral deposition

  17. Corticosteroid-related central nervous system side effects

    Directory of Open Access Journals (Sweden)

    Miriam Ciriaco

    2013-01-01

    Full Text Available Corticosteroids have been used since the 50s as anti-inflammatory and immunosuppressive drugs for the treatment of several pathologies such as asthma, allergy, rheumatoid arthritis, and dermatological disorders. Corticosteroids have three principal mechanisms of action: 1 inhibit the synthesis of inflammatory proteins blocking NF-kB, 2 induce the expression of anti-inflammatory proteins by IkB and MAPK phosphatase I, and 3 inhibit 5-lipoxygenase and cyclooxygenase-2. The efficacy of glucocorticoids in alleviating inflammatory disorders results from the pleiotropic effects of the glucocorticoid receptors on multiple signaling pathways. However, they have adverse effects: Growth retardation in children, immunosuppression, hypertension, hyperglycemia, inhibition of wound repair, osteoporosis, metabolic disturbances, glaucoma, and cataracts. Less is known about psychiatric or side effects on central nervous system, as catatonia, decreased concentration, agitation, insomnia, and abnormal behaviors, which are also often underestimated in clinical practice. The aim of this review is to highlight the correlation between the administration of corticosteroids and CNS adverse effects, giving a useful guide for prescribers including a more careful assessment of risk factors and encourage the use of safer doses of this class of drugs.

  18. Muscle function in rheumatic disease patients treated with corticosteroids.

    Science.gov (United States)

    Rothstein, J M; Delitto, A; Sinacore, D R; Rose, S J

    1983-02-01

    Clinical and experimental data indicate that long-term corticosteroid use leads to atrophy of the type 2 muscle fibers. The purpose of this study was to characterize and quantify the nature of muscle function in rheumatic disease patients who have been on long-term corticosteroid therapy. Quadriceps function (i.e., peak torque and power) in 19 patients (11 with rheumatoid arthritis, five with systemic lupus erythematosis, and 3 other) and 11 age- and activity-matched normal controls was measured with an isokinetic dynamometer (Cybex II), during four constant velocity movements. Power was significantly lower for the patients at all speeds. At the higher speeds the patients' deficit in power production increased as indicated by a difference in the slopes of power-velocity regression lines. Measures of peak torque could not be consistently used to differentiate the groups. Patients with rheumatic diseases receiving corticosteroids have a decreased ability to generate muscle power. The method described allows for quantification of these deficits in a clinical setting.

  19. A CASE REPORT-ANTENATAL DIAGNOSIS OF FETAL INTRACRANIAL HAEMORHAGE

    Directory of Open Access Journals (Sweden)

    Kalyani

    2015-10-01

    Full Text Available 26 years old para 1 with 26 weeks of pregnancy presented with intermittent fever. Her obstetric history included one spontaneous first trimester miscarriage and one previous Caesarean Section for meconium stained amniotic fluid. Her antenatal course was uneventful so far. On investigation she tested IgM dengue positive. Her WBC count, platelet count and coagulation profiles were within normal limits. Obstetric sonography was done which was suggestive of a single live intrauterine gestation corresponding with growth appropriate for gestational age with moderate polyhydramnios (AFI 25cms with hyperechoic cerebral cisterns suggestive of intracranial haemorrhage. Fetal MRI was done which revealed generalized atrophy of the brain parenchyma with subdural haematoma over posterior cerebral convexities extending along tentorial leaflets. Patient went into preterm labour at 27 weeks and delivered male baby of 980gms which was an intrapartum fetal demise. Fetal intracranial hemorrhage occurs in 5 in 10,000 pregnancies. Hemorrhage may occur either within the cerebral ventricles (Intraventricular haemorrhage, IVH, subdural space or infratentorial fossa. IVH are common variety and are characteristic of immature brain. IVH are subdivided according to their severity into four grades: the first three grades are limited to the ventricles, while the fourth grade includes parenchymal involvement occurring in the most severe cases. Fetal stroke is caused by antenatal hemorrhagic, ischemic or thrombotic injury. Although there is no identifiable risk factor in 50% of cases of fetal stroke, the most common maternal conditions associated with it are alloimmune thrombocytopenia and trauma. Outcome is usually poor, for those fetuses affected with high grade IVH or subdural hemorrhages. USG helps in accurate diagnosis of fetal ICH and prenatal MRI also contributes to the accuracy of diagnosis.

  20. Assessment of prescription profile of pregnant women visiting antenatal clinics.

    Directory of Open Access Journals (Sweden)

    Eze UI

    2007-09-01

    Full Text Available Managing medical complications in pregnancy is a challenge to clinicians. Objectives: This study profiled some disease and prescription patterns for pregnant women attending antenatal clinics (ANCs in Nigeria. A risk classification of the medicines was also determined. Methods: Medical case files of 1,200 pregnant women attending antenatal clinics of 3 health facilities in Benin City, Nigeria were investigated. Disease pattern was determined from their diagnoses. The prescription pattern was assessed using WHO indicators, and the United States Food and Drug Administration classification of medicines according to risk to the foetus. Results: A total of 1,897 prescriptions of the 1,200 pregnant women attendees during the period under review were evaluated. Results indicated that malaria 554 (38% was the most prevalent disease, followed by upper respiratory tract infections (URTIs, 13% and gastrointestinal disturbances (GIT, 12%. The average number of drugs prescribed per encounter was found to be 3.0, and 2,434 (43% of medicines were prescribed by generic name. Minerals/ Vitamins 2,396 (42% were the most frequently prescribed medicines, and antibiotics occurred in 502 (8.8% of the total medicines. Of all medicines prescribed, 984 (17% were included in the foetal risk category C and 286 (5% in category D. Conclusion: The study concluded that malaria fever occurred most frequently followed by URTIs and GIT disturbances among the pregnant women. Minerals, vitamins and to a less extent anti-malarials topped the list of the prescribed medicines. The average number of medicines per encounter was much higher than WHO standards. The occurrence of contraindicated medicines was low.

  1. Antenatal embolization of a large placental chorioangioma: a case report

    Directory of Open Access Journals (Sweden)

    Babic Inas

    2012-07-01

    Full Text Available Abstract Introduction A chorioangioma is the most common benign tumor of the placenta. The majority of pregnancies with chorioangiomas are asymptomatic. Pregnancies with large chorioangiomas are associated with maternal and fetal complications, such as growth restriction, cardiomegaly, congestive heart failure, fetal anemia, thrombocytopenia, nonimmune hydrops and intrauterine fetal death. There are several modalities of treatment published to date with various results. Our case was the third such case report published on the successful treatment with antenatal embolization of the feeding vessel of the chorioangioma. To the best of our knowledge, there have been no published cases about antenatal treatment of placental chorioangiomas in Saudi Arabia, or any other Gulf state. Case presentation We describe the case of a 28-year-old Arab woman diagnosed at 22 weeks of gestation with a chorioangioma. A glue material - enbucrilate (Histoacryl - was used for embolization of the feeding vessel. Intrauterine fetal blood transfusions were performed twice, as a treatment for fetal anemia. The fetus developed heart failure at 30 weeks of gestation. A Cesarean section was performed and the outcome was a live baby with right ventricular hypertrophy. The baby was admitted to our neonatal intensive care unit and discharged at 42 days following birth in a stable condition,with follow-up with our cardiology team. Conclusion In this case, we found that intrauterine embolization of the feeding vessel of a chorioangioma with Histoacryl was a valid treatment option that carried a small risk considering the good pregnancy outcome.

  2. National health insurance, social influence and antenatal care use in Ghana.

    Science.gov (United States)

    Owoo, Nkechi S; Lambon-Quayefio, Monica P

    2013-08-06

    The study explores the importance of social influence and the availability of health insurance on maternal care utilization in Ghana through the use of antenatal care services. A number of studies have found that access to health insurance plays a critical role in women's decision to utilize antenatal care services. However, little is known about the role that social forces play in this decision. This study uses village-level data from the 2008 Ghana Demographic and Health Survey to investigate the effects of health insurance and social influences on the intensity of antenatal care utilization by Ghanaian women. Using GIS information at the village level, we employ a spatial lag regression model in this study. Results indicate that, controlling for a host of socioeconomic and geographical factors, women who have health insurance appear to use more antenatal services than women who do not. In addition, the intensity of antenatal visits appears to be spatially correlated among the survey villages, implying that there may be some social influences that affect a woman's decision to utilize antenatal care. A reason for this may be that women who benefit from antenatal care through positive pregnancy outcomes may pass this information along to their peers who also increase their use of these services in response. Traditional/Cultural leaders as "gate-keepers" may be useful in the dissemination of maternal health care information. Public health officials may also explore the possibility of disseminating information relating to maternal care services via the mass media.

  3. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature.

    Science.gov (United States)

    Simkhada, Bibha; Teijlingen, Edwin R van; Porter, Maureen; Simkhada, Padam

    2008-02-01

    This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries. Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it. A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched. A systematic review was carried out and both quantitative and qualitative studies were included. Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women's age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them. More qualitative research is required to explore the effect of women's satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women's overall (social, political and economic) status needs to be considered.

  4. Quantum repeated games revisited

    CERN Document Server

    Frackiewicz, Piotr

    2011-01-01

    We present a scheme for playing quantum repeated 2x2 games based on the Marinatto and Weber's approach to quantum games. As a potential application, we study twice repeated Prisoner's Dilemma game. We show that results not available in classical game can be obtained when the game is played in the quantum way. Before we present our idea, we comment on the previous scheme of playing quantum repeated games.

  5. Effects of antenatal dexamethasone treatment on glucocorticoid receptor and calcyon gene expression in the prefrontal cortex of neonatal and adult common marmoset monkeys

    Directory of Open Access Journals (Sweden)

    Feldon Joram

    2010-03-01

    Full Text Available Abstract Background Synthetic glucocorticoids such as dexamethasone (DEX are commonly used to promote fetal lung maturation in at-risk preterm births, but there is emerging evidence of subsequent neurobehavioral abnormalities in these children e.g. problems with inattention/hyperactivity. However, molecular pathways mediating effects of glucocorticoid overexposure on motor and cognitive development are poorly understood. Methods In this study with common marmoset monkeys, we investigated for neonatal and adulthood effects of antenatal DEX treatment on the expression of the corticosteroid receptors and also calcyon, a risk gene for attention-deficit/hyperactivity disorder, in the prefrontal cortex (PFC. Pregnant marmosets were exposed to DEX (5 mg/kg body weight or vehicle during early (days 42-48 or late (days 90-96 stages of the 144-day pregnancy. Results In neonates, relative to controls, glucocorticoid receptor (GR mRNA levels were significantly reduced after the late DEX treatment in the medial, orbital and dorsal PFC and after the early DEX treatment in the dorsal PFC. The early DEX exposure, specifically, resulted in significant reduction in calcyon mRNA expression in the medial, orbital, dorsal and lateral PFC relative to controls. Mineralocorticoid receptor (MR mRNA levels were not significantly affected by DEX treatment. In adults, PFC GR, calcyon, and MR mRNA levels were not significantly affected by early or late prenatal DEX treatment. Conclusion These findings indicate that antenatal DEX treatment could lead to short-term alterations in PFC expression of the GR and calcyon genes, with possible neurodevelopmental functional consequences.

  6. Integrating couple relationship education in antenatal education - a study of perceived relevance among expectant Danish parents.

    Science.gov (United States)

    Axelsen, Solveig Forberg; Brixval, Carina Sjöberg; Due, Pernille; Koushede, Vibeke

    2014-12-01

    Little is known about which elements antenatal education should encompass to meet the needs of parents today. Psycho-social aspects relating to couple- and parenthood have generally not been covered in Danish antenatal education, although studies suggest that parents need this information. The aim of this study was to examine perceived relevance of couple relationship topics integrated in an antenatal programme among intervention participants in the NEWBORN trial. Our study shows that 84% of the participants found it relevant to learn about communication skills and changes in the relationship during and after pregnancy.

  7. Integrating couple relationship education in antenatal education - A study of perceived relevance among expectant Danish parents

    DEFF Research Database (Denmark)

    Axelsen, Solveig Forberg; Brixval, Carina Sjöberg; Due, Pernille;

    2014-01-01

    Little is known about which elements antenatal education should encompass to meet the needs of parents today. Psycho-social aspects relating to couple- and parenthood have generally not been covered in Danish antenatal education, although studies suggest that parents need this information. The aim...... of this study was to examine perceived relevance of couple relationship topics integrated in an antenatal programme among intervention participants in the NEWBORN trial. Our study shows that 84% of the participants found it relevant to learn about communication skills and changes in the relationship during...

  8. [Antenatal closure of ductus arteriosus following maternal intoxication by niflumic acid].

    Science.gov (United States)

    Bouissou, A; Glorieux, I; Dulac, Y; Marcoux, M O; Casper, C

    2006-01-01

    Antenatal closure of the ductus arteriosus is an uncommon event that has been considered as a risk factor for development of congestive heart failure and persistent pulmonary hypertension of the newborn. We report here on a case of antenatal ductus arteriosus closure due to niflumic acid maternal intoxication at 32 weeks of gestation. Fetal extraction was performed few days later because of echographic signs of congestive heart failure. The child survived after 3 days of severe persistent pulmonary hypertension. This case emphasizes the potential risk of niflumic acid during pregnancy and the need of antenatal echographic monitoring for optimal management.

  9. Implementation of repeat HIV testing during pregnancy in Kenya: a qualitative study.

    Science.gov (United States)

    Rogers, Anna Joy; Weke, Elly; Kwena, Zachary; Bukusi, Elizabeth A; Oyaro, Patrick; Cohen, Craig R; Turan, Janet M

    2016-07-11

    Repeat HIV testing in late pregnancy has the potential to decrease rates of mother-to-child transmission of HIV by identifying mothers who seroconvert after having tested negative for HIV in early pregnancy. Despite being national policy in Kenya, the available data suggest that implementation rates are low. We conducted 20 in-depth semi-structured interviews with healthcare providers and managers to explore barriers and enablers to implementation of repeat HIV testing guidelines for pregnant women. Participants were from the Nyanza region of Kenya and were purposively selected to provide variation in socio-demographics and job characteristics. Interview transcripts were coded and analyzed in Dedoose software using a thematic analysis approach. Four themes were identified a priori using Ferlie and Shortell's Framework for Change and additional themes were allowed to emerge from the data. Participants identified barriers and enablers at the client, provider, facility, and health system levels. Key barriers at the client level from the perspective of providers included late initial presentation to antenatal care and low proportions of women completing the recommended four antenatal visits. Barriers to offering repeat HIV testing for providers included heavy workloads, time limitations, and failing to remember to check for retest eligibility. At the facility level, inconsistent volume of clients and lack of space required for confidential HIV retesting were cited as barriers. Finally, at the health system level, there were challenges relating to the HIV test kit supply chain and the design of nationally standardized antenatal patient registers. Enablers to improving the implementation of repeat HIV testing included client dissemination of the benefits of antenatal care through word-of-mouth, provider cooperation and task shifting, and it was suggested that use of an electronic health record system could provide automatic reminders for retest eligibility. This study

  10. In vitro effects of crude extracts of Parkia biglobosa (Mimosaceae), Stereospermum kunthianum (Bignoniaceae) and Biophytum petersianum (Oxalidaceae) on corticosteroid secretion in rat.

    Science.gov (United States)

    Kodjo, K M; Contesse, V; Do Rego, J L; Aklikokou, K; Titrikou, S; Gbeassor, M; Vaudry, H

    2006-08-01

    Previous studies conducted in guinea pig, rat and rabbit have revealed that crude extracts from Parkia biglobosa, Stereospermum kunthianum and Biophytum petersianum exert hypotensive and/or hypoglycemic activities. Since corticosteroids are involved in the control of arterial blood pressure and glycemia, we have investigated the possible effects of these plant extracts on rat adrenal tissue in vitro. Short-term administration of crude semi-ethanolic extracts of P. biglobosa and S. kunthianum to perifused rat adrenal tissue did not induce any significant changes in corticosteroid output. Conversely, the B. petersianum extract caused a dose-dependent increase in corticosterone and aldosterone secretion. Repeated infusions or prolonged administration of B. petersianum extract did not produce any apparent attenuation of the steroid response. Altogether, these data indicate that a semi-ethanolic extract of B. petersianum dose-dependently stimulates corticosterone and aldosterone secretion in rat without any desensitization phenomenon.

  11. Reduced mandibular growth in experimental arthritis in the temporomandibular joint treated with intra-articular corticosteroid.

    Science.gov (United States)

    Stoustrup, Peter; Kristensen, Kasper D; Küseler, Annelise; Gelineck, John; Cattaneo, Paolo M; Pedersen, Thomas K; Herlin, Troels

    2008-04-01

    The aim of this investigation was to study the effect of intra-articular (i.a.) corticosteroid injections (IACIs) in the temporomandibular joint (TMJ) on mandibular development in antigen-induced TMJ arthritis. Ten-week-old female New Zealand white rabbits (n = 42) were randomly divided into four groups: group A, control (no injections); group B, placebo (repeated i.a. TMJ saline injections); group C, untreated arthritis (repeated induction of TMJ arthritis); and group D, steroid (repeated induction of TMJ arthritis + IACI). All animals had two tantalum implants inserted in the right side of the mandible serving as stable landmarks for later growth analysis. One implant was inserted close to the symphysis and one in the molar region. Computerized tomographic (CT) full-head scans were carried out at 14 (T1) and 26 (T2) weeks of age. (Dropout of animals at T2; group C, n = 7, and group D, n = 3.) Absolute and relative intra- and inter-group growth variations were evaluated during the growth period by comparison of CT scans. One-way analysis of variance was used for T1 statistical analysis, and absolute intra-group and relative inter-group growth differences between T1 and T2 were evaluated by Student's t-tests. At T2, the animals in the group A had greater sagittal and vertical mandibular growth compared with the other three groups. TMJ arthritis caused diminished mandibular growth. However, relative mandibular growth was significantly less in group D. The findings of this study do not indicate a positive long-term effect in the use of IACI in the TMJ as an early treatment intervention against TMJ inflammation in growing individuals.

  12. Single-Center Retrospective Evaluation of Inhaled Corticosteroid Use for Chronic Obstructive Pulmonary Disease Exacerbation Patients Receiving Systemic Corticosteroids.

    Science.gov (United States)

    Steuber, Taylor; Shiltz, Dane

    2016-11-01

    Purpose: To determine the frequency of inappropriate inhaled corticosteroid (ICS) therapy when it is prescribed concurrently with systemic corticosteroids; to identify cost-savings potential in the setting of chronic obstructive pulmonary disease (COPD) exacerbations. Methods: Patients admitted to 1 of 8 hospital locations utilizing an integrated electronic health record within the health system for COPD exacerbations treated with systemic corticosteroids (equivalent to at least 30 mg of oral prednisone) between July 1, 2013 and June 30, 2014 were included in a retrospective chart review. Endpoints assessed included number of ICS, with or without long-acting beta-2 agonists (LABA), respiratory medications potentially wasted due to overlap therapy with systemic corticosteroids, as well as overall cost attributed to drug product, administration products, and respiratory therapy labor cost from potentially inappropriate overlap therapy. Results were extrapolated based on the number of admissions within the specified time period. Length of stay data were also compared between the 2 groups (overlap therapy vs no overlap therapy) to determine whether overlap therapy results in a reduction of hospital stay. Results: A total of 10,710 admissions were identified and 74 charts were randomly identified for review. Forty-six (62%) patients received at least one dose of overlapping ICS or ICS/LABA. One hundred forty-two nebulized budesonide vials were wasted along with 43 ICS or ICS/LABA inhalers. A total cost of $8,152.75 was attributed to drug product, administration products, and labor cost. Extrapolating to the 10,710 admissions identified, there would potentially be 20,551 wasted budesonide vials and 6,223 wasted ICS or ICS/LABA inhalers, resulting in an estimated annual cost savings of $1,180,090.03 for the health system. Additionally, length of stay was shorter in the group not receiving overlap therapy compared to the group receiving overlap therapy, but it was not

  13. Antenatal glucocorticoids attenuate activation of the inflammatory reaction and clotting in preterm lambs

    NARCIS (Netherlands)

    Jaarsma, AS; Geven, WB; van Oeveren, W; Bambang-Oetomo, S

    2004-01-01

    Recently we have shown that activation of inflammatory reaction and clotting can be found immediately after delivery in preterm lambs ventilated for respiratory distress syndrome (RDS). To investigate whether antenatal glucocorticoids would attenuate postnatal activation of the inflammatory reaction

  14. Does female education explain the disparity in the use of antenatal ...

    African Journals Online (AJOL)

    Background: Nigeria is among the countries with a high number of annual ... Results: Education is statistically associated with the number of antenatal ..... morbidity, mortality and disability to be highest among ..... Gender disparity in enrol-.

  15. Use of Inhaled and Oral Corticosteroids in Pregnancy and the Risk of Malformations or Miscarriage

    DEFF Research Database (Denmark)

    Bjørn, Anne-Mette Bay; Ehrenstein, Vera; Nohr, Ellen Aagaard

    2014-01-01

    Corticosteroids are potent anti-inflammatory and immunosuppressive drugs, which sometimes must be given to pregnant women. Corticosteroids have been suspected to be teratogenic for many years; however, there is conflicting evidence regarding the association. Based on a literature review of three...... databases, this MiniReview provides an overview of inhaled and oral corticosteroid use in pregnancy with specific emphasis on the association between use of corticosteroids during pregnancy and risk of miscarriage and congenital malformations in offspring. Use of corticosteroids among pregnant women ranged...... from 0.2% to 10% and increased nearly two-fold in recent years. Taken together, the evidence suggests that use of corticosteroids in early pregnancy is not associated with an increased risk of congenital malformations overall or oral clefts in offspring; at the same time, published estimates...

  16. Enhancing focused antenatal care in Ghana: An exploration into perceptions of practicing midwives

    OpenAIRE

    A. Baffour-Awuah; P.P. Mwini-Nyaledzigbor; Richter, S.

    2015-01-01

    Objective: The specific objectives of this study were to explore the perceptions of midwives on focused antenatal care at a large urban hospital in Tema, Ghana. Methodology: An interpretive descriptive design was used to explore, interpret and describe the perceptions of midwives in the provision of focused antenatal services to pregnant women. Purposive sampling techniques were used to recruit participants (midwives). Data were collected by conducting individual semi-structured interviews...

  17. Whose Knowledge Counts? : A Study of Providers and Users of Antenatal Care in Rural Zimbabwe

    OpenAIRE

    2005-01-01

    This thesis presents perspectives and experiences of different stakeholders and their ways of reasoning around pregnancy and pregnancy care. Data were generated from individual interviews with 25 health care providers, 18 women and 6 traditional birth attendants (TBAs) as well as 11 focus groups discussions with women, men and TBAs. The challenges experienced by health care providers in their provision of antenatal care, while attempting to change antenatal care through routines proven to ha...

  18. Childbirth information feeds for first time Malawian mothers who attended antenatal clinics

    OpenAIRE

    Malata, Address; Chirwa, Ellen

    2011-01-01

    Childbirth information received by mothers during antenatal period influences their satisfaction with the care during perinatal period. It is important for the midwives to know the type of information that satisfies their clients. This study found that the childbirth information that mothers received during antenatal period did not satisfy them. On the other hand, although some of the information received at home was useful, some information had potential to cause fear, anxiety and ill health...

  19. Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial)

    OpenAIRE

    Stutchfield, Peter Roy; Whitaker, Rhiannon; Gliddon, Angela E; Hobson, Lucie; Kotecha, Sailesh; Doull, Iolo J M

    2013-01-01

    Objectives To determine whether antenatal betamethasone prior to elective term caesarean section (CS) affects long term behavioural, cognitive or developmental outcome, and whether the risk of asthma or atopic disease is reduced. Design A questionnaire based follow-up of a multicentre randomised controlled trial (Antenatal Steroids for Term Elective Caesarean Section, BMJ 2005). Setting Four UK study centres from the original trial. Participants 862 participants from the four largest recruiti...

  20. An instrument for broadened risk assessment in antenatal health care including non-medical issues

    OpenAIRE

    Amber Amanda Vos; Mieke J van Veen; Erwin Birnie; Semiha Denktas; Eric AP Steegers; Bonsel, Gouke J

    2015-01-01

    Introduction: Growing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed a non-invasive, standardized instrument for comprehensive antenatal risk assessment. The current study presents the application-oriented development of a risk screening instrument for early antenata...

  1. Maternal Antenatal Bereavement and Neural Tube Defect in Live-Born Offspring

    DEFF Research Database (Denmark)

    Ingstrup, Katja Glejsted; Wu, Chun Sen; Olsen, Jørn

    2016-01-01

    BACKGROUND: Maternal emotional stress during pregnancy has previously been associated with congenital neural malformations, but most studies are based on data collected retrospectively. The objective of our study was to investigate associations between antenatal maternal bereavement due to death...... was seen (OR = 0.84; 95% confidence interval: 0.52-1.33). CONCLUSION: Overall maternal bereavement in the antenatal period was not related to NTDs in liveborn offspring....

  2. Selective imaging modalities after first pyelonephritis failed to identify significant urological anomalies, despite normal antenatal ultrasounds

    DEFF Research Database (Denmark)

    Mola, Gylli; Wenger, Therese Ramstad; Salomonsson, Petra

    2017-01-01

    AIM: We investigated the consequences of applying different imaging guidelines for urological anomalies after first pyelonephritis in children with normal routine antenatal ultrasounds. METHODS: The cohort comprised 472 children treated for their first culture-positive pyelonephritis...... identified all patients initially treated with surgery and avoided 65 scintigraphies. CONCLUSION: Dilated VUR was the dominant anomaly in a cohort with first time pyelonephritis and normal antenatal ultrasound. The optimal imaging strategy after pyelonephritis must be identified....

  3. Community outreach midwifery-led model improves antenatal access in a disadvantaged population.

    Science.gov (United States)

    Reeve, Carole; Banfield, Sally; Thomas, Amanda; Reeve, David; Davis, Stephanie

    2016-06-01

    This study aimed to assess the impact of a new model of antenatal care for women living in a very remote area. This is a retrospective 2-year evaluation of antenatal care. Two hundred thirteen pregnant women in Aboriginal communities in the Fitzroy Valley of Western Australia participated in this study. The implementation of a midwifery-led interdisciplinary model of antenatal outreach care. The indicators measured were numbers of antenatal visits, their location and quality care indicators (presentation in first trimester, alcohol and smoking, ultrasound and blood-borne virus screening) and outcome indicators (birth weight, prematurity, in utero deaths and mode of delivery). There was an increase in access to antenatal care and improvements in quality-of-care indicators. The proportion of visits provided in local Aboriginal communities increased from 10% to 24%. There were statistically significant increases in women presenting in the first trimester (40-58%), screening for alcohol and smoking (48-93%) and having an ultrasound in pregnancy (59-94%). There were no significant improvements in neonatal outcome indicators. There is a large disparity in maternal and child health outcomes between Aboriginal and Torres Strait Islander (Indigenous) and non-Indigenous Australians thought to be due to decreased access to antenatal care, poorer socioeconomic status and the associated risk factors. The change in model of care resulted in earlier presentation for antenatal care, increased numbers of antenatal visits and increased screening for risk factors. Regular auditing of services enables the identification of opportunity for improvement with the goal of improving health outcomes. © 2015 National Rural Health Alliance Inc.

  4. Do assisted-reproduction twin pregnancies require additional antenatal care?

    Science.gov (United States)

    Jauniaux, E; Ben-Ami, I; Maymon, R

    2013-02-01

    obviously at higher risk of perinatal complications than singletons due to a natural increase in the incidence of fetal anomalies, antenatal disorders and obstetric and neonatal complications associated with the development of two fetuses instead of one. Overall, our review indicates that some antenatal complications are more frequent in assisted-conception twin pregnancies than in spontaneous twin pregnancies but their prevalence is low and thus their impact on the morbidity and mortality of an individual assisted-conception twin pregnancy is limited. Assisted reproduction treatment has become available to older women with pre-existing maternal medical conditions such as chronic hypertension and diabetes. The increased obstetrical risks in this population must be considered prior to attempts at assisted conception, and the transfer of more than one embryo should be avoided in women with a pre-existing maternal medical condition.

  5. Benign fasciculations and Corticosteroid use: possible association? An update

    Directory of Open Access Journals (Sweden)

    Marco Orsini

    2011-09-01

    Full Text Available Fasciculations are characterized by visible subtle and fast contractions of muscle, even wormlike in movement, by the contraction of a fascicle of muscle fibers. The authors present the case study of a 28-year-old patient with the appearance of migratory and diffuse fasciculations with an onset after partial tapering off of oral corticosteroides (60 mg total dose indicated for treatment of Minimal change Glomerulopathy. Clinical Neurological physical exam allied with an ENMG, besides other complementary laboratory exams were used for screening the above-mentioned patient. Afterwards, current research relating to the topic at hand was made in order to update the data available in the Bireme, Scielo and PubMed Data Banks using the following key words: Fasciculation’s, motor neuron disease, and benign fasciculations in the Portuguese, English as well as Spanish language. Although fasciculation’s are most commonly associated with Motor neuron disease as well as with certain metabolic disorders, they may also be present in individuals with absolutely no underlying pathological disorders. In our case, fasciculation potentials that have been present for six months, with no other signs of a neurogenic disorder as well as absence of laboratory findings, the patient received a diagnosis of Benign Fasciculation Syndrome (BFS.We believe that the use of corticosteroides in high doses with subsequent tapering contributed to the fasciculation’s, especially due to the changes that this causes on the ionic channels. Fasciculation’s are symptoms seen in a large range of conditions, and also being the main symptom of the so-called Benign Fasciculation Syndrome. We have presented an example of this clinical syndrome in a patient whose complaint was fasciculation’s, with complete clinical remission of symptoms following complete tapering off of corticosteroid six months previously.

  6. Taenia solium tapeworms synthesize corticosteroids and sex steroids in vitro.

    Science.gov (United States)

    Valdez, R A; Jiménez, P; Fernández Presas, A M; Aguilar, L; Willms, K; Romano, M C

    2014-09-01

    Cysticercosis is a disease caused by the larval stage of Taenia solium cestodes that belongs to the family Taeniidae that affects a number of hosts including humans. Taeniids tapeworms are hermaphroditic organisms that have reproductive units called proglottids that gradually mature to develop testis and ovaries. Cysticerci, the larval stage of these parasites synthesize steroids. To our knowledge there is no information about the capacity of T. solium tapeworms to metabolize progesterone or other precursors to steroid hormones. Therefore, the aim of this paper was to investigate if T. solium tapeworms were able to transform steroid precursors to corticosteroids and sex steroids. T. solium tapeworms were recovered from the intestine of golden hamsters that had been orally infected with cysticerci. The worms were cultured in the presence of tritiated progesterone or androstenedione. At the end of the experiments the culture media were analyzed by thin layer chromatography. The experiments described here showed that small amounts of testosterone were synthesized from (3)H-progesterone by complete or segmented tapeworms whereas the incubation of segmented tapeworms with (3)H-androstenedione, instead of (3)H-progesterone, improved their capacity to synthesize testosterone. In addition, the incubation of the parasites with (3)H-progesterone yielded corticosteroids, mainly deoxicorticosterone (DOC) and 11-deoxicortisol. In summary, the results described here, demonstrate that T. solium tapeworms synthesize corticosteroid and sex steroid like metabolites. The capacity of T. solium tapeworms to synthesize steroid hormones may contribute to the physiological functions of the parasite and also to their interaction with the host.

  7. Reconfigurable multiport EPON repeater

    Science.gov (United States)

    Oishi, Masayuki; Inohara, Ryo; Agata, Akira; Horiuchi, Yukio

    2009-11-01

    An extended reach EPON repeater is one of the solutions to effectively expand FTTH service areas. In this paper, we propose a reconfigurable multi-port EPON repeater for effective accommodation of multiple ODNs with a single OLT line card. The proposed repeater, which has multi-ports in both OLT and ODN sides, consists of TRs, BTRs with the CDR function and a reconfigurable electrical matrix switch, can accommodate multiple ODNs to a single OLT line card by controlling the connection of the matrix switch. Although conventional EPON repeaters require full OLT line cards to accommodate subscribers from the initial installation stage, the proposed repeater can dramatically reduce the number of required line cards especially when the number of subscribers is less than a half of the maximum registerable users per OLT. Numerical calculation results show that the extended reach EPON system with the proposed EPON repeater can save 17.5% of the initial installation cost compared with a conventional repeater, and can be less expensive than conventional systems up to the maximum subscribers especially when the percentage of ODNs in lightly-populated areas is higher.

  8. Revisiting the TALE repeat.

    Science.gov (United States)

    Deng, Dong; Yan, Chuangye; Wu, Jianping; Pan, Xiaojing; Yan, Nieng

    2014-04-01

    Transcription activator-like (TAL) effectors specifically bind to double stranded (ds) DNA through a central domain of tandem repeats. Each TAL effector (TALE) repeat comprises 33-35 amino acids and recognizes one specific DNA base through a highly variable residue at a fixed position in the repeat. Structural studies have revealed the molecular basis of DNA recognition by TALE repeats. Examination of the overall structure reveals that the basic building block of TALE protein, namely a helical hairpin, is one-helix shifted from the previously defined TALE motif. Here we wish to suggest a structure-based re-demarcation of the TALE repeat which starts with the residues that bind to the DNA backbone phosphate and concludes with the base-recognition hyper-variable residue. This new numbering system is consistent with the α-solenoid superfamily to which TALE belongs, and reflects the structural integrity of TAL effectors. In addition, it confers integral number of TALE repeats that matches the number of bound DNA bases. We then present fifteen crystal structures of engineered dHax3 variants in complex with target DNA molecules, which elucidate the structural basis for the recognition of bases adenine (A) and guanine (G) by reported or uncharacterized TALE codes. Finally, we analyzed the sequence-structure correlation of the amino acid residues within a TALE repeat. The structural analyses reported here may advance the mechanistic understanding of TALE proteins and facilitate the design of TALEN with improved affinity and specificity.

  9. Knowledge, Perception, and Attitude of Pregnant Women Towards the Role of Physical Therapy in Antenatal Care - A Cross Sectional Study

    Directory of Open Access Journals (Sweden)

    Nayak R

    2016-01-01

    Full Text Available Background: Physiotherapy plays an essential role in obstetrics, both in the antenatal and postnatal periods. Antenatal exercises are recommended for the health benefits and safe delivery that they secure of pregnant mothers. However, studies on the efficacy of this approach in developing countries like India are limited in literature.The objective of this study was to determine knowledge, perception, and attitude of pregnant women towards the role of physical therapy in antenatal care. Methods: A descriptive survey research design was used for this cross-sectional study. A total of 106 pregnant women attending regular antenatal checkups in tertiary care centers in Mangalore, Karnataka, India were recruited. Data were obtained on maternal characteristics, knowledge, perception, and attitude towards the role of physiotherapy in antenatal care. Results: 46% of subjects knew about antenatal exercises. The majority of them were not aware or not sure about the different type of antenatal exercises avaliable.60% of the respondents had a positive attitude to physiotherapy during antenatal care. However, only 30% of the participants had adequate knowledge of the benefits of antenatal exercise and this was not influenced by maternal sociodemographic characteristics. Conclusion: A majority of Indian pregnant women demonstrate inadequate knowledge but have positive attitude towards role of physiotherapy in antenatal care.

  10. Socio Demographic Factors Determining the Adequacy of Antenatal Care among Pregnant Women Visiting Ekiti State Primary Health Centers

    Directory of Open Access Journals (Sweden)

    Ikeoluwapo O. Ajayi

    2013-08-01

    Full Text Available A cross sectional study was conducted in Primary Health Centers among pregnant women to elucidate adequacy of antenatal care across different socio demographic variables. Four hundred respondents were proportionately selected from 18 primary health centers using simple random sampling. Exit interviews were conducted using the adapted antenatal care exit interview form of the Safe Motherhood Needs Assessment package. Data was analyzed using descriptive statistics and Chi square test. Adequacy of antenatal care in this study was measured by the single adequacy indicators which are duration of pregnancy at entry into antenatal care and number of antenatal visits; which are particularly suitable for developing countries. Age of respondents, means of transportation to the PHCs, occupation, location and level of education of the respondents were found to be determinants of whether the pregnant women attended their first antenatal visit in the first trimester, similarly, age of the respondents was a predictor of whether the women made up to four antenatal visits by their third trimester. Occupation and level of education were determinants of whether or not the pregnant women made their first antenatal visits at the first trimester. More respondents who were not working and those who were unskilled workers made their first antenatal visit at the first trimester compared to those who were skilled workers; work place policies and the fact that antenatal booking are made on weekdays and at work hours may hinder or be discouraging to the working class mothers.

  11. Subconjunctival mycetoma after sub-Tenon's corticosteroid injection.

    Science.gov (United States)

    Galor, Anat; Karp, Carol L; Forster, Richard K; Dubovy, Sander R; Gaunt, Morgan L; Miller, Darlene

    2009-09-01

    To describe a case of a subconjunctival mycetoma that developed after a patient received a sub-Tenon's injection of triamcinolone acetonide. Case report. A 76-year-old white male presented with a subconjunctival mass in the area of a previous posterior sub-Tenon's corticosteroid injection for wet age-related macular degeneration. Microbiologic and pathologic analysis of the mass revealed the causative organism to be the pigmented fungus Exophiala jeanselmei. This is the first published case of an Exophiala-associated subconjunctival mycetoma.

  12. Corticosteroids increase superoxide anion production by rat liver microsomes.

    Science.gov (United States)

    Nelson, D H; Ruhmann-Wennhold, A

    1975-01-01

    Superoxide anion production by liver microsomes from intact, adrenalectomized, and cortisoltreated adrenalectomized rats has been determined. The amount formed was roughly proportionate to the amount of cortisol given, and a similar response was seen in the activity of NADPH-cytochrome c reductase. The amount of measurable superoxide anion was markedly reduced by the addition of superoxide dismutase. The increased production of this potent free radical with cortisol therapy suggests that its formation may contribute to some of the harmful effects of corticosteroids given in more than physiologic amounts. PMID:239969

  13. Experimental corticosteroid induction of Pneumocystis carinii pneumonia in piglets

    DEFF Research Database (Denmark)

    Nielsen, Jens; Bille-Hansen, Vivi; Settnes, O.P.

    1999-01-01

    Animal models of Pneumocystis carinii (Pc) pneumonia (PCP) play a central role in research on the Pc microorganism itself and the disease, especially the pathogenesis and the host defence. The classic rat model with corticosteroid-induced reactivation of a latent infection has been most widely used...... of the frontal lung lobes and/or atelectatic looking diaphragmatic lobes. Histopathologically, there was a focal interstitial pneumonia. Alveolar walls and interstitia had mononuclear cell infiltrations and the alveolar lumina were occluded by foamy acidophilic honeycomb material with a varying number of Pc...

  14. Corticosteroids for renal scar prevention in children with acute pyelonephritis.

    Science.gov (United States)

    Sakulchit, Teeranai; Goldman, Ran D

    2017-04-01

    Question Acute pyelonephritis in children is of great concern and I usually refer these patients to a pediatrician or send them to the emergency department owing to the risk of renal scarring. Are steroids an acceptable treatment to reduce risk of scarring? Answer Several agents have been studied in an effort to prevent renal scar formation following acute pyelonephritis in children. Use of corticosteroids, in conjunction with standard therapy for acute pyelonephritis, shows promising findings. However, evidence is very limited and steroids should not be offered on a regular basis as part of treatment. Copyright© the College of Family Physicians of Canada.

  15. Action mechanism of corticosteroids to aggravate Guillain-Barré syndrome

    OpenAIRE

    2015-01-01

    Corticosteroids have been proved to be ineffective for Guillain-Barré syndrome, but the mechanism remains unknown. In a rabbit model of axonal Guillain-Barré syndrome, treatment with corticosteroids significantly reduced macrophage infiltration in the spinal ventral roots and the survival rate as well as clinical improvement. On 30th day after onset, there was significantly higher frequency of axonal degeneration in the corticosteroids-treated rabbits than saline-treated rabbits. Corticostero...

  16. A severe case of acute exogenous lipoid pneumonia treated with systemic corticosteroid

    OpenAIRE

    Hideki Yasui; Koshi Yokomura; Takafumi Suda

    2016-01-01

    Acute exogenous lipoid pneumonia is a rare disorder in adults. A treatment of choice for lipoid pneumonia has not been established, and systemic corticosteroid use remains controversial. We report the case of a 32-year-old man with schizophrenia who presented with kerosene-induced acute exogenous lipoid pneumonia that was treated with a systemic corticosteroid. In this case, supportive therapy did not improve the patient's condition, so systemic corticosteroid therapy was commenced four days ...

  17. Osteonecrosis in a Patient with Crohn's Disease Unrelated to Corticosteroid Use

    Directory of Open Access Journals (Sweden)

    Ali Khan

    2001-01-01

    Full Text Available Osteonecrosis is a feared complication of corticosteroid use. However, a direct association between corticosteroid use and osteonecrosis has never been proven. The present report examines the case of a patient with longstanding Crohn's disease who had never been treated with corticosteroids and who developed osteonecrosis of the talus. The association of systemic inflammatory disorders with osteonecrosis and the possible association with vascular thrombosis are discussed.

  18. Should all adjunctive corticosteroid therapy be avoided in the management of hemodynamically stabile Staphylococcus aureus bacteremia?

    Science.gov (United States)

    Forsblom, E; Nurmi, A-M; Ruotsalainen, E; Järvinen, A

    2016-03-01

    The purpose of this study was to examine the prognostic impact of corticosteroids in hemodynamically stabile Staphylococcus aureus bacteremia (SAB). There were 361 hemodynamically stabile methicillin-sensitive SAB patients with prospective follow-up and grouping according to time-point, dose and indication for corticosteroid therapy. To enable analyses without external interfering corticosteroid therapy all patients with corticosteroid therapy equivalent to prednisone >10 mg/day for ≥1 month prior to positive blood culture results were excluded. Twenty-five percent (92) of patients received corticosteroid therapy of which 11 % (40) had therapy initiated within 1 week (early initiation) and 9 % (31) had therapy initiated 2-4 weeks after (delayed initiation) positive blood culture. Twenty-one patients (6 %) had corticosteroid initiated after 4 weeks and were not included in the analyses. A total of 55 % (51/92) received a weekly prednisone dose >100 mg. Patients with early initiated corticosteroid therapy had higher mortality compared to patients treated without corticosteroid therapy at 28 days (20 % vs. 7 %) (OR, 3.11; 95%CI, 1.27-7.65; p corticosteroid therapy predicted 28-day (HR, 3.75; 95%CI, 1.60-8.79; p = 0.002) and 90-day (HR, 3.10; 95%CI, 1.50-6.39; p = 0.002) mortality in Cox proportional hazards regression analysis. When including only patients receiving early initiated corticosteroid therapy with prednisone ≥100 mg/week the negative prognostic impact on 28-day mortality was accentuated (HR 4.8, p = 0.001). Corticosteroid therapy initiation after 1 week of positive blood cultures had no independent prognostic impact. Early initiation of corticosteroid therapy may be associate to increased mortality in hemodynamically stabile SAB.

  19. Antenatal care attendance, a surrogate for pregnancy outcome? The case of Kumasi, Ghana.

    Science.gov (United States)

    Asundep, Ntui N; Jolly, Pauline E; Carson, April; Turpin, Cornelius A; Zhang, Kui; Tameru, Berhanu

    2014-07-01

    Antenatal care (ANC) has been shown to influence infant and maternal outcomes. WHO recommends 4 ANC visits for uncomplicated pregnancies. However, pregnant women in Ghana are required to attend 8-13 antenatal visits. We investigated the association of ANC attendance with adverse pregnancy outcomes (defined as low infant birth weight, stillbirth, preterm delivery or small for gestational age). A quantitative cross-sectional study was conducted on 629 women, age 19-48 years who presented for delivery at two selected public hospitals and 16 traditional birth attendants from July to November 2011. Socio-demographic and antenatal information were collected using a structured questionnaire. ANC attendance, medical and obstetric/gynecological history were abstracted from maternal antenatal records. Data were analyzed using Chi square and logistic regression. Twenty-two percent of the women experienced an adverse outcome. Eleven percent of the women attended 5 children) was also associated with adverse birth outcomes. Women screened for syphilis or use of insecticide-treated bed nets had a 40 and 36% (p = 0.0447 and p = 0.0293) reduced likelihood of experiencing an adverse pregnancy outcome respectively. After adjusting for confounders, attending <4 antenatal visits was associated with adverse pregnancy outcome compared with ≥4 ANC visits (Adjusted OR 2.55; 95% CI 1.16-5.63; p = 0.0202). Attending <4 antenatal visits and high parity were associated with adverse pregnancy outcomes for uncomplicated pregnancies.

  20. Utility of immunochromatographic assay as a rapid point of care test for screening of antenatal syphilis

    Directory of Open Access Journals (Sweden)

    Bineeta Kashyap

    2015-01-01

    Full Text Available Background and Objectives: Syphilis is one of the most common preventable causes of adverse effects during pregnancy. Antenatal screening prevents the delay between diagnosis and treatment there by reducing the risk of congenital syphilis. The objective of this study was to evaluate the utility of an immunochromatographic assay as a point of care test for antenatal screening of syphilis. Materials and Methods: Sera of 200 antenatal mothers were evaluated for serodiagnosis of syphilis by the venereal disease research laboratory (VDRL, Treponema pallidum hemagglutination assay (TPHA and SD BIOLINE Syphilis 3.0 test. The performance of SD BIOLINE Syphilis 3.0 test was compared with VDRL as screening assay and TPHA as a confirmatory test. Results: The antenatal prevalence of syphilis was found to be 2% by both VDRL and TPHA. The sensitivity, specificity, positive predictive value, and the negative predictive value of SD BIOLINE Syphilis 3.0 test were 75%, 100%, 100%, and 99.45%, respectively. Conclusions: Antenatal screening and treatment of maternal syphilis are cost-effective health interventions even under the low prevalence of infection. SD BIOLINE Syphilis 3.0 test, although having less sensitivity than the existing testing strategy, can have a tremendous impact on the disease burden if used prudently for the screening of antenatal mothers in peripheral health settings.

  1. Effects of Antenatal Maternal Depression and Anxiety on Children's Early Cognitive Development: A Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Gladys Ibanez

    Full Text Available Studies have shown that depression or anxiety occur in 10-20% of pregnant women. These disorders are often undertreated and may affect mothers and children's health. This study investigates the relation between antenatal maternal depression, anxiety and children's early cognitive development among 1380 two-year-old children and 1227 three-year-old children.In the French EDEN Mother-Child Cohort Study, language ability was assessed with the Communicative Development Inventory at 2 years of age and overall development with the Ages and Stages Questionnaire at 3 years of age. Multiple regressions and structural equation modeling were used to examine links between depression, anxiety during pregnancy and child cognitive development.We found strong significant associations between maternal antenatal anxiety and poorer children's cognitive development at 2 and 3 years. Antenatal maternal depression was not associated with child development, except when antenatal maternal anxiety was also present. Both postnatal maternal depression and parental stimulation appeared to play mediating roles in the relation between antenatal maternal anxiety and children's cognitive development. At 3 years, parental stimulation mediated 13.2% of the effect of antenatal maternal anxiety while postnatal maternal depression mediated 26.5%.The partial nature of these effects suggests that other mediators may play a role. Implications for theory and research on child development are discussed.

  2. Use of antenatal services and delivery care in Entebbe, Uganda: a community survey

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    Muwanga Moses

    2007-10-01

    Full Text Available Abstract Background Disparities in perinatal health care occur worldwide. If the UN Millennium Development Goals in maternal and child health are to be met, this needs to be addressed. This study was conducted to facilitate our understanding of the changing use of maternity care services in a semi-urban community in Entebbe Uganda and to examine the range of antenatal and delivery services received in health care facilities and at home. Methods We conducted a retrospective community survey among women using structured questionnaires to describe the use of antenatal services and delivery care. Results In total 413 women reported on their most recent pregnancy. Antenatal care attendance was high with 96% attending once, and 69% the recommended four times. Blood pressure monitoring (95% and tetanus vaccination (91% were the services most frequently reported and HIV testing (47%, haematinics (58% and presumptive treatment for malaria (66% least frequently. Hospital clinics significantly outperformed public clinics in the quality of antenatal service. A significant improvement in the reported quality of antenatal services received was observed by year (p Conclusion Although antenatal services were well utilised, the quality of services varied. Women were able and willing to travel to a facility providing a good service. Access to essential skilled birth attendants remains difficult especially for less educated, poorer women, commonly mediated by financial and transport difficulties and several simple post delivery practices were commonly neglected. These factors need to be addressed to ensure that high quality care reaches the most vulnerable women and infants.

  3. Social capital and antenatal depression among Chinese primiparas: A cross-sectional survey.

    Science.gov (United States)

    Zhou, Chi; Ogihara, Atsushi; Chen, Hao; Wang, Weijue; Huang, Liu; Zhang, Baodan; Zhang, Xueni; Xu, Liangwen; Yang, Lei

    2017-08-24

    The aim of this study is to investigate the associations between social capital and antenatal depression among Chinese primiparas. A cross-sectional design was used and a questionnaire survey was conducted with 1471 participants using the intercept method at the provincial hospital in Zhejiang in 2016. Antenatal depression was evaluated using the Edinburgh Postnatal Depression Scale (EPDS) and social capital was assessed by the Chinese version of Social Capital Assessment Questionnaire (C-SCAQ). The prevalence of antenatal depression was assessed among Chinese primiparas in their third trimesters. The antenatal depression prevalence among sub-groups with lower social trust (ST), social reciprocity (SR), social network (SN), and social participation (SP) were significantly higher than those among higher score sub-groups. In the fully adjusted model, primiparas' antenatal depression was significantly associated with ST, SR, SN, and SP. Compared to the structural social capital, the cognitive social capital was a more crucial dimension to the prevalence of antenatal depression. For future community pregnancy health care management programs in China, it might be beneficial to add more social capital related intervention. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Antenatal Microbiome: Potential Contributor to Fetal Programming and Establishment of the Microbiome in Offspring.

    Science.gov (United States)

    Wright, Michelle L; Starkweather, Angela R

    2015-01-01

    Endogenous and exogenous exposures during fetal development have potential to impact birth and health outcomes of offspring. Accumulating evidence suggests exposures may alter the antenatal microbiome and subsequently alter the microbiome and health of offspring. The purpose of this integrative review is to summarize and critically evaluate the current state of knowledge regarding the assessment of the antenatal microbiome on the health of human offspring. The article provides a brief summary of the known factors affecting the human microbiome and studies that assessed relationships between the antenatal microbiome and health outcomes of the offspring. An integrative review was conducted to examine human research studies that focused on the antenatal microbiome and the health of the offspring using the electronic databases PubMed/MEDLINE and CINAHL from 2004 to the present. In addition to the known individual factors that are associated with establishment of the microbiome, the results of the integrative review suggest that medications (including antibiotics) and comorbidities (including infectious diseases, diet, socioeconomic status, and exposure to pollutants) should also be measured. The composition of the antenatal microbiome at various time points and body sites may be important mediators of short- and long-term health outcomes in offspring. In order to advance our understanding of the role of the antenatal microbiome on health and disease risk of the offspring, it will be important to further elucidate the composition of a healthy microbiome and specific mechanisms that contribute to altered health in later life.

  5. Utility of immunochromatographic assay as a rapid point of care test for screening of antenatal syphilis.

    Science.gov (United States)

    Kashyap, Bineeta; Sagar, Tanu; Kaur, Iqbal R

    2015-01-01

    Syphilis is one of the most common preventable causes of adverse effects during pregnancy. Antenatal screening prevents the delay between diagnosis and treatment there by reducing the risk of congenital syphilis. The objective of this study was to evaluate the utility of an immunochromatographic assay as a point of care test for antenatal screening of syphilis. Sera of 200 antenatal mothers were evaluated for serodiagnosis of syphilis by the venereal disease research laboratory (VDRL), Treponema pallidum hemagglutination assay (TPHA) and SD BIOLINE Syphilis 3.0 test. The performance of SD BIOLINE Syphilis 3.0 test was compared with VDRL as screening assay and TPHA as a confirmatory test. The antenatal prevalence of syphilis was found to be 2% by both VDRL and TPHA. The sensitivity, specificity, positive predictive value, and the negative predictive value of SD BIOLINE Syphilis 3.0 test were 75%, 100%, 100%, and 99.45%, respectively. Antenatal screening and treatment of maternal syphilis are cost-effective health interventions even under the low prevalence of infection. SD BIOLINE Syphilis 3.0 test, although having less sensitivity than the existing testing strategy, can have a tremendous impact on the disease burden if used prudently for the screening of antenatal mothers in peripheral health settings.

  6. Self-reported osteoporosis prevention in inhaled corticosteroid users in community pharmacy setting

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    Valerie Chan

    2015-05-01

    Full Text Available Objectives: The use of inhaled corticosteroids is the standard maintenance therapy in asthma therapy and as adjunct therapy in moderate to severe chronic obstructive pulmonary disease. A dose-related increase in fracture risk is associated with inhaled corticosteroid use; there is an inverse relationship between bone mineral density and duration and cumulative dose of inhaled corticosteroid. Adequate intake of calcium and vitamin D are cornerstones of osteoporosis prevention. The objectives are to assess whether the proportion of patients receiving inhaled corticosteroids are taking calcium and vitamin D; the association between long-term inhaled corticosteroid use and abnormal bone mineral density or fractures; and how many qualified patients received bone mineral density scans. Methods: Patients who filled a prescription for inhaled corticosteroids at selected community pharmacies across Alberta were recruited for a survey of their osteoporosis prevention activities. Results: A total of 256 patients from 12 community pharmacies were included. The average age was 60 ± 17.4 years with 65% female. There were 21%, 51%, and 28% of patients on high, medium, and low dose inhaled corticosteroids, respectively. Only 17% of patients >50 years old received recommended calcium and vitamin D supplementation and 87 (73% of the qualified patients received bone mineral density scan. Conclusion: Osteoporosis prevention in inhaled corticosteroid users is currently poorly addressed. More promotion is needed to raise pharmacist awareness of the risks of inhaled corticosteroids.

  7. Tumour necrosis factor (TNFalpha) as a novel therapeutic target in symptomatic corticosteroid dependent asthma

    National Research Council Canada - National Science Library

    Howarth, P H; Babu, K S; Arshad, H S; Lau, L; Buckley, M; McConnell, W; Beckett, P; Al Ali, M; Chauhan, A; Wilson, S J; Reynolds, A; Davies, D E; Holgate, S T

    2005-01-01

    .... However, as asthma becomes more severe and chronic, it adopts additional characteristics including corticosteroid refractoriness and involvement of neutrophils suggestive of an altered inflammatory...

  8. A Case of Recurrent Acute Pancreatitis Due to Intra-Articular Corticosteroid Injection

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    Patompong Ungprasert

    2014-03-01

    Full Text Available Context Corticosteroid is a well-established cause of drug-induced pancreatitis. However, acute pancreatitis from intraarticularinjection of corticosteroid has never been described. Case report A 69-year-old male presented with acuteabdominal pain and was diagnosed with acute pancreatitis. The patient had one episode of acute pancreatitis two yearearlier. Both episodes occurred after intra-articular cortisone injection. Investigations for other causes of pancreatitis werenegative. Conclusion We report the first case of acute pancreatitis from intra-articular corticosteroid injection. Physiciansshould be aware of this adverse reaction of corticosteroid that can even occur with local administration.

  9. Plasma corticosteroid dynamics in channel catfish, Ictalurus punctatus (Rafinesque), during and after oxygen depletion

    Science.gov (United States)

    Tomasso J.R., Davis; Parker, N.C.

    1981-01-01

    Plasma corticosteroid concentrations in channel catfish, Ictalurus punctatus, (normally 1.0 ± 0.3 μg/100 ml) increased significantly (to 5.9 ± 1.2μg/100 ml) in response to acute oxygen depletion and then returned to control levels within 30 min after the dissolved oxygen concentration was increased; however, a secondary increase in plasma corticosteroid levels was observed 6 h after exposure. Corticosteroid levels also increased in fish exposed to dissolved oxygen concentration of blue was not effective in preventing interrenal response to low dissolved oxygen. No diurnal plasma corticosteroid rhythm was observed in fish exposed to diurnal chemical rhythms of culture ponds.

  10. Hubungan Frekuensi Kunjungan Antenatal Care (ANC dengan Kejadian Prematur

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    Evi Esti Utami

    2016-03-01

    Full Text Available The cause of infant mortality is mostly due to perinatal matters. Almost 2-27% of all perinatal death is caused by prematurity with low birth weight (BBLR. Reducing mortality rate on perinatal can be achieved by observing all pregnant women and fi nding as well as addressing infl uenced factors of neonatal safety. This research aims to identify correlation between frequencies of Antenatal Care (ANC with incidence of prematurity. This is an observational study with case-control design using retrospective approach. Total population was 1335 and of 156 was choosen as research respondents deviding into 78 as case respondents and 78 as control groups. The result of statistic analysis showed that p value=0,837 (p>0,05 means frequencies of ANC did not have correlation with prematurity. Conclusion, (1 during the period of 1 January 2011 and 29 February 2012, it found 207 (8,13% premature baby delivered, (2 at about 80,8% mother who delivered premature baby had normal ANC 4 times or more with the pattern 1-1-2 in every semester, (3 statistically ANC was not having correlation with premature baby.

  11. Late entry to antenatal care in New South Wales, Australia

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    Rubin George

    2006-08-01

    Full Text Available Abstract Aims This study aimed to assess the prevalence of women who entered antenatal care (ANC late and to identify factors related to the late entry to ANC in New South Wales (NSW in 2004. Methods The NSW Midwives Data Collection contained data of 85,034 women who gave birth in 2004. Data were downloaded using SAS and transferred to STATA 8.0. Entering ANC after 12 weeks of gestation was classified as late. The Andersen Health Seeking Behaviour Model was used for selection and analyses of related factors. Regression and hierarchical analyses were used to identify significant factors and their relative contributions to the variation of pregnancy duration at entry to ANC. Results 41% of women commenced ANC after 12 weeks of gestation. Inequality existed between groups of women with predisposing characteristics and enabling resources contributed more to the variation in pregnancy duration at entry to ANC than needs. The groups of women with highest risk were teenagers, migrants from developing countries, women living in Western Sydney, Aboriginal and Torres Strait Islanders, women with three or more previous pregnancies and heavy smokers. The high risk groups with largest number of women were migrants from developing countries and women living in Western Sydney. Conclusion A large number of women in NSW entered ANC late in their pregnancies. Efforts to increase early entry to ANC should be targeted on identified high risk groups of women.

  12. Antenatal depression in East Asia: a review of the literature.

    Science.gov (United States)

    Schatz, David Beck; Hsiao, Mei-Chun; Liu, Chia-Yih

    2012-06-01

    This current study's goal is to summarize the literature regarding Antenatal Depression (AD) in the East Asian countries of Taiwan, China (including Hong Kong and Macau), Japan, and Korea. The main search utilized a Pub med Chinese Electronic Periodical Service (CEPS) literature review using keywords 'AD', and 'Prenatal Depression' with searches for 'Japan', 'Korea', 'Taiwan', 'Hong Kong' and Macau'. The rates of AD in East Asia appear to be relatively close to those in the Western literature, although certain studies showed slightly decreased rates. Many of the risk factors for AD were the same in the Eastern and Western literature. These risk factors included demographic factors such as younger age, smoking, low education and income, and unemployment. Other risk factors were physical symptoms such as menstrual pains and nausea. Finally, psychological factors such as a poor response to the pregnancy, poor spousal support, and poor family support were associated with AD. With regard to treatment, there were no studies examining the administration of psychotropic medications for AD. The literature from East Asia both confirmed many Western findings and made unique contributions to the literature on AD. The treatment of AD in East Asia appears to be an entity which, despite its morbidity, has not been adequately studied.

  13. Integrating active tuberculosis case finding in antenatal services in Zambia.

    Science.gov (United States)

    Kancheya, N; Luhanga, D; Harris, J B; Morse, J; Kapata, N; Bweupe, M; Henostroza, G; Reid, S E

    2014-12-01

    Three out-patient antenatal care (ANC) clinics in Lusaka, Zambia. To estimate tuberculosis (TB) prevalence in human immunodeficiency virus (HIV) infected and symptomatic, non-HIV-infected pregnant women and explore the feasibility of routine TB screening in ANC settings. Peer educators administered TB symptom questionnaires to pregnant women attending their first ANC clinic visit. Presumptive TB patients were defined as all HIV-infected women and symptomatic non-HIV-infected women. Sputum samples were tested using smear microscopy and culture to estimate TB prevalence. All 5033 (100%) women invited to participate in the study agreed, and 17% reported one or more TB symptoms. Among 1152 presumed TB patients, 17 (1.5%) had previously undiagnosed culture-confirmed TB; 2 (12%) were smear-positive. Stratified by HIV status, TB prevalence was 10/664 (1.5%, 95%CI 0. 7-2.8) among HIV-infected women and 7/488 (1.4%, 95%CI 0.6-2.9) among symptomatic non-HIV-infected women. In HIV-infected women, the only symptom significantly associated with TB was productive cough; symptom screening was only 50% sensitive. There is a sizable burden of TB in pregnant women in Zambia, which may lead to adverse maternal and infant outcomes. TB screening in ANC settings in Zambia is acceptable and feasible. More sensitive diagnostics are needed.

  14. Recursive quantum repeater networks

    CERN Document Server

    Van Meter, Rodney; Horsman, Clare

    2011-01-01

    Internet-scale quantum repeater networks will be heterogeneous in physical technology, repeater functionality, and management. The classical control necessary to use the network will therefore face similar issues as Internet data transmission. Many scalability and management problems that arose during the development of the Internet might have been solved in a more uniform fashion, improving flexibility and reducing redundant engineering effort. Quantum repeater network development is currently at the stage where we risk similar duplication when separate systems are combined. We propose a unifying framework that can be used with all existing repeater designs. We introduce the notion of a Quantum Recursive Network Architecture, developed from the emerging classical concept of 'recursive networks', extending recursive mechanisms from a focus on data forwarding to a more general distributed computing request framework. Recursion abstracts independent transit networks as single relay nodes, unifies software layer...

  15. Single and repeated elective abortions in Japan: a psychosocial study.

    Science.gov (United States)

    Kitamura, T; Toda, M A; Shima, S; Sugawara, M

    1998-09-01

    Despite its social, legal and medical importance, termination of pregnancy (TOP) (induced abortion) has rarely been the focus of psychosocial research. Of a total of 1329 women who consecutively attended the antenatal clinic of a general hospital in Japan, 635 were expecting their first baby. Of these 635 women, 103 (16.2%) had experienced TOP once previously (first aborters), while 47 (7.4%) had experienced TOP two or more times (repeated aborters). Discriminant function analysis was performed using psychosocial variables found to be significantly associated with either first abortion or repeated abortion in bivariate analyses. This revealed that both first and repeated aborters could be predicted by smoking habits and an unwanted current pregnancy while the repeated aborters appear to differ from first aborters in having a longer pre-marital dating period, non-arranged marriages, smoking habits, early maternal loss experience or a low level of maternal care during childhood. These findings suggest that both the frequency of abortion and its repetition have psychosocial origins.

  16. Nonsurgical Management of Oral Mucocele by Intralesional Corticosteroid Therapy

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    Rupam Sinha

    2016-01-01

    Full Text Available Background. Oral mucocele is a common lesion resulting from an alteration of minor salivary glands due to mucus accumulation. Rapid appearance, specific location, history of trauma, bluish colour, and consistency help in the diagnosis. Conventional surgical removal is the treatment of choice but has several disadvantages like damage to adjacent ducts with further development of satellite lesions. Therefore, the present study was undertaken to evaluate the efficacy of intralesional corticosteroid injection (betamethasone as a nonsurgical treatment procedure in oral mucoceles. Material and Method. A total of 20 cases (males and females, 10–30 years of age with clinically diagnosed oral mucoceles were given 1 mL of betamethasone intralesionally. All the patients were examined after a period of 7, 14, and 21 days to evaluate the response of the lesion towards treatment and consequently given the 2nd, 3rd, 4th injections. If the lesion resolved after one or two injections, the treatment was discontinued. Results. Out of the 20 cases, 18 of them showed complete regression of the lesion whereas the remaining 2 cases showed decrease in size. All the patients received maximum of 4 consecutive shots in weekly interval. Conclusion. Intralesional corticosteroid therapy can be considered as the first choice in the treatment of oral mucoceles.

  17. Protective effect of corticosteroids on radiation pneumonitis in mice

    Energy Technology Data Exchange (ETDEWEB)

    Gross, N.J.; Narine, K.R.; Wade, R.

    1988-01-01

    We explored the protective effect of corticosteroids on the mortality of mice that received thoracic irradiation. Methylprednisolone, 100 mg/kg/week, given from 11 weeks after gamma irradiation of the thorax resulted in an increase in the LD50 (11-26 weeks) from 14.3 +/- 0.3 (mean +/- SE) Gy to 17.6 +/- 0.4 Gy, P less than 0.001, a protection factor of 1.2. Withdrawal of steroids at various times during the period of radiation pneumonitis resulted in accelerated mortality in the next 2-4 weeks, so that the cumulative mortality caught up with that of control animals by 4 weeks after steroid withdrawal. However, after the end of the usual period of pneumonitis withdrawal of steroids did not result in accelerated mortality, suggesting that the time when steroids are protective corresponds to the duration of pneumonitis. A smaller dose of steroids, 25 mg/kg/week, was found to be as protective as the larger dose used in the above experiments. The possibility that corticosteroids reduce mortality, even when given many weeks after radiation, may have important practical and theoretical implications.

  18. Evolution of ligand specificity in vertebrate corticosteroid receptors

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    Deitcher David L

    2011-01-01

    Full Text Available Abstract Background Corticosteroid receptors include mineralocorticoid (MR and glucocorticoid (GR receptors. Teleost fishes have a single MR and duplicate GRs that show variable sensitivities to mineralocorticoids and glucocorticoids. How these receptors compare functionally to tetrapod MR and GR, and the evolutionary significance of maintaining two GRs, remains unclear. Results We used up to seven steroids (including aldosterone, cortisol and 11-deoxycorticosterone [DOC] to compare the ligand specificity of the ligand binding domains of corticosteroid receptors between a mammal (Mus musculus and the midshipman fish (Porichthys notatus, a teleost model for steroid regulation of neural and behavioral plasticity. Variation in mineralocorticoid sensitivity was considered in a broader phylogenetic context by examining the aldosterone sensitivity of MR and GRs from the distantly related daffodil cichlid (Neolamprologus pulcher, another teleost model for neurobehavioral plasticity. Both teleost species had a single MR and duplicate GRs. All MRs were sensitive to DOC, consistent with the hypothesis that DOC was the initial ligand of the ancestral MR. Variation in GR steroid-specificity corresponds to nine identified amino acid residue substitutions rather than phylogenetic relationships based on receptor sequences. Conclusion The mineralocorticoid sensitivity of duplicate GRs in teleosts is highly labile in the context of their evolutionary phylogeny, a property that likely led to neo-functionalization and maintenance of two GRs.

  19. Misuse of Topical Corticosteroids for Cosmetic Purpose in Antananarivo, Madagascar

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    F. A. Sendrasoa

    2017-01-01

    Full Text Available This cross-sectional study was conducted in Antananarivo, Madagascar, from June to September 2012. We aim to evaluate the misuse of TC on the face for cosmetic purpose and the adverse effects due to its application. A questionnaire-based analysis was done among females who use topical corticosteroids on the face for cosmetic purpose. Of the 770 women questioned, 384 (49,8% used topical corticosteroids for cosmetic purpose whose mean age was 38 years (range 16–73 years. Two hundred and sixty-one females (68% used TC combined with handcrafted cosmetics, and 123 (32% used TC alone. “Pandalao,” which contains salicylic acid, peppermint oil, lanolin, powder of Juanes de Vigo (mercury powder, and Vaseline, is the most handcrafted cosmetic combined with TC in our study (used by 29,4% respondents. Only one (0,26% had obtained the TC by physician’s prescription, 234 (61% from cosmetic retailers, 92 (23% directly from local pharmacies, 49 (12% from beauticians, and 15 (4% from unspecified sources. Lightening of skin color was the main reason for using TC in 44,8% of respondents in the absence of any primary dermatosis. Pigmentation disorders (63,2% and cutaneous atrophy (52,1% were the most adverse effects noted.

  20. Topical corticosteroid-induced rosacea-like dermatitis: A clinical study of 110 cases

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    Sanjay K Rathi

    2011-01-01

    Full Text Available Background: Prolonged and continuous use of topical steroids leads to rosacea-like dermatitis with variable clinical presentations. Aims: To study the various clinical presentations of patients with topical corticosteroid-induced rosacea-like dermatitis (TCIRD, who had a history of prolonged and repeated use of topical steroids for reasons other than the known disease entities. Methods: A total of 110 patients were enrolled for the study over a period of 2 years, excluding all those with the known disease entity in which topical steroids were commonly used. Detailed history which also included the source and the type of topical steroid use was taken along with clinical examination. Results: There were 12 males and 98 females with their age ranging from 18 to 54 years. The duration of topical steroid use ranged from 4 months to 20 years. The most common clinical presentation was diffuse erythema of the face. Most of the patients had rebound phenomenon on discontinuation of the steroid. The most common topical steroid used was Betamethasone valerate, which could be due to its easy availability and low cost. Conclusion: Varied clinical presentations are seen with prolonged and continuous use of topical steroids. The treatment of this dermatitis is difficult, requiring complete cessation of the offending steroid, usually done in a tapering fashion.

  1. Experimentally Induced Preterm Birth in Sheep Following a Clinical Course of Antenatal Betamethasone: Effects on Growth and Long-Term Survival.

    Science.gov (United States)

    Nguyen, Vivian B; De Matteo, Robert; Harding, Richard; Stefanidis, Aneta; Polglase, Graeme R; Black, M Jane

    2017-08-01

    Preterm births account for approximately 10% of births worldwide, with the majority (∼80%) being moderate preterm. Our aim was to determine the effects of moderate preterm birth on survival and long-term growth of male and female offspring using an ovine model of preterm birth that was preceded by a clinically relevant dose of corticosteroids. Ewes were induced to deliver preterm or at term; those assigned to deliver preterm were administered antenatal betamethasone (11.4 mg, 2 doses, 24 hours apart). The growth (body weight and body dimensions) of offspring was monitored to adulthood (62 weeks) when the animals were humanely killed for organ collection. Survival in the immediate period following preterm birth was high (75% for both sexes). However, there were unexpected deaths between 5 and 12 weeks of age, as a result of vitamin E/selenium deficiency; this only occurred in preterm offspring. From birth until adolescence, preterm lambs were lighter than term lambs (controls). After this time, there was gradual catch-up in body weight in preterm females, whereas in preterm males, body weight remained lower than in controls. Preterm sheep were smaller in stature than controls throughout life. This clinically relevant model of preterm birth leads to equally high survival rates in both sexes and is an excellent animal model in which to examine the effects of moderate preterm birth on growth and development of organ systems into adulthood.

  2. Corticosteroid Use and Complications in a US Inflammatory Bowel Disease Cohort

    Science.gov (United States)

    Waljee, Akbar K.; Wiitala, Wyndy L.; Govani, Shail; Stidham, Ryan; Saini, Sameer; Hou, Jason; Feagins, Linda A.; Khan, Nabeel; Good, Chester B.; Vijan, Sandeep; Higgins, Peter D. R.

    2016-01-01

    Background and Aims Corticosteroids are effective for the short-term treatment of inflammatory bowel disease (IBD). Long-term use, however, is associated with significant adverse effects. To define the: (1) frequency and duration of corticosteroid use, (2) frequency of escalation to corticosteroid-sparing therapy, (3) rate of complications related to corticosteroid use, (4) rate of appropriate bone density measurements (dual energy X-ray absorptiometry [DEXA] scans), and (5) factors associated with escalation and DEXA scans. Methods Retrospective review of Veterans Health Administration (VHA) data from 2002–2010. Results Of the 30,456 Veterans with IBD, 32% required at least one course of corticosteroids during the study time period, and 17% of the steroid users had a prolonged course. Among these patients, only 26.2% underwent escalation of therapy. Patients visiting a gastroenterology (GI) physician were significantly more likely to receive corticosteroid-sparing medications. Factors associated with corticosteroid-sparing medications included younger age (OR = 0.96 per year,95%CI:0.95, 0.97), male gender (OR = 2.00,95%CI:1.16,3.46), GI visit during the corticosteroid evaluation period (OR = 8.01,95%CI:5.85,10.95) and the use of continuous corticosteroids vs. intermittent corticosteroids (OR = 2.28,95%CI:1.33,3.90). Rates of complications per 1000 person-years after IBD diagnosis were higher among corticosteroid users (venous thromboembolism [VTE] 9.0%; fragility fracture 2.6%; Infections 54.3) than non-corticosteroid users (VTE 4.9%; fragility fracture 1.9%; Infections 26.9). DEXA scan utilization rates among corticosteroid users were only 7.8%. Conclusions Prolonged corticosteroid therapy for the treatment of IBD is common and is associated with significant harm to patients. Patients with prolonged use of corticosteroids for IBD should be referred to gastroenterology early and universal efforts to improve the delivery of high quality care should be undertaken

  3. Awareness Regarding Anemia, Gestational Diabetes and Pregnancy Induced Hypertension among Antenatal Women Attending Outpatient Department in a Rural Hospital

    OpenAIRE

    George M; George N; Ramesh N

    2016-01-01

    "Introduction: Antenatal mothers should not only be aware of normal antenatal care but also be aware about common morbidities like anemia, gestational diabetes mellitus (GDM), pregnancy induced hypertension (PIH), etc., which can have adverse pregnancy outcomes. This study was conducted to assess the awareness regarding anemia, GDM and PIH among antenatal women attending outpatient clinic in a rural hospital. Methods: This was a cross sectional study done during the period of October-Novem...

  4. Vulnerable pregnant women in antenatal practice: Caregiver's perception of workload, associated burden and agreement with objective caseload, and the influence of a structured organisation of antenatal risk management.

    Science.gov (United States)

    de Groot, Nynke; Venekamp, Angélica A; Torij, Hanneke W; Lambregtse-Van den Berg, Mijke P; Bonsel, Gouke J

    2016-09-01

    pregnancy care for vulnerable women is often perceived as a burden by caregivers as vulnerable clients require complex case management, additional time, and more often show adverse perinatal outcomes. Vulnerable clients bring about additional work strain for the caregiver, especially when the workload is high. We define client vulnerability as coexistence of psychopathology, psychosocial problems or substance use, together with features of deprivation. We investigated, as part of a national programme, whether the subjective caregiver's perception of workload and the objective registry-based caseload of vulnerable clients are in agreement, and whether a structured organisation of antenatal risk management reduces the burden associated with the perceived workload, in particular if the objective caseload is high. we combined three data sources: (1) at the unit level (i.e. midwifery practice, obstetric unit) interview data from caregivers, from which we derived a) the (subjective) caregiver's perception of workload, b) the associated burden and c) organisational structure of antenatal risk management, (2) at the unit level perinatal registry data, from which we derived a) unit characteristics and b) (objective) unit specific caseload, and (3) at the individual client level survey data collected during the first antenatal visit, from which the prevalence of vulnerable clients was derived. The study area was the South-West Netherlands (2.5 million inhabitants), containing areas with varying degrees of urbanisation and deprivation. sixteen units had complete data on all measures. Generally, subjective workload and objective caseload were only weakly related, the relation being modified by the organisation of antenatal risk management. If the organisational structure of antenatal risk management was low, the experienced burden was high, even if the objective caseload was low. Highly structured antenatal risk management was associated with a medium to low burden. our

  5. The relationship between antenatal care and preterm birth: the importance of content of care.

    Science.gov (United States)

    Beeckman, Katrien; Louckx, Fred; Downe, Soo; Putman, Koen

    2013-06-01

    Antenatal care can play an important role in the prevention of preterm birth. Evaluation of antenatal care is usually based on the number of visits rather than the content of care, using tools such as the Adequacy of Prenatal Care Use index. This article presents an analysis of the relation between specific elements of antenatal care and the risk of preterm birth compared with considering the number of visits only. A prospective cohort study was conducted in the Brussels Metropolitan Region. In all, 333 women were consecutively recruited at the beginning of their antenatal care trajectory and followed until birth. Information on timing and content for every visit was recorded by structured interview. A new tool was developed to measure the antenatal care trajectory, which included Content and Timing of care in Pregnancy (CTP). Odds ratios (OR) (adjusted and unadjusted) for preterm birth were calculated for the Adequacy of Prenatal Care Use and CTP model. The number of visits alone was not associated with preterm birth. In contrast, a significant association was found between the content and timing of care and preterm birth. Compared with the CTP lowest ('inadequate') category, women in the CTP 'sufficient' (OR 0.30; 95% CI 0.09-0.94) and CTP 'appropriate' (OR 0.21; 95% CI 0.06-0.68) category had a lower risk. This study suggests that measurement of the content and timing of care of antenatal care using the new CTP tool is a better assessment of the risk of preterm birth than assessment of the number of antenatal visits alone.

  6. Antenatal hydronephrosis: Negative predictive value of normal postnatal ultrasound - a 5-year study

    Energy Technology Data Exchange (ETDEWEB)

    Moorthy, I.; Joshi, N.; Cook, J.V. E-mail: jcook@epsom-sthelier.nhs.uk; Warren, M

    2003-12-01

    AIM: To determine whether normal postnatal ultrasound, as part of a strict screening protocol for the detection and follow-up of antenatal hydronephrosis, effectively excludes the majority of babies with congenital urinary tract abnormalities that would otherwise present with a urinary tract infection. MATERIALS AND METHODS: We retrospectively reviewed all babies who had postnatal follow-up of antenatally detected hydronephrosis over a 5-year period at our institution, a district general Trust with a specialist paediatric unit. We then studied all babies presenting with urinary tract infection before their first birthday to our institution over the same period. By cross-referencing these two study groups we were able to determine which babies developed a urinary tract infection having been previously discharged after normal postnatal ultrasound. RESULTS: Four hundred and twenty-five babies had postnatal follow-up of antenatal hydronephrosis. Of these, 284 were investigated with ultrasound alone. In the same 5-year period, 230 babies presented with urinary tract infection before their first birthday. Only three of these babies had been previously discharged after normal postnatal ultrasound. The negative predictive value of a normal postnatal ultrasound was therefore 98.9% (281/284) for babies who subsequently presented with a urinary tract infection before their first birthday. CONCLUSION: Careful antenatal and postnatal ultrasound with strict protocols is effective in detecting congenital renal tract abnormalities. Infants discharged after normal postnatal ultrasound are highly unlikely to still have an undetected urinary tract abnormality. We suggest that all babies with antenatal hydronephrosis are started on prophylactic antibiotics at birth, pending further investigation. All babies without features of severe obstruction antenatally should have their postnatal ultrasound delayed for a month. We recommend selective use of micturating cystourethrogram (MCUG

  7. Male perspectives on incorporating men into antenatal HIV counseling and testing.

    Directory of Open Access Journals (Sweden)

    David A Katz

    Full Text Available BACKGROUND: Male partner involvement in antenatal voluntary HIV counseling and testing (VCT has been shown to increase uptake of interventions to reduce the risk of HIV transmission in resource-limited settings. We aimed to identify methods for increasing male involvement in antenatal VCT and determine male correlates of accepting couple counseling in these settings. METHODOLOGY/PRINCIPAL FINDINGS: We invited women presenting to a Nairobi antenatal clinic to return with their male partners for individual or couples VCT. Male attitudes towards VCT and correlates of accompanying female partners to antenatal clinic and receiving couple counseling were determined. Of 1,993 women who invited their partner, 313 (16% returned with their partners to ANC. Men attending antenatal clinic were married (>99%, employed (98%, and unlikely to report prior HIV testing (14%. Wanting an HIV test (87% or health information (11% were the most commonly cited reasons for attending. Most (95% men who came to antenatal clinic accepted HIV testing and 39% elected to receive counseling as a couple. Men who received counseling with partners were younger, had fewer children, and were less knowledgeable about prevention of mother-to-child HIV transmission (PMTCT than those who received counseling individually (p<0.05. Only 27% of men stated they would prefer HIV testing at a site other than the ANC. There was agreement between male and female reports for sociodemographic characteristics; however, men were more likely to report HIV preventive behaviors and health communication within the partnership than their partners (p<0.05. CONCLUSIONS/SIGNIFICANCE: Offering VCT services to men at antenatal clinic with options for couple and individual counseling is an important opportunity and acceptable strategy for increasing male involvement in PMTCT and promoting male HIV testing.

  8. Risk factors for incident HIV infection among antenatal mothers in rural Eastern Cape, South Africa

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    Charles Bitamazire Businge

    2016-01-01

    Full Text Available Background: The prevalence of HIV among antenatal clients in South Africa has remained at a very high rate of about 29% despite substantial decline in several sub-Saharan countries. There is a paucity of data on risk factors for incident HIV infection among antenatal mothers and women within the reproductive age bracket in local settings in the Eastern Cape, South Africa. Objective: To establish the risk factors for incident HIV infection among antenatal clients aged 18–49 years attending public antenatal clinics in rural Eastern Cape, South Africa. Design: This was an unmatched case–control study carried out in public health antenatal clinics of King Sabata District Municipality between January and March 2014. The cases comprised 100 clients with recent HIV infection; the controls were 200 HIV-negative antenatal clients. Socio-demographic, sexual, and behavioral data were collected using interviewer-administered questionnaires adapted from the standard DHS5 women's questionnaire. Multivariate logistic regression models were used to identify the independent risk factors for HIV infection. A p<0.05 was considered statistically significant. Results: The independent risk factors for incident HIV infection were economic dependence on the partner, having older male partners especially among women aged ≤20 years, and sex under the influence of alcohol. Conclusions: Therefore, effective prevention of HIV among antenatal mothers in KSDM must target the improvement of the economic status of women, thereby reducing economic dependence on their sexual partners; address the prevalent phenomenon of cross-generation sex among women aged <20 years; and regulate the brewing, marketing, and consumption of alcohol.

  9. Impact of maternal body mass index on the antenatal detection of congenital anomalies.

    Science.gov (United States)

    Best, K E; Tennant, P W G; Bell, R; Rankin, J

    2012-11-01

    To investigate the association between maternal body mass index (BMI) and antenatal ultrasound detection of congenital anomalies. Population-based register study. North of England (UK). All pregnancies (n = 3096) associated with a congenital anomaly notified to the Northern Congenital Abnormality Survey (NorCAS) during 2006-2009. Cases with chromosomal and teratogenic anomalies (n = 611) or without information on antenatal scanning (n = 4) were excluded. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for antenatal detection according to maternal BMI categories were estimated using logistic regression. For all anomalies combined, cases were defined as 'detected' if any congenital anomaly was suspected antenatally. Organ system-specific anomalies were defined as detected if an anomaly of the correct system was suspected. Antenatal detection of any anomaly occurred in 1146 of 2483 (46.2%) cases with normal karyotype. The odds of detection were significantly decreased in obese (BMI ≥ 30 kg/m(2)) women compared with women of recommended BMI (18.5-24.9 kg/m(2); aOR, 0.77; 95% CI, 0.60-0.99; P = 0.046). Cardiovascular system anomalies were suspected antenatally in 109 of 945 (11.5%) cases. The odds of detecting a cardiovascular anomaly were significantly greater in underweight women (BMI BMI (aOR, 2.95; 95% CI, 1.13-7.70; P = 0.027). There was no association between BMI and detection in any other organ system or between BMI and termination of pregnancy for fetal anomaly. Antenatal ultrasound detection of a congenital anomaly is decreased in obese pregnant women. This has implications for the scanning and counselling of obese women. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  10. How does group antenatal care function within a caseload midwifery model? A critical ethnographic analysis.

    Science.gov (United States)

    Allen, J; Kildea, S; Stapleton, H

    2015-05-01

    caseload midwifery and CenteringPregnancy™ (a form of group antenatal care) are two models of maternity care that are separately associated with better clinical outcomes, maternal satisfaction scores and positive experiences compared to standard care. One study reported exclusively on younger women׳s experiences of caseload midwifery; none described younger women׳s experiences of group antenatal care. We retrieved no studies on the experiences of women who received a combination of caseload midwifery and group antenatal care. examine younger women׳s experiences of caseload midwifery in a setting that incorporates group antenatal care. a critical, focused ethnographic approach. the study was conducted in an Australian hospital and its associated community venue from 2011 to 2013. purposive sampling of younger (19-22 years) pregnant and postnatal women (n=10) and the caseload midwives (n=4) who provided group antenatal care within one midwifery group practice. separate focus group interviews with women and caseload midwives, observations of the setting and delivery of group antenatal care, and examination of selected documents. Thematic analyses of the women׳s accounts have been given primary significance. Coded segments of the midwives interview data, field notes and documents were used to compare and contrast within these themes. we report on women׳s first encounters with the group, and their interactions with peers and midwives. The group setting minimised the opportunity for the women and midwives to get to know each other. this study challenges the practice of combining group antenatal care with caseload midwifery and recommends further research. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Antenatal exposure to betamethasone: psychological functioning and health related quality of life 31 years after inclusion in randomised controlled trial

    OpenAIRE

    Dalziel, Stuart R; Lim, Vanessa K; Lambert, Anthony; McCarthy, Dianne; Parag, Varsha; Rodgers, Anthony; Harding, Jane E.

    2005-01-01

    Objectives To determine if antenatal exposure to betamethasone for the prevention of neonatal respiratory distress syndrome alters psychological functioning and health related quality of life in adulthood.

  12. Neurodevelopmental Outcome After a Single Course of Antenatal Steroids in Children Born Preterm: A Systematic Review and Meta-analysis

    National Research Council Canada - National Science Library

    Sotiriadis, Alexandros; Tsiami, Alexandra; Papatheodorou, Stefania; Baschat, Ahmet A; Sarafidis, Kosmas; Makrydimas, George

    2015-01-01

    .... We included randomized and nonrandomized trials reporting on the neurodevelopmental outcomes of children whose mothers were administered a single course of betamethasone or dexamethasone antenatally...

  13. Herpes simplex virus type 2: Seroprevalence in antenatal women

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    Rathore Shagufta

    2010-01-01

    Full Text Available Aims: To determine the seroprevalence of herpes simplex type 2 (HSV-2 infection in pregnant females, assess the frequency of unrecognized infection and identify the demographic profile and risk factors associated with the seroprevalence. Materials and Methods: Two hundred randomly selected, asymptomatic pregnant females attending the Obstetrics and Gynecology Outpatient Department for a routine antenatal check-up constituted the study group. Serum specimens were screened for HSV-2 infection by detecting IgG class antibodies against HSV-2-specific glycoprotein G-2 using an enzyme-linked immunosorbent assay kit. Results: A seroprevalence of 7.5% was found in our study. Seropositivity was maximum in the age group ≥30 years (22.20%, followed by 26-30 years (9.7%, 21-25 years (2.20% and ≤20 years (0%. HSV-2 seropositivity was found to be significantly associated with increasing age, parity, number of sexual partners, duration of sexual activity and history of abortions (P < 0.05. No statistically significant correlation was observed between seropositivity and other demographic variables such as place of residence, education, annual family income and occupation (P > 0.05. No statistically significant association of seropositivity with present or past history suggestive of other sexually transmitted infections was found. None of our cases tested positive for human immunodeficiency syndrome (HIV. Conclusion: A relatively low prevalence of HSV-2 seropositivity was found in our study, with a high frequency of unrecognized and asymptomatic infections. Our findings suggest that type-specific serotesting could be an efficient strategy to diagnose clinically asymptomatic HSV-2 infections and, therefore, to reduce the risk of HSV-2 and HIV sexual transmission by prophylactic counseling against unprotected intercourse. It may also be a useful adjunct in detecting cases who present with symptoms not directly suggestive of genital herpes.

  14. Contraception awareness and practice among antenatal attendees in Uyo, Nigeria

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    Augustine Vincent Umoh

    2011-12-01

    Full Text Available INTRODUCTION: Contraception is major component of reproductive health. The study aims to document the awareness of contraception and its use in Uyo, South-south Nigeria and provide useful information for future intervention strategies. METHODS: A cross-sectional study using pretested questionnaires among antenatal attendees in a tertiary and a secondary health facility in Uyo. RESULTS: A total of 550 women took part in the study. Majority of respondents (92.4% were aware of contraception while 52.6% had ever used any form of contraception. The condom (60.3% and the pill (49.9% were the most common forms of contraception that the women had heard of, mostly from the doctor (36.9%, radio (33.8% and nurse (28.5%. The condom (46.7%, withdrawal method (14.1% and the pills (13.3% were the most commonly used forms of contraception. Majority of the women (70.5% planned to use contraception in the future and this intention was significantly related to the woman's educational status (p<0.05 but not to religion or occupation. Fear of side effects, uncertainty about its need, partner objection and previous side effects were the common reasons given for unwillingness to use contraception in the future. CONCLUSION: Our study has shown that while there is good contraceptive awareness in Uyo, Nigeria, this is not matched by commensurate contraceptive prevalence but prospects for improvement exist. There�s need to tackle known obstacles to contraceptive uptake. Also targeted campaigns and every available opportunity should be used to provide reproductive counseling to women especially on contraception.

  15. The Effects of Antenatal Training Sessions on Prenatal Outcomes

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    Masoumeh Delaram

    2012-03-01

    Full Text Available Objective: To study maternal and neonatal outcomes, the nulliparous women submitted to a trainingprogram in third trimester.Materials and methods: This randomized controlled trial was carried out on 64 nulliparous pregnantwomen divided into two groups according to their participation including; training group; n=34 or not;n=34. The program consisted of 8 meetings (between the 28 th and the 40 th gestational week duringwhich educational activities were developed. The control group received the standard care. Maternaland neonatal outcomes also were recorded. Data were analyzed by SPSS 16, and P<0.05 wasconsidered significant.Results: There was no significant difference in age and body mass index in both groups, but asignificant difference was found in both the gestational age based on last menstrual period (LMP, andultrasonography, as well as in the cervix dilatation at the time the women arrived for delivery in bothgroups (P<0.05.The difference was also significant in the reasons of admission in hospital (P=0.04,oxytocin induction (P=0.01, mode of delivery (P=0.01, and gestational age of infants based onphysical examination in both groups. Birth outcomes were also similar in both groups and no adverseeffects of the interaction were found.Conclusion: Antenatal training program in nulliparous women was associated with arriving at maternityward in active labor, decreasing oxytocin induction, and cesarean section and increasing the gestationalage of infants based on physical examination, Training program offered to pregnant women by midwives,is an important low-technology health promotion tool, and may be performed at low cost in most settings .Whether these results also apply to multiparous women or not, requires additional studies.

  16. Neuromodulation and antenatal depression: a review

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    Kim DR

    2015-04-01

    Full Text Available Deborah R Kim,1 Jessica L Snell,1 Grace C Ewing,1 John O’Reardon2 1Department of Psychiatry, Penn Center for Women’s Behavioral Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 2Department of Psychiatry, Rowan University, Rowan School of Medicine, Cherry Hill, NJ, USA Background: Depression during pregnancy affects 5%–8% of women. While the percentage of women in the US taking serotonin reuptake inhibitors during pregnancy has risen over the last decade, pregnant women continue to report that they prefer non-pharmacologic interventions. Objective: We review the literature regarding neuromodulation techniques for major depressive disorder during pregnancy. The rationale for their use in this population, new developments, and future directions are discussed. Methods: A literature search was conducted in PubMed Plus, Ovid Medline, and Embase to collect all articles on neuromodulation for the treatment of depression during pregnancy. Key search words included electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation, transcranial direct current stimulation, neuromodulation, depression, and pregnancy. Given the sparse literature, all articles from 1960 to 2014 that addressed the use of neuromodulation in pregnancy were included. Conclusion: The data support the use of electroconvulsive therapy in all trimesters of pregnancy for major depressive disorder. New data are emerging for the use of transcranial magnetic stimulation in pregnancy, which is likely safe, but more data are needed before it can be recommended as a primary treatment modality during pregnancy. Other neuromodulation techniques have not been well studied in this population. Keywords: electroconvulsive therapy, transcranial magnetic stimulation, pregnancy, depression, antenatal depression, perinatal

  17. Antibiotics in Addition to Systemic Corticosteroids for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

    NARCIS (Netherlands)

    J.M.A. Daniels; D. Snijders; C.S. de Graaff; F. Vlaspolder; H.M. Jansen; W.G. Boersma

    2010-01-01

    Rationale: The role of antibiotics in acute exacerbations is controversial and their efficacy when added to systemic corticosteroids is unknown. Objectives: We conducted a randomized, placebo-controlled trial to determine the effects of doxycycline in addition to corticosteroids on clinical outcome,

  18. Is enough attention being given to the adverse effects of corticosteroid therapy?

    NARCIS (Netherlands)

    Hougardy, DMC; Peterson, GM; Bleasel, MD; Randall, CTC

    2000-01-01

    Background: Although the corticosteroids are valuable anti-inflammatory and immunosuppressive agents, they also possess many potential adverse effects, especially with continued use. In particular, long-term corticosteroid exposure carries a significant risk of osteoporosis. Aim: To review the use o

  19. Design and Synthesis of 6α-Corticosteroid Haptens and Their Bovine Serum Albumin (BSA) Conjugates

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    The site of attachment of protein carrier to corticosteroids has great influence on the specificity of produced antibody. In order to obtain highly specific and accurate antibodies for bioimmunoassay determination of cortisol, different tether lengths of 6α-corticosteroid haptens and their BSA conjugates were designed and synthesized.

  20. Prescription audit of corticosteroid usage in the department of dermatology at a tertiary care teaching hospital

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    Mirshad PV

    2013-08-01

    Full Text Available Background: Corticosteroids are a group of commonly used drugs in dermatology practice whose non judicious use frequently results in undesirable and unwanted effects. Prescribing them rationally with care allows us to derive the maximum benefit out of them with minimal side effects. Methods: Retrospective analysis of 112 case files belonging to patients admitted in the department of dermatology over a period of one year was undertaken to ascertain the usage pattern of corticosteroids in relation to their potency, strength, frequency, duration, route, quantity to be applied. The data thus collected was expressed in terms of averages, ratios and proportions. Results: The total number of formulations prescribed were 929 out of which 10.8% were corticosteroids. The average number of formulations prescribed per patient was 8.29. About 78(70% patients admitted in dermatology received corticosteroids. Topical steroids were prescribed in 50 patients (44.7 % out of whom 36 (72% received only topical, the remaining 14(28% were prescribed both systemic and topical corticosteroids. Brand names were used in all cases. Highly potent corticosteroids like clobetasol, halobetasol and mometasone were prescribed to 39(50% of all cases who received topical corticosteroids. Conclusion: The study reveals the deficiencies which exist in the present prescribing pattern of corticosteroids. Educational interventions among the doctors as well as students should be carried out to in order to promote rational drug use. [Int J Basic Clin Pharmacol 2013; 2(4.000: 411-413

  1. Irreversible neurological worsening following high-dose corticosteroids in advanced progressive multiple sclerosis

    NARCIS (Netherlands)

    Koch, M; De Keyser, J

    2006-01-01

    Background: A course of high-dose corticosteroids has been shown to hasten recovery from a relapse of multiple sclerosis (MS). Some patients with progressive MS ask for a course with corticosteroids outside a relapse, hoping to gain some functional improvement. Objective: To describe 4 patients with

  2. Corticosteroid-induced osteoporosis prevention : longitudinal practice patterns in The Netherlands 2001-2005

    NARCIS (Netherlands)

    Duyvendak, M.; Naunton, M.; Atthobari, J.; van den Berg, P. B.; Brouwers, J. R. B. J.

    2007-01-01

    We investigated prevention trends and predictors for osteoporosis prevention in long term corticosteroid users. The use of bisphosphonates increased from 2001 to 2005. Longer duration of corticosteroid use and DMARD use were predictors for receiving prevention. Females appear reasonably well treated

  3. The Pentapeptide Repeat Proteins

    Energy Technology Data Exchange (ETDEWEB)

    Vetting,M.; Hegde, S.; Fajardo, J.; Fiser, A.; Roderick, S.; Takiff, H.; Blanchard, J.

    2006-01-01

    The Pentapeptide Repeat Protein (PRP) family has over 500 members in the prokaryotic and eukaryotic kingdoms. These proteins are composed of, or contain domains composed of, tandemly repeated amino acid sequences with a consensus sequence of [S, T,A, V][D, N][L, F]-[S, T,R][G]. The biochemical function of the vast majority of PRP family members is unknown. The three-dimensional structure of the first member of the PRP family was determined for the fluoroquinolone resistance protein (MfpA) from Mycobacterium tuberculosis. The structure revealed that the pentapeptide repeats encode the folding of a novel right-handed quadrilateral {beta}-helix. MfpA binds to DNA gyrase and inhibits its activity. The rod-shaped, dimeric protein exhibits remarkable size, shape and electrostatic similarity to DNA.

  4. Original article title: "Comparison of therapeutic efficacy of topical corticosteroid and oral zinc sulfate-topical corticosteroid combination in the treatment of vitiligo patients: a clinical trial"

    Directory of Open Access Journals (Sweden)

    Omidian Mohammad

    2011-03-01

    Full Text Available Abstract Background Vitiligo is the most prevalent pigmentary disorder which occurs worldwide, with an incidence rate between 0.1-4 percent. It is anticipated that the discovery of biological pathways of vitiligo pathogenesis will provide novel therapeutic and prophylactic targets for future approaches to the treatment and prevention of vitiligo. The purposes of this study were evaluating the efficacy of supplemental zinc on the treatment of vitiligo. Methods This randomized clinical trial was conducted for a period of one year. Thirty five patients among 86 participants were eligible to entrance to the study. The patients in two equal randomized groups took topical corticosteroid and combination of oral zinc sulfate-topical corticosteroid. Results The mean of responses in the corticosteroid group and the zinc sulfate-corticosteroid combination group were 21.43% and 24.7%, respectively. Conclusion Although, the response to corticosteroid plus zinc sulfate was more than corticosteroid, there was no statistically significant difference between them. It appeared that more robust long-term randomized controlled trials on more patients, maybe with higher doses of zinc sulfate, are needed to fully establish the efficacy of oral zinc in management of vitiligo. Trial Registration chiCTRTRC10000930

  5. Under-attending free antenatal care is associated with adverse pregnancy outcomes

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    Heinonen Seppo

    2007-09-01

    Full Text Available Abstract Background Most pertinent studies of inadequate antenatal care concentrate on the risk profile of women booking late or not booking at all to antenatal care. The objective of this study was to assess the outcome of pregnancies when free and easily accessible antenatal care has been either totally lacking or low in number of visits. Methods This is a hospital register based cohort study of pregnancies treated in Kuopio University Hospital, Finland, in 1989 – 2001. Pregnancy outcomes of women having low numbers (1–5 of antenatal care visits (n = 207 and no antenatal care visits (n = 270 were compared with women having 6–18 antenatal visits (n = 23137. Main outcome measures were: Low birth weight, fetal death, neonatal death. Adverse pregnancy outcomes were controlled for confounding factors (adjusted odds ratios, OR: s in multiple logistic regression models. Results Of the analyzed pregnant population, 1.0% had no antenatal care visits and 0.77% had 1–5 visits. Under- or non-attendance associated with social and health behavioral risk factors: unmarried status, lower educational level, young maternal age, smoking and alcohol use. Chorio-amnionitis or placental abruptions were more common complications of pregnancies of women avoiding antenatal care, and pregnancy outcome was impaired. After logistic regression analyses, controlling for confounding, there were significantly more low birth weight infants in under- and non-attenders (OR:s with 95% CI:s: 9.18 (6.65–12.68 and 5.46 (3.90–7.65, respectively more fetal deaths (OR:s 12.05 (5.95–24.40 and 5.19 (2.04–13.22, respectively and more neonatal deaths (OR:s 10.03 (3.85–26.13 and 8.66 (3.59–20.86, respectively. Conclusion Even when birth takes place in hospital, non- or under-attendance at antenatal care carries a substantially elevated risk of severe adverse pregnancy outcome. Underlying adverse health behavior and possible abuse indicate close surveillance of the

  6. Repeating the Past

    Science.gov (United States)

    Moore, John W.

    1998-05-01

    As part of the celebration of the Journal 's 75th year, we are scanning each Journal issue from 25, 50, and 74 years ago. Many of the ideas and practices described are so similar to present-day "innovations" that George Santayana's adage (1) "Those who cannot remember the past are condemned to repeat it" comes to mind. But perhaps "condemned" is too strong - sometimes it may be valuable to repeat something that was done long ago. One example comes from the earliest days of the Division of Chemical Education and of the Journal.

  7. Corticosteroids reduce IL-6 in ASM cells via up-regulation of MKP-1.

    Science.gov (United States)

    Quante, Timo; Ng, Yee Ching; Ramsay, Emma E; Henness, Sheridan; Allen, Jodi C; Parmentier, Johannes; Ge, Qi; Ammit, Alaina J

    2008-08-01

    The mechanisms by which corticosteroids reduce airway inflammation are not completely understood. Traditionally, corticosteroids were thought to inhibit cytokines exclusively at the transcriptional level. Our recent evidence, obtained in airway smooth muscle (ASM), no longer supports this view. We have found that corticosteroids do not act at the transcriptional level to reduce TNF-alpha-induced IL-6 gene expression. Rather, corticosteroids inhibit TNF-alpha-induced IL-6 secretion by reducing the stability of the IL-6 mRNA transcript. TNF-alpha-induced IL-6 mRNA decays at a significantly faster rate in ASM cells pretreated with the corticosteroid dexamethasone (t(1/2) = 2.4 h), compared to vehicle (t(1/2) = 9.0 h; P ASM cells.

  8. An interesting uncommon side effect of topical corticosteroids-hidradenitis suppurativa

    Directory of Open Access Journals (Sweden)

    Yugandar Inakanti

    2015-07-01

    Full Text Available There are many local and systemic side-effects of topical corticosteroids. To the best of our Knowledge, Hidradenitis Supportive (HS due to topical corticosteroids has not been reported previously. We report a 39-year old, male patient who started himself a topical corticosteroid Pander Plus cream because of itching, scaly lesions over groins and buttocks since 6 months. After 4 months of topical treatment, he developed pus discharging sinuses over both groins and buttocks. Based on patient history, clinical and laboratory findings and the exclusion of other diagnoses, HS points out the use of topical corticosteroids. The case well highlights this unusual condition and represents the first case reported in India to our best of the knowledge. Having performed thorough literature search I would like to discuss in this report the evidence for this relation and stress the importance of appropriate usage of topical corticosteroids.

  9. Pelaksanaan Antenatal Care Berhubungan dengan Anemia pada Kehamilan Trimester III di Puskesmas Sedayu I Yogyakarta

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    Fatimah Fatimah

    2015-11-01

    Full Text Available Anemia is one of the problems in Indonesia that important to examine, especially for pregnant women. This research used quantitative with explanatory design. Population were 44 pregnant women in 3 trimester selected by the total sampling technique. The independent variable were implementation of the antenatal care by midwives and dependent variable is anemia in 3 trimester of pregnancy at Puskesmas Sedayu I Yogyakarta. Data was collected using questionnaire. The analysis used was chi-square. The results of study showed that there was 33 (75% of antenatal care in good category, with no anemia were 32 (72.7% respondents, and there was a significant relationship between antenatal care and anemia in the third trimester of pregnancy with p-value=0.004. In conclusion, there was a significant relationship between antenatal care and anemia in the third trimester of pregnancy. Suggestions were needed to maintain and improve the care of midwives in antenatal care to improve the health of pregnant women, especially anemia in pregnancy.

  10. Antenatal depressive symptoms associated with specific life events and sources of social support among Italian women.

    Science.gov (United States)

    Agostini, Francesca; Neri, Erica; Salvatori, Paola; Dellabartola, Sara; Bozicevic, Laura; Monti, Fiorella

    2015-05-01

    This study aimed to identify different kinds of stressful life events and social support associated with antenatal depressive symptoms in a sample of pregnant Italian women. We conducted the study at a primary health-care centre in an urban area (northeast Italy). Mainly recruited at antenatal classes, 404 eligible pregnant women completed a socio-demographic questionnaire that included questions about the present pregnancy, the Edinburgh Depression Scale (EDS) to estimate the prevalence of depressive symptoms, the Multidimensional Scale of Perceived Social Support and List of Threatening Experiences Questionnaire to investigate the quality and nature of social support and recent negative life events. Of the 404 women, 60 (14.9 %) scored 13 or higher on the EDS. This group reported significantly lower social support from various sources-family, friends, and significant others; only in primiparous women were depressive symptoms significantly related to lower support from friends. Women with EDS scores equal or higher than 13 also reported a higher occurrence of recent stressful life events-specifically, death or a serious problem with a close friend or relative, unemployment, financial problems, and moving or housing difficulties. Regression analyses showed that women with high levels of social support or with a positive experience of pregnancy were less likely to experience antenatal depressive symptoms. Our results underscore the associations among antenatal depression, specific life stressors, and low social support from various sources. Clinical attention to these psychosocial correlates is recommended toward detecting vulnerability to antenatal depressive symptoms.

  11. Thrown off balance: the effect of antenatal inflammation on the developing lung and immune system.

    Science.gov (United States)

    Kunzmann, Steffen; Collins, Jennifer J P; Kuypers, Elke; Kramer, Boris W

    2013-06-01

    In recent years, translational research with various animal models has been helpful to answer basic questions about the effect of antenatal inflammation on maturation and development of the fetal lung and immune system. The fetal lung and immune systems are very plastic and their development can be conditioned and influenced by both endogenous and/or exogenous factors. Antenatal inflammation can induce pulmonary inflammation, leading to lung injury and remodeling in the fetal lung. Exposure to antenatal inflammation can induce interleukin-1α production, which enhances surfactant protein and lipid synthesis thereby promoting lung maturation. Interleukin-1α is therefore a candidate for the link between lung inflammation and lung maturation, preventing respiratory distress syndrome in preterm infants. Antenatal inflammation can, however, cause structural changes in the fetal lung and affect the expression of growth factors, such as transforming growth factor-beta, connective tissue growth factor, fibroblast growth factor-10, or bone morphogenetic protein-4, which are essential for branching morphogenesis. These alterations cause alveolar and microvascular simplification resembling the histology of bronchopulmonary dysplasia. Antenatal inflammation may also affect neonatal outcome by modulating the responsiveness of the immune system. Lipopolysaccharide-tolerance (endotoxin hyporesponsiveness/immunoparalysis), induced by exposure to inflammation in utero, may prevent fetal lung damage, but increases susceptibility to postnatal infections. Moreover, prenatal exposure to inflammation appears to be a predisposition for the development of adverse neonatal outcomes, like bronchopulmonary dysplasia, if the preterm infant is exposed to a second postnatal hit, such as mechanical ventilation oxygen exposure, infections, or steroids.

  12. Antenatal treatment in two Dutch families with pyridoxine-dependent seizures.

    Science.gov (United States)

    Bok, Levinus A; Been, Jasper V; Struys, Eduard A; Jakobs, Cornelis; Rijper, Elisabeth A M; Willemsen, Michèl A

    2010-03-01

    Incidental reports suggest that antenatal treatment of pyridoxine dependent seizures (PDS) may improve neurodevelopmental outcome of affected patients. Two families with PDS are reported, both with two affected siblings. Antenatal treatment with pyridoxine was instituted during the second pregnancy in each family (50 and 60 mg daily from 3 and 10 weeks of gestation, respectively). Perinatal characteristics and neurodevelopmental outcome at 4 (Family A) and 12 (Family B) years of age were compared between the untreated and treated child within each family. Meconium-stained amniotic fluid was present in both first pregnancies and abnormal foetal movements were noticed in one. In the treated infants, pregnancy and birth were uncomplicated. In family A, postnatal pyridoxine supplementation prevented neonatal seizures. Both children in family A were hypotonic and started walking after 2 years of age; both had white matter changes on MRI, and the first child was treated for squint. IQ was 73 and 98 in the antenatally untreated and treated child, respectively. The second child in family B developed seizures on the seventh day, because pyridoxine maintenance therapy had not been instituted after birth. Seizures responded rapidly to pyridoxine supplementation. MRI showed large ventricles and a mega cisterna magna. IQ was 80 and 106 in the antenatally untreated and treated child respectively. Both children had normal motor development. These results suggest that antenatal pyridoxine supplementation may be effective in preventing intrauterine seizures, decreasing the risk of complicated birth and improving neurodevelopmental outcome in PDS.

  13. Hemolytic Uremic Syndrome-associated Encephalopathy Successfully Treated with Corticosteroids.

    Science.gov (United States)

    Hosaka, Takashi; Nakamagoe, Kiyotaka; Tamaoka, Akira

    2017-09-25

    The encephalopathy that occurs in association with hemolytic uremic syndrome (HUS), which is caused by enterohemorrhagic Escherichia coli (E. coli), has a high mortality rate and patients sometimes present sequelae. We herein describe the case of a 20-year-old woman who developed encephalopathy during the convalescent stage of HUS caused by E.coli O26. Hyperintense lesions were detected in the pons, basal ganglia, and cortex on diffusion-weighted brain MRI. From the onset of HUS encephalopathy, we treated the patient with methylprednisolone (mPSL) pulse therapy alone. Her condition improved, and she did not present sequelae. Our study shows that corticosteroids appear to be effective for the treatment of some patients with HUS encephalopathy.

  14. Oral Corticosteroids in Asthma: A Review of Benefits and Risks

    Directory of Open Access Journals (Sweden)

    Robert Schellenberg

    2007-01-01

    Full Text Available Oral corticosteroids (OCS play an integral role in the pharmacological management of asthma, as well as a number of other inflammatory and autoimmune disorders. However, although their broad spectrum of effect is beneficial in controlling inflammation, it can also lead to undesirable effects on other cells, resulting in adverse effects. The purpose of the present review is to discuss the particular benefits of OCS and to outline the optimal role of these agents in the management of asthma, drawing on evidence-based medicine and current clinical practice guidelines. The mandate for the present review also covers an analysis of the risk:benefit ratio as it pertains to OCS use in asthma. The more common adverse effects will be discussed and weighed against the possible benefits.

  15. short history of anti-rheumatic therapy. IV. Corticosteroids

    Directory of Open Access Journals (Sweden)

    P. Marson

    2011-06-01

    Full Text Available In 1948 a corticosteroid compound was administered for the first time to a patient affected by rheumatoid arthritis by Philip Showalter Hench, a rheumatologist at the Mayo Clinic in Rochester, Minnesota (USA. He was investigating since 1929 the role of adrenal gland-derived substances in rheumatoid arthritis. For the discovery of cortisone and its applications in anti-rheumatic therapy, Hench, along with Edward Calvin Kendall and Tadeusz Reichstein, won the 1950 Nobel Prize for Medicine. In this review we summarize the main stages that led to the identification of the so-called compound E, which was used by Hench. We also consider the subsequent development of steroid therapy in rheumatic diseases, through the introduction of new molecules with less mineralocorticoid effects, such as prednisone, and more recently, deflazacort.

  16. Chronic rhinitis: Effects of local corticosteroids on eosinophils

    Directory of Open Access Journals (Sweden)

    Ursulović Dejan D.

    2002-01-01

    Full Text Available Clinical manifestation of chronic rhinitis is due to local release of mediators from inflammatory cells. Eosinophil leukocytes are important in pathogenesis of nasal hypersensitivity as well as nasal hyperreactivity [1,2]. The aim of the study was to follow-up the effect of local corticosteroid treatment on a number of eosinophils in nasal secretion of patients with chronic rhinitis. The study was prospective and controlled. A total number of 88 subjects was included in the study. Patients with chronic rhinitis who were treated with local corticosteroids (63 constituted the experimental group (37 with isolated allergic rhinitis, 10 with isolated nonallergic noninfective hyperreactive rhinitis, 10 with allergic rhinitis associated with nasal polyposis and 6 with nonallergic noninfective hyperreactive rhinitis associated with nasal polyposis. There were 25 patients with chronic rhinitis in the control group (18 with iso- lated allergic rhinitis, 2 with isolated nonallergic noninfective hyperreactive rhinitis, 3 with allergic rhinitis associated with nasal polyposis, and 2 with nonallergic noninfective, hyperreactive rhinitis associated with nasal polyposis. During the treatment with beclomethasone dipropionate aqueous nasal spray (daily dose was 400 micrograms during 6 weeks for isolated rhinitis and 6 months for associated forms of rhinitis, control examinations were regularly performed. The first control was after one week the second after six weeks, the third after three months and the fourth after six months. The same control was carried out in the control group of patients who were without therapy. Cytological examination of nasal secretions included brush method of collecting secretions, staining smears with Leishman's stain and light microscopic scrutinising of nasal smear magnified up to 1000 times. The results of the study demonstrated the highly significant decrease in the number of eosinophils after the therapy in patients with isolated

  17. Inhaled corticosteroids: Effects on growth and bone health.

    Science.gov (United States)

    Skoner, David P

    2016-12-01

    Both slowed growth in children and reduced bone mineral density (BMD) are systemic effects of corticosteroids, and there is concern about the degree to which these systemic effects affect growth and BMD. To engage in a data-driven discussion of the effects of inhaled corticosteroids (ICSs) on growth in children and BMD. Articles were selected based on their relevance to this review. Studies of ICSs in children in which growth was a secondary outcome have revealed slowed growth associated with low doses of budesonide, fluticasone propionate, and beclomethasone dipropionate. In the study of budesonide, the effect was permanent, and in the study of fluticasone propionate, the effect was long-lasting, but it is unclear whether the effect was permanent. However, the results of studies in which growth was the primary outcome were mixed. Slowed growth was detected in a study of beclomethasone dipropionate; however, slowed growth was not detected in a study of ciclesonide or flunisolide. A decrease in BMD acquisition in children was associated with high doses but not low to medium doses of ICSs. In adults, there was a dose-related effect of ICSs on BMD. Both higher daily dose and larger cumulative dose were associated with increased bone density loss. Because of the systemic effects on growth and bone health, children should be monitored for growth using stadiometry every 3 to 6 months and BMD should be monitored yearly in patients being treated with high doses of ICSs. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  18. Complications of plantar fascia rupture associated with corticosteroid injection.

    Science.gov (United States)

    Acevedo, J I; Beskin, J L

    1998-02-01

    From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7 degrees (P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.

  19. Effectiveness of Corticosteroid Injections for Treatment of de Quervain's Tenosynovitis.

    Science.gov (United States)

    Oh, Jinhee K; Messing, Susan; Hyrien, Ollivier; Hammert, Warren C

    2017-07-01

    Although surgery can provide definitive treatment for de Quervain's tenosynovitis, nonoperative treatment could be preferable if symptoms are predictably relieved. We sought to determine the effectiveness of corticosteroid injections as treatment for de Quervain's tenosynovitis and to evaluate patient characteristics as predictors of treatment outcome. A retrospective study was conducted using our institutional database International Classification of Disease, version 9 (ICD-9) code list for de Quervain's tenosynovitis. Treatment success was defined as relief of symptoms after 1 or 2 injections. Relief was defined as resolution or improvement to the extent that the patient did not seek further intervention. Failure was defined as a subsequent surgical release or a third injection. Logistic regression analyses were performed to look for univariate associations between patient demographics/comorbidities and risk of treatment failure. The treatment outcome of 222 limbs from 199 patients was studied. Of the 222 limbs, 73.4% (95% confidence interval [CI], 66.9%-79.1%) experienced treatment success within 2 injections, and 51.8% (95% CI, 45.0%-58.6%) experienced success after 1 injection. Body mass index (BMI) >30 and female sex were found to be significantly associated with treatment failure, with a 2.4-fold increase (95% CI, 1.02%-5.72%) in odds and 3.23 times greater (95% CI, 1.08%-9.67%) odds of failure, respectively. Although not reaching statistical significance, African American race, hypothyroidism, and carpal tunnel syndrome suggested increased odds of failure. This study indicates that corticosteroid injections are a useful treatment for de Quervain's tenosynovitis, leading to treatment success 73.4% of the time within 2 injections. This study also suggests that female sex and BMI >30 are associated with increased treatment failure.

  20. The effect in premature infants of prenatal corticosteroids on endogenous surfactant synthesis as measured with stable isotopes

    NARCIS (Netherlands)

    J.E.H. Bunt (Jan Erik); V.P. Carnielli (Virgilio); J.L.D. Wattimena (Josias); W.C.J. Hop (Wim); P.J.J. Sauer (Pieter); L.J.I. Zimmermann (Luc)

    2000-01-01

    textabstractMost in vitro studies show that prenatal administration of corticosteroids stimulates the synthesis of surfactant phosphatidylcholine (PC), but studies in animals are controversial. Whether prenatal corticosteroids stimulate surfactant PC synthesis in humans

  1. Inhaled corticosteroid treatment modulates ZNF432 gene variant's effect on bronchodilator response in asthmatics

    Science.gov (United States)

    Wu, Ann C.; Himes, Blanca E.; Lasky-Su, Jessica; Litonjua, Augusto; Peters, Stephen P.; Lima, John; Kubo, Michiaki; Tamari, Mayumi; Nakamura, Yusuke; Qiu, Weiliang; Weiss, Scott T.; Tantisira, Kelan

    2013-01-01

    Background Single nucleotide polymorphisms (SNPs) influence a patient's response to inhaled corticosteroids and β2-agonists, and the effect of treatment with inhaled corticosteroids is synergistic with the effect of β2-agonists. We hypothesized that use of inhaled corticosteroids could influence the effect of SNPs associated with bronchodilator response. Objective To assess whether, among asthma subjects, the association of SNPs with bronchodilator response is different between those treated with inhaled corticosteroids vs. those on placebo. Methods A genome-wide association analysis was conducted using 581 white subjects from the Childhood Asthma Management Program (CAMP). Using data for 449,540 SNPs, we conducted a gene by environment analysis in PLINK with inhaled corticosteroid treatment as the environmental exposure and bronchodilator response as the outcome measure. We attempted to replicate the top 12 SNPs in the Leukotriene Modifier Or Corticosteroid or Corticosteroid-Salmeterol (LOCCS) Trial. Results The combined P-value for the CAMP and LOCCS populations was 4.81E-08 for rs3752120, which is located in the zinc finger protein gene ZNF432, and has unknown function. Conclusions Inhaled corticosteroids appear to modulate the association of bronchodilator response with variant(s) in the ZNF432 gene among adults and children with asthma. Clinical Implications Clinicians who treat asthma patients with inhaled corticosteroids should be aware that the patient's genetic makeup likely influences response as measured in lung function. Capsule Summary Our study suggests that inhaled corticosteroids could influence the effect of multiple SNPs associated with bronchodilator response across the genome. PMID:24280104

  2. All-optical repeater.

    Science.gov (United States)

    Silberberg, Y

    1986-06-01

    An all-optical device containing saturable gain, saturable loss, and unsaturable loss is shown to transform weak, distorted optical pulses into uniform standard-shape pulses. The proposed device performs thresholding, amplification, and pulse shaping as required from an optical repeater. It is shown that such a device could be realized by existing semiconductor technology.

  3. Bidirectional Manchester repeater

    Science.gov (United States)

    Ferguson, J.

    1980-01-01

    Bidirectional Manchester repeater is inserted at periodic intervals along single bidirectional twisted pair transmission line to detect, amplify, and transmit bidirectional Manchester 11 code signals. Requiring only 18 TTL 7400 series IC's, some line receivers and drivers, and handful of passive components, circuit is simple and relatively inexpensive to build.

  4. Effectiveness of advertising availability of prenatal ultrasound on uptake of antenatal care in rural Uganda: A cluster randomized trial.

    Science.gov (United States)

    Cherniak, William; Anguyo, Geoffrey; Meaney, Christopher; Yuan Kong, Ling; Malhame, Isabelle; Pace, Romina; Sodhi, Sumeet; Silverman, Michael

    2017-01-01

    In rural Uganda pregnant women often lack access to health services, do not attend antenatal care, and tend to utilize traditional healers/birth attendants. We hypothesized that receiving a message advertising that "you will be able to see your baby by ultrasound" would motivate rural Ugandan women who otherwise might use a traditional birth attendant to attend antenatal care, and that those women would subsequently be more satisfied with care. A cluster randomized trial was conducted across eight rural sub-counties in southwestern Uganda. Sub-counties were randomized to a control arm, with advertisement of antenatal care with no mention of portable obstetric ultrasound (four communities, n = 59), or an intervention arm, with advertisement of portable obstetric ultrasound. Advertisement of portable obstetric ultrasound was further divided into intervention A) word of mouth advertisement of portable obstetric ultrasound and antenatal care (one communitity, n = 16), B) radio advertisement of only antenatal care and word of mouth advertisement of antenatal care and portable obstetric ultrasound (one community, n = 7), or C) word of mouth + radio advertisement of both antenatal care and portable obstetric ultrasound (two communities, n = 75). The primary outcome was attendance to antenatal care. 159 women presented to antenatal care across eight sub-counties. The rate of attendance was 65.1 (per 1000 pregnant women, 95% CI 38.3-110.4) where portable obstetric ultrasound was advertised by radio and word of mouth, as compared to a rate of 11.1 (95% CI 6.1-20.1) in control communities (rate ratio 5.9, 95% CI 2.6-13.0, padvertising antenatal care and portable obstetric ultrasound by radio attendance was significantly improved. This study suggests that women can be motivated to attend antenatal care when offered the concrete incentive of seeing their baby.

  5. Repeat survey of current practice regarding corticosteroid prophylaxis for patients at increased risk of adverse reaction to intravascular contrast agents

    Energy Technology Data Exchange (ETDEWEB)

    Radhakrishnan, S. [Department of Radiology, Wishaw General Hospital, Lanarkshire Acute Hospitals NHS Trust, 50, Netherton Street, Wishaw, Lanarkshire ML2 0DP (United Kingdom)]. E-mail: sureshradhakrish@hotmail.com; Manoharan, S. [Department of Radiology, Wishaw General Hospital, Lanarkshire Acute Hospitals NHS Trust, 50, Netherton Street, Wishaw, Lanarkshire ML2 0DP (United Kingdom); Fleet, M. [Department of Radiology, Wishaw General Hospital, Lanarkshire Acute Hospitals NHS Trust, 50, Netherton Street, Wishaw, Lanarkshire ML2 0DP (United Kingdom)

    2005-01-01

    AIM: To compare the findings of a survey undertaken by us in 2002 regarding steroid premedication given in radiology departments to reduce the risk of adverse reactions in patients at increased risk of intravascular contrast media reactions with a similar survey published in 1994 by R. Seymour et al. The high risk patients considered in our survey were patients with history of asthma, drug allergies, hay fever and eczema. MATERIALS AND METHODS: A total of 225 questionnaires were sent to the consultant in charge for audit for radiology departments from the list given by the Royal College of Radiologists. 175 of the 225 questionnaires were returned (response rate 77.8%) and of these 172 were analysed with respect to the type, dose and duration of steroids. RESULTS: Compared to the survey in 1994, it was found that the number of departments who use steroid cover for all category of risk factors had increased compared to previous survey (73.8% in 2002 versus 55.3% in 1994 (p=0.001). There is now almost universal use of non-ionic contrast 98.8% versus 82.4% in 1994 (p=0.001). There is no agreed policy among radiology departments for the need or the dose or duration of steroid cover. CONCLUSION: Despite the more widespread use of non-ionic contrast media, the use of steroid premedication has increased which is contrary to what is expected as the incidence of adverse reaction to non ionic media is less than ionic contrast media.

  6. HUBUNGAN PENGETAHUAN, SIKAP IBU HAMIL TERHADAP KUNJUNGAN PELAYANAN ANTENATAL DI KECAMATAN KALIMANAH KABUPATEN PURBALINGGA

    Directory of Open Access Journals (Sweden)

    Ichda Masrianto

    2012-09-01

    Full Text Available Low coverage of antenatal care are caused by efficiency knowledge of antenatal care (ANC, and correspounds with attitude of pregnant women to ward ANC. The research were examined correlation between knowledge and attitude of pregnant women to ward ANC and ANC visits. Subject were 76 women who have the first baby (born on Agust 1999, in Kalimanah Purbalingga district. The result indicated no significant correlation were found between pregnant women age and ANC visits, there is no significant correlation between women children number and ANC visits, but some significant correlation were found between education, knowledge, attitude and ANC visits, knowledge and attitude with ANC visits.  Key Words : Attitude to Health, Antenatal Care.

  7. Teenage pregnancy antenatal and perinatal morbidity: results from a tertiary centre in Greece.

    Science.gov (United States)

    Pergialiotis, V; Vlachos, D-E G; Gkioka, E; Tsotra, K; Papantoniou, N; Vlachos, G D

    2015-01-01

    We present the experience of a tertiary referral hospital in Greece, evaluating obstetric and perinatal outcomes among teenage and average maternal age (AMA) women. We retrospectively assessed all singleton pregnancies during a twelve-month period (January-December 2012). A total of 1,704 cases were reviewed and divided into two groups: one of AMA mothers (20-34 years old) (1,460 women) and the other of teenage mothers (12-19 years old) (244 women). We observed significantly higher incidence rates of preterm births (p teenage mothers. Antenatal surveillance was decreased among teenage mothers (p Teenage pregnancy is accompanied by significant antenatal and perinatal complications that need specific obstetrical attention. Obstetricians should be aware of these complications in order to ameliorate the antenatal outcome of childbearing teenagers.

  8. Experiences of expressing and storing colostrum antenatally: A qualitative study of mothers in regional Western Australia.

    Science.gov (United States)

    Brisbane, Joanna M; Giglia, Roslyn C

    2015-06-01

    This qualitative study explored the experiences and breastfeeding outcomes of a group of mothers who expressed colostrum in the antenatal period. In-depth interviews were conducted over the telephone with 12 women who had attended a unique antenatal lactation clinic appointment at 37 weeks' gestation. Seven main response themes were identified. Most women reflected positively upon their attendance and reported that the experience of expressing colostrum allowed them to become familiar with their breasts and gave them a sense of security by having a supply of colostrum stored for possible use after birth. The main negative emotions reported were a sense of embarrassment at expressing the colostrum, particularly in front of another person, the difficulties with expressing colostrum and in one instance, the physical pain associated with the process. Antenatal expression of colostrum may improve maternal breastfeeding confidence. Further research using long-term records will determine whether this practice improves breastfeeding outcomes.

  9. The influence of antenatal exposure to phthalates on subsequent female reproductive development in adolescence

    DEFF Research Database (Denmark)

    Hart, Roger; Doherty, Dorota A; Frederiksen, Hanne

    2014-01-01

    We hypothesised that antenatal exposure to ubiquitous phthalates may lead to an earlier menarche and a lower prevalence of polycystic ovarian syndrome (PCOS) and polycystic ovarian morphology (PCO) in adolescence. The Western Australian Pregnancy Cohort (Raine) Study recruited 3000 women at 18...... weeks of gestation in 1989-91, 1377 had antenatal serum stored without thawing at -80°C. An unselected subset was evaluated in the early follicular phase for PCO and PCOS by ultrasound and serum evaluation in adolescence. Serum was analysed for Anti-Mullerian Hormone (AMH), inhibin B, sex.......m) was protective against PCOS in adolescence (p=0.001, p=0.005, respectively). There were negative associations of MEP with PCO (p=0.022), and MEP with serum AMH (p=0.031). Consequently our data suggests that antenatal exposure to environmental phthalates may be associated with oestrogenic and/or anti...

  10. Antenatal care strengthening for improved health behaviours in Jimma, Ethiopia, 2009-2011

    DEFF Research Database (Denmark)

    Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe

    2016-01-01

    (OR 2.4, 95% CI: 1.5; 3.5). There was no effect on infant immunisation coverage and negative effect on number of antenatal visits. The effect on various outcomes was modified by maternal education, and results indicate increased health facility delivery (OR 2.4, 95% CI: 0.8; 6.9) and breast feeding......INTRODUCTION: health systems in low-income settings are not sufficiently reaching the poor, and global disparities in reproductive health persist. The frequency and quality of health education during antenatal care is often low. Further studies are needed on how to improve the performance of health...... systems in low income settings to improve maternal and child health. OBJECTIVES: to assess the effectiveness of a participatory antenatal care intervention on health behaviours and to illuminate how the different socioeconomic groups responded to the intervention in Jimma, Ethiopia. SETTING, INTERVENTION...

  11. Antenatal pelvic floor exercises: a survey of both patients' and health professionals' beliefs and practice.

    Science.gov (United States)

    Guerrero, K; Owen, L; Hirst, G; Emery, S

    2007-10-01

    The aim was to discover how often women perform pelvic floor exercises (PFE) in the antenatal period and how they wished to be taught. We compared this with the opinions of the health professionals looking after them. A total of 54 women attending the antenatal day assessment unit completed questionnaires. A total of 21 obstetricians, 29 midwives and 25 GPs returned similar questionnaires. Most women think they should be performing PFE daily but only 15% do so. Some 57% of the women wanted to be taught in the antenatal period. Over 50% of the women/midwives believed that PFE should be taught in an individual basis. Obstetricians/GPs favoured classes. A total of 76% of the women want midwives to teach them PFE and 57% of midwives agree. Most health professionals felt that they had not received adequate training on PFE. The midwife is felt to be the best placed person to teach PFE. Health professionals give PFE low priority.

  12. Do antenatal education classes decrease use of epidural analgesia during labour? – a Danish RCT

    DEFF Research Database (Denmark)

    Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Axelsen, Solveig Forberg;

    , and reduce fear during birth which in turn may decrease use of pain relief. Few randomised trials have examined the effect of attending antenatal education in small groups on use of epidural analgesia and among these conclusions are conflicting. The objective of this study was therefore to examine the effect......Background: Epidural analgesia is widely used as pain relief during labour but has negative side effects, such as prolonged labour and increased risk of obstetric interventions. Antenatal education in small groups may increase trust in own ability to cope at home in the early stages of labour...... on whether to implement the NEWBORN program in a clinical setting also depend upon the trial effect on psycho-social outcomes which will be analysed in near future. Main messages (max 200 anslag): 1. No effect of antenatal education in small groups on use of epidural analgesia as pain relief during labour...

  13. Oral and inhaled corticosteroids: Differences in P-glycoprotein (ABCB1) mediated efflux

    Energy Technology Data Exchange (ETDEWEB)

    Crowe, Andrew, E-mail: a.p.crowe@curtin.edu.au; Tan, Ai May

    2012-05-01

    There is concern that P-glycoprotein mediated efflux contributes to steroid resistance. Therefore, this study examined bidirectional corticosteroid transport and induction capabilities for P-glycoprotein (P-gp) to understand which of the systemic and inhaled corticosteroids interacted with P-gp to the greatest extent. Hydrocortisone, prednisolone, prednisone, methylprednisolone, and dexamethasone represented systemically active drugs, while fluticasone propionate, beclomethasone dipropionate, ciclesonide and budesonide represented inhaled corticosteroids. Aldosterone and fludrocortisone represented mineralocorticoids. All drugs were detected using individually optimised HPLC protocols. Transport studies were conducted through Caco-2 monolayers. Hydrocortisone and aldosterone had efflux ratios below 1.5, while prednisone showed a P-gp mediated efflux ratio of only 1.8 compared to its active drug, prednisolone, with an efflux ratio of 4.5. Dexamethasone and beclomethasone had efflux ratios of 2.1 and 3.3 respectively, while this increased to 5.1 for methylprednisolone. Fluticasone showed an efflux ratio of 2.3. Protein expression studies suggested that all of the inhaled corticosteroids were able to induce P-gp expression, from 1.6 to 2 times control levels. Most of the systemic corticosteroids had higher passive permeability (> 20 × 10{sup −6} cm/s) compared to the inhaled corticosteroids (> 5 × 10{sup −6} cm/s), except for budesonide, with permeability similar to the systemic corticosteroids. Inhaled corticosteroids are not transported by P-gp to the same extent as systemic corticosteroids. However, they are able to induce P-gp production. Thus, inhaled corticosteroids may have greater interactions with other P-gp substrates, but P-gp itself is less likely to influence resistance to the drugs. -- Highlights: ► Inhaled corticosteroids are only weak substrates for P-gp, including budesonide. ► Inhaled corticosteroid potent P-gp inducers especially

  14. Burden of corticosteroid use in patients with systemic lupus erythematosus: results from a Delphi panel.

    Science.gov (United States)

    Petri, M; Bechtel, B; Dennis, G; Shah, M; McLaughlin, T; Kan, H; Molta, C

    2014-09-01

    Corticosteroid-related adverse events (AEs) are commonly reported in systemic lupus erythematosus (SLE), but are often under-represented in claims data. The most common corticosteroid-related AEs are not necessarily the most costly. The present study aimed to examine corticosteroid-related AE rates and identify the associated cost consequences in patients with SLE from the perspective of rheumatologists treating SLE in the United States (US). A modified Delphi process and RAND Appropriateness Method was used to estimate corticosteroid-related AEs and costs based on data from SLE-treating US rheumatologists and estimates from alternative sources. The panel (n=10) participated in two web-based questionnaires, covering disease severity, corticosteroid use, corticosteroid-related AEs, and resource utilization associated with treatment of the AEs. Eight members of the panel then participated in a guided discussion by interactive teleconference, in which the costs associated with specific corticosteroid-related AEs were also discussed. Consensus was achieved in the teleconference when a single response category (consensus values from 1 to 4 [4=strongly agree, 1=strongly disagree]) accounted for ≥80% of responses. Thirteen consensus statements were developed following two Delphi rounds. Costs were estimated for eight corticosteroid-associated AEs from the panel of rheumatologists. In the patients with SLE treated by these physicians, 41.5% were considered to have mild disease, 36.5% moderate disease, and 22.0% severe disease. The number of specialist visits, corticosteroid use, and corticosteroid dose increased with disease severity. The estimated rates of all AEs (except for cataracts) were at least doubled in patients receiving corticosteroid doses>20 mg/day compared with ≤20 mg/day. The highest estimated mean total costs of an event (for the required treatment duration for one patient) were for avascular necrosis ($14,460) and serious infection ($11,660). The

  15. Antenatal Screening for Hypothyroidism and Childhood Cognitive Impairment

    Science.gov (United States)

    Lazarus, John H.; Bestwick, Jonathan P.; Channon, Sue; Paradice, Ruth; Maina, Aldo; Rees, Rhian; Chiusano, Elisabetta; John, Rhys; Guaraldo, Varvara; George, Lynne M.; Perona, Marco; Dall’Amico, Daniela; Parkes, Arthur B.; Jooman, Mohammed; Wald, Nicholas J.

    2013-01-01

    Background Children born to women with low thyroid hormone levels have been reported to have decreased cognitive function. Methods We conducted a randomized trial in which pregnant women at a gestation of 15 weeks 6 days or less provided blood samples for measurement of thyrotropin and free thyroxine (T4). Women were assigned to a screening group (in which measurements were obtained immediately) or a control group (in which serum was stored and measurements were obtained shortly after delivery). Thyrotropin levels above the 97.5th percentile, free T4 levels below the 2.5th percentile, or both were considered a positive screening result. Women with positive findings in the screening group were prescribed 150 μg of levothyroxine per day. The primary outcome was IQ at 3 years of age in children of women with positive results, as measured by psychologists who were unaware of the group assignments. Results Of 21,846 women who provided blood samples (at a median gestational age of 12 weeks 3 days), 390 women in the screening group and 404 in the control group tested positive. The median gestational age at the start of levothyroxine treatment was 13 weeks 3 days; treatment was adjusted as needed to achieve a target thyrotropin level of 0.1 to 1.0 mIU per liter. Among the children of women with positive results, the mean IQ scores were 99.2 and 100.0 in the screening and control groups, respectively (difference, 0.8; 95% confidence interval [CI], −1.1 to 2.6; P = 0.40 by intention-to-treat analysis); the proportions of children with an IQ of less than 85 were 12.1% in the screening group and 14.1% in the control group (difference, 2.1 percentage points; 95% CI, −2.6 to 6.7; P = 0.39). An on-treatment analysis showed similar results. Conclusions Antenatal screening (at a median gestational age of 12 weeks 3 days) and maternal treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age. (Funded by the Wellcome Trust UK and

  16. Rural Indonesia women’s traditional beliefs about antenatal care

    Directory of Open Access Journals (Sweden)

    Agus Yenita

    2012-10-01

    Full Text Available Abstract Background The Indonesia Maternal Mortality Rate (MMR of 420/100.00 live births remains among the highest in East Asia while coverage of births assisted by skilled providers is still low. Traditional beliefs have been a key factor associated with the choice between midwives or traditional birth attendants (TBA and the low number of antenatal care visits in rural West Sumatra. Methods We conducted three focus groups with 16 women from rural West Java to describe their perception regarding issues related to traditional beliefs. Focus group discussions provided data for the content analysis. Results The majority of the 16 women interviewed was from Village Dago, West Java and had only an elementary school education. Their ages ranged from 19 to 40 years. Most were multiparous housewives with an income of IDR 918.750 per month, which was lower than the monthly income in West Java (IDR. 1.172.060. Emerging from the focus group discussion were four main themes regarding their pregnancy and traditional beliefs: 1 pregnancy was a normal cycle in women’s life (pregnancy is a natural phenomena, not a sickness; no recognition of danger signs during pregnancy and death of baby or mother during pregnancy was brought about by God’s will; 2 women followed the traditional beliefs (positive motivation to follow the traditional beliefs and fear of not following the traditional beliefs; 3 relying on TBA called paraji rather than midwife (parajis are kind, tolerant and patient and have more experience than midwives; more accessibility than midwives and encouragement of natural birth and 4 midwives are more secure than paraji; (they use a medical standard of care. Conclusions Women’s beliefs grounded in religion and tradition permeated the village culture making it difficult to counter their long held health practices with practices based on recent advances in health care. Use of TBA in this village was still dominant and women believed that following

  17. Discourse Acts in Antenatal Clinic Literacy Classroom in South-Western Nigeria

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    Taiwo, Rotimi

    2007-01-01

    Full Text Available This study examines the organization of discourse in antenatal classrooms in south-western Nigeria. Antenatal literacy classrooms are classes organized in hospitals and health centres for pregnant women to intimate them with the necessary health information needed in pregnancy. The data for this study were randomly selected from series of data recorded during some antenatal classes in some selected hospitals in Ile-Ife and its environs, all in south-western Nigeria. The data consist of tape recordings of the classroom sessions and observational notes. The study reveals that three categories of discourse act were most prominent in the data - informative, elicitation and directive. This shows that the antenatal educators were more active in the classes than the students. They maximized the use of their power in discourse, which gives them the [+ HIGHER] role. They therefore had the privilege to talk while the mothers listened. This places the pregnant women at the disadvantage of being passive learners, who cannot see the knowledge being passed across beyond the context of the class. Despite that they have access to information, they are not adequately empowered to influence the society with what they are being exposed to. Their perception of their role in the discourse was that of listeners. The findings have significant implications for health literacy programmes in Nigeria. It clearly shows that health literacy programmes, as we have observed in antenatal classrooms exist only as an aspect of functional health literacy - the aspect that recognizes that pregnant women need to know about their health by listening to experts. This makes the practice, as it is essentially transactional. The study concludes that for antenatal classrooms to achieve their goal of health security of pregnant women and their foetus, they have to be more interactive. There must be a departure from the lecture method used now to a method that actually involves the mothers.

  18. Antenatal Health Care and Postnatal Dental Check-Ups Prevent Early Childhood Caries.

    Science.gov (United States)

    Nakai, Yukie; Mori, Yukako; Tamaoka, Izumi

    2016-01-01

    The first stage of early childhood caries (ECC) is infection by mutans streptococci, of which the primary infection source is the child's mother. Early intervention programs including antenatal and postnatal phases are effective for reducing ECC. This study was conducted to assess the respective effects of antenatal health care and postnatal care such as regular dental check-ups on reducing ECC among 3-year-old Japanese children. This nested case-control study of 155 three-year-old children (49.0% boys) was conducted at a dental clinic that provides collaborative health services with the Obstetrics and Gynecology Clinic, Okayama. Child characteristics and the mothers' antenatal data were collected retrospectively from the dental charts. They were divided into two groups: caries-free children (n = 77) and children without ECC (n = 78). Most of the children (81.9%) received regular check-ups with topical fluoride application. Most of the mothers reported morning sickness during pregnancy (81.3%), normal delivery (72.9%), and used antenatal health care (80.6%). Over half (55.5%) were primigravida. Adjusted odds ratio (AOR) and 95% confidential interval (95% CI) were computed to assess the strength of association using logistic regression analysis. Receiving antenatal health care (AOR, 3.27; 95% CI, 1.30-8.24) and child's having regular check-ups (AOR, 3.42; 95% CI, 1.35-8.69) were significantly associated with caries-free status among three-year old children. For ECC prevention, antenatal health care is as effective as regular check-ups up to three years of age. The results of this retrospective study demonstrate that maternal health education during pregnancy is effective for ECC prevention.

  19. Strategies for coping with labour: does antenatal education translate into practice?

    Science.gov (United States)

    Spiby, H; Henderson, B; Slade, P; Escott, D; Fraser, R B

    1999-02-01

    There is little evidence to associate attendance at antenatal classes with a reduction in psychological distress or increased satisfaction with the experience of labour. There may be several reasons for this, including failure to implement coping strategies. A within-subjects research design explored the use in labour of coping strategies taught in antenatal classes and the role of practice. Women's views about using these strategies and their expectations of their midwives and birth companions were also identified. Following Ethics Committee approval and providing informed consent, 121 nulliparous women completed a questionnaire at their final antenatal class. This included questions on confidence and the amount of effort required to use coping strategies, the involvement hoped for from birth companions and midwives in using coping strategies in labour and satisfaction with the amount of practice of coping strategies. Within 72 hours of delivery, women were interviewed to obtain a narrative of the events of labour and their use of the coping strategies (sighing-out-slowly breathing, Laura Mitchell relaxation and postural change). A questionnaire obtained information on the involvement of the midwife and birth companion. Women used the three coping strategies to different extents. Midwives were not involved to the extent that women had hoped for antenatally. Birth companions achieved a level of involvement closer to women's hopes than that achieved by midwives. A significant proportion of women expressed dissatisfaction with the amount of practice of coping strategies during antenatal classes. The findings of this study of a group of well-prepared women raise questions about the correct components of antenatal classes and how midwives and birth companions can be involved optimally in this aspect of a woman's labour. Further research is required to determine how women can best be helped to cope with the experience of labour.

  20. Repeat HIV testing during pregnancy and delivery: missed opportunities in a rural district hospital in Zambia.

    Science.gov (United States)

    Heemelaar, Steffie; Habets, Nicole; Makukula, Ziche; van Roosmalen, Jos; van den Akker, Thomas

    2015-03-01

    To assess coverage of repeat HIV testing among women who delivered in a Zambian hospital. HIV testing of pregnant women and repeat testing every 3 months during pregnancy and breastfeeding is the recommended policy in areas of high HIV prevalence. A prospective implementation study in a second-level hospital in rural Zambia. Included were all pregnant women who delivered in hospital during May and June 2012. Data regarding antenatal visits and HIV testing were collected by two investigators using a standardised form. Of 401 women who delivered in hospital, sufficient antenatal data could be retrieved for 322 (80.3%) women. Of these 322 women, 301 (93.5%) had attended antenatal care (ANC) at least once. At the time of discharge after delivery in hospital, 171 (53.1%) had an unclear HIV status because their negative test result was more than 3 months ago or of an unknown date, or because they had not been tested at all during pregnancy or delivery. An updated HIV status was present for 151 (46.9%) women: 25 (7.8%) were HIV positive and 126 (39.1%) had tested negative within the last 3 months. In this last group, 79 (24.5%) had been tested twice or more during pregnancy. During the study period, none of the women was tested during admission for delivery. Despite high ANC coverage, opportunities for repeat HIV testing were missed in almost half of all women who delivered in this hospital in a high-prevalence HIV setting. © 2014 John Wiley & Sons Ltd.

  1. The Process of Adapting an Australian Antenatal Group-Based Parenting Program to Japanese and Vietnamese Public Service Settings

    Science.gov (United States)

    Goto, Aya; Suzuki, Yuriko; Tsutomi, Hiroshi; Nguyen, Vinh Quang; Nguyen, Tu Van Thi; Yamazaki, Sachiko; Okazaki, Keiko; Nguyen, Tuyet Hong Thi; Hoang, Hoa Quoc; Yasumura, Seiji

    2012-01-01

    Antenatal maternal mental health status not only predicts postpartum mental status, but also influences family health. In Asia, however, little scientific research has been conducted on antenatal parenting intervention to date, nor has there been much emphasis on fathers in considerations of parenting support. Building upon our past research…

  2. Utilization Patterns of Antenatal Services Among Pregnant Women: A Longitudinal Study in Rural Area of North Karnataka.

    Directory of Open Access Journals (Sweden)

    C.S.Metgud

    2009-05-01

    Full Text Available Objectives: 1.To study the profile of antenatal care received 2. To know the factors influencing the utilization Study Design: Longitudinal study.Setting: Shindolli village of Belgaum District Participants: All women (n =130 in this village who were pregnant at the start of the study and who became pregnant during the study. Statistical Analysis: Proportions and Chi-square Test Results: Most of the pregnant women (92.31% were registered for antenatal care, but only 30.00% of them were registered in the 1st trimester of pregnancy. As regards to TT immunization, 70.77% of the pregnant women had received 2 doses or 1 booster dose. Iron and Folic Acid supplementation was taken by 59.68% of the pregnant women. Nearly 39.52 % of pregnant women were provided with full antenatal care. The main antenatal care provider for pregnant women was doctor (64.52%. The provision of full antenatal care package was found to be significantly higher among the pregnant women belonging to social classes I and II and in those who have studied above SSLC. Conclusion: The study shows early and wide spread use of antenatal care, but it also reveals that the antenatal visits occur late in the pregnancy. The literacy of women has significant bearing on utilization of antenatal care by the pregnant women.

  3. Wealth and antenatal care use: Implications for maternal health care utilisation in Ghana

    OpenAIRE

    Arthur, Eric

    2012-01-01

    The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths....

  4. [Antenatal Steroid Therapy in Threatened Premature Birth - State of the Art].

    Science.gov (United States)

    Stavropoulou, Dimitra; Hentschel, Roland

    2017-09-15

    The aim of this work is to provide an overview of the recommendations in the current literature for the induction of lung maturation therapy. In particular, special attention is focused on specific situations, such as chorioamnionitis, intrauterine growth retardation and preeclampsia, which often lead to premature birth. Additionally, some aspects of antenatal steroid therapy, despite its widespread use, still require clarification. Among them is the repetitive administration of steroid therapy. On the basis of the Cochrane analysis of 2015, advantages and disadvantages for children and pregnant women are explained. Furthermore, the data on the use of antenatal steroid therapy in multiple pregnancies remain insufficient. © Georg Thieme Verlag KG Stuttgart · New York.

  5. [Antenatal emergency call. Indications. Role of the SAMU (Medical Emergency Care Services)].

    Science.gov (United States)

    Lallemand, E; Drouet, N; Faudemay, C; Lacroute, J M; Menthonnex, P

    1989-01-01

    The increased incidence of antenatal distress calls to the SAMU (emergency medical squad) by pediatric obstetricians in maternity departments (6 times in 5 years) poses the problem of recognizing their indications. Based on case reports of 128 newborns who profited from antenatal assistance, the authors attempt to define the indications. The elimination of student physicians in training for anesthesiology-intensive care, additional participants during SAMU transportation of patients, makes it even more necessary to define these indications accurately so that a single language of communication and procedure may be instituted for all who are involved in this effort.

  6. Meta-analysis of prophylactic corticosteroid use in post-ERCP pancreatitis

    Directory of Open Access Journals (Sweden)

    Lu Mingqin

    2008-02-01

    Full Text Available Abstract Background Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography and benefit of pharmacological treatment is unclear. Although prophylactic use of corticosteroid for reduction of pancreatic injury after ERCP has been evaluated, discrepancy about beneficial effect of corticosteroid on pancreatic injury still exists. The aim of current study is to evaluate effectiveness and safety of corticosteroid in prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP. Methods We employed the method recommended by the Cochrane Collaboration to perform a meta-analysis of seven randomized controlled trials (RCTs of corticosteroid in prevention of post-ERCP pancreatitis (PEP around the world. Results Most of the seven RCTs were of high quality. When the RCTs were analyzed, odds ratios (OR for corticosteroid were 1.13 [95% CI (0.89~1.44, p = 0.32] for PEP, 1.61 [95% CI (0.74~3.52, p = 0.23] for severe PEP, 0.92 [95% CI (0.57~1.48, p = 0.73] for post-ERCP hyperamylasemia respectively. The results indicated that there were no beneficial effects of corticosteroid on acute pancreatitis and hyperamylasemia. No evidence of publication bias was found. Conclusion Corticosteroids cannot prevent pancreatic injury after ERCP. Therefore, their use in the prophylaxis of PEP is not recommended.

  7. A severe case of acute exogenous lipoid pneumonia treated with systemic corticosteroid

    Directory of Open Access Journals (Sweden)

    Hideki Yasui

    2016-01-01

    Full Text Available Acute exogenous lipoid pneumonia is a rare disorder in adults. A treatment of choice for lipoid pneumonia has not been established, and systemic corticosteroid use remains controversial. We report the case of a 32-year-old man with schizophrenia who presented with kerosene-induced acute exogenous lipoid pneumonia that was treated with a systemic corticosteroid. In this case, supportive therapy did not improve the patient's condition, so systemic corticosteroid therapy was commenced four days after he ingested the kerosene. After corticosteroid commencement, the patient's symptoms and hypoxia improved within a few days. Although some radiological characteristics of this disorder have been reported previously, the process of radiological improvement of exogenous lipoid pneumonia is not well known. In this case, computed tomography findings changed dramatically after corticosteroid therapy was initiated. Extensive bilateral consolidations that were observed on admission improved. Although pneumatoceles developed two weeks after corticosteroid commencement, they were nearly gone after two months of the treatment. While corticosteroid therapy is not suitable for all cases, it should be considered for severe or refractory cases.

  8. Duct Leakage Repeatability Testing

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Iain [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sherman, Max [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-01-01

    Duct leakage often needs to be measured to demonstrate compliance with requirements or to determine energy or Indoor Air Quality (IAQ) impacts. Testing is often done using standards such as ASTM E1554 (ASTM 2013) or California Title 24 (California Energy Commission 2013 & 2013b), but there are several choices of methods available within the accepted standards. Determining which method to use or not use requires an evaluation of those methods in the context of the particular needs. Three factors that are important considerations are the cost of the measurement, the accuracy of the measurement and the repeatability of the measurement. The purpose of this report is to evaluate the repeatability of the three most significant measurement techniques using data from the literature and recently obtained field data. We will also briefly discuss the first two factors. The main question to be answered by this study is to determine if differences in the repeatability of these tests methods is sufficient to indicate that any of these methods is so poor that it should be excluded from consideration as an allowed procedure in codes and standards.

  9. Development and validation of a liquid chromatography-tandem mass spectrometry method for the simultaneous determination of nine corticosteroid residues in bovine liver samples

    Energy Technology Data Exchange (ETDEWEB)

    Dusi, Guglielmo, E-mail: guglielmo.dusi@izsler.it [Istituto Zooprofilattico Sperimentale della Lombardia e dell' Emilia Romagna, ' B. Ubertini' , Via Bianchi 9, 25124 Brescia (Italy); Gasparini, Mara; Curatolo, Michele; Assini, Walter; Bozzoni, Eros; Tognoli, Nadia; Ferretti, Enrica [Istituto Zooprofilattico Sperimentale della Lombardia e dell' Emilia Romagna, ' B. Ubertini' , Via Bianchi 9, 25124 Brescia (Italy)

    2011-08-26

    A liquid chromatography tandem mass spectrometry (LC-MS/MS) confirmatory method for the simultaneous determination of nine corticosteroids in liver, including the four MRL compounds listed in Council Regulation 37/2010, was developed. After an enzymatic deconjugation and a solvent extraction of the liver tissue, the resulting solution was cleaned up through an SPE Oasis HLB cartridge. The analytes were then detected by liquid chromatography-negative-ion electrospray tandem mass spectrometry, using deuterium-labelled internal standards. The procedure was validated as a quantitative confirmatory method according to the Commission Decision 2002/657/EC criteria. The results showed that the method was suitable for statutory residue testing regarding the following performance characteristics: instrumental linearity, specificity, precision (repeatability and intra-laboratory reproducibility), recovery, decision limit (CC{alpha}), detection capability (CC{beta}) and ruggedness. All the corticosteroids can be detected at a concentration around 1 {mu}g kg{sup -1}; the recoveries were above 62% for all the analytes. Repeatability and reproducibility (within-laboratory reproducibility) for all the analytes were below 7.65% and 15.5%, respectively.

  10. [Anaphylaxis after injection of corticosteroid preparations--carboxymethylcellulose as a hidden allergen].

    Science.gov (United States)

    Oppliger, Roland; Hauser, Conrad

    2004-11-01

    Two patients developed anaphylaxis after injection of a corticosteroid preparation containing carboxymethylcellulose (E466). In both cases skin tests yielded positive immediate type reactions to pure carboxymethylcellulose. This hydrophilic derivative of cellulose has found wide application in the pharmaceutical, cosmetics and food industry. The diagnosis is based on skin testing as 9% of the normal population was found to have serum IgE antibodies to this compound. In case of anaphylaxis after injection of corticosteroids, carboxymethylcellulose in addition to corticosteroids should be included for skin testing.

  11. Corticosteroid administration alters the mechanical properties of isolated collagen fascicles in rat-tail tendon

    DEFF Research Database (Denmark)

    Haraldsson, B T; Aagaard, P; Crafoord-Larsen, D;

    2009-01-01

    . The present study examined the biomechanical effects of intratendinous corticosteroid injections on healthy rat-tail tendon collagen fascicles. A total of 24 Wistar male rats were divided into (A) a corticosteroid group where the animals were injected in the tail tendon with methylprednisolone acetate, 1.0 m......L of 40 mg/mL mixed with 1.0 mL 9% saline (n=12), and (B) a control group that was injected with 9% saline (n=12). Three days after the injections, the animals were sacrificed and single individual collagen fascicles were collected and underwent displacement to failure. Corticosteroid administration...

  12. PERIOCULAR CORTICOSTEROID INJECTIONS IN UVEITIS: EFFECTS AND COMPLICATIONS

    Science.gov (United States)

    Sen, H. Nida; Vitale, Susan; Gangaputra, Sapna S.; Nussenblatt, Robert B.; Liesegang, Teresa L.; Levy-Clarke, Grace A.; Rosenbaum, James T.; Suhler, Eric B.; Thorne, Jennifer E.; Foster, C. Stephen; Jabs, Douglas A.; Kempen, John H.

    2014-01-01

    Purpose To evaluate the benefits and complications of periocular depot corticosteroid injections in patients with ocular inflammatory disorders. Design Multicenter retrospective cohort study. Participants A total of 914 patients (1192 eyes) who had received at least one periocular corticosteroid injection at 5 tertiary uveitis clinics in the United States. Methods Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study. Demographic and clinical characteristics were obtained at every visit via medical record review by trained reviewers. Main Outcome Measures Control of inflammation, improvement of visual acuity to 20/40 or better, improvement of visual acuity loss attributed to macular edema, incident cataract affecting visual acuity, cataract surgery, ocular hypertension and glaucoma surgery. Results Among 914 patients (1192 eyes) who received at least one periocular injection during follow-up, 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤6 months, 72.7% [95% confidence interval (95%CI): 69.1-76.3] of the eyes achieved complete control of inflammation and 49.7% [95%CI:45.5-54.1] showed an improvement in visual acuity (VA) from worse than 20/40 to 20/40 or better. Among the subset with VA worse than 20/40 attributed to macular edema, 33.1% [95%CI: 25.2-42.7] improved to 20/40 or better. By 12 months, the cumulative incidence of one or more visits with an intraocular pressure≥24 mmHg and ≥30 mmHg was 34.0% [95%CI: 24.8-45.4] and 15.0% [95%CI: 11.8-19.1] respectively; glaucoma surgery was performed in 2.4% [95%CI: 1.4-3.9] of eyes. Within 12 months, among phakic eyes initially 20/40 or better, the incidence of a reduction in VA to worse than 20/40 attributed to cataract was 20.2% [95%CI: 15.9-25.6]; cataract surgery was performed within 12 months in 13.8 % [95%CI: 11.1-17.2] of the initially phakic eyes

  13. Prevalence and Risk Factors of Antenatal Depression among Omani Women in a Primary Care Setting; Cross-sectional study

    Directory of Open Access Journals (Sweden)

    Mohammed Al-Azri

    2016-02-01

    Full Text Available Objectives: This study aimed to identify the prevalence of antenatal depression and the risk factors associated with its development among Omani women. No previous studies on antenatal depression have been conducted in Oman. Methods: This descriptive cross-sectional study was carried out between January and November 2014 in Muscat, Oman. Pregnant Omani women ≥32 gestational weeks who were attending one of 12 local primary care health centres in Muscat for routine antenatal care were invited to participate in the study (n = 986. An Arabic version of the validated self-administered Edinburgh Postnatal Depression Scale questionnaire was used to measure antenatal depression. A cut-off score of ≥13 was considered to indicate probable depression. Results: A total of 959 women participated in the study (response rate: 97.3%. Of these, 233 were found to have antenatal depression (24.3%. A bivariate analysis showed that antenatal depression was associated with unplanned pregnancies (P = 0.010, marital conflict (P = 0.001 and a family history of depression (P = 0.019. The adjusted odds ratio (OR after logistic multivariate regression analysis showed that antenatal depression was significantly associated with unplanned pregnancies (OR: 1.37; 95% confidence interval [CI]: 1.02–1.86 and marital conflict (OR: 13.83; 95% CI: 2.99–63.93. Conclusion: The prevalence of antenatal depression among the studied Omani women was high, particularly in comparison to findings from other Arab countries. Thus, antenatal screening for depression should be considered in routine primary antenatal care. Couples should also be encouraged to seek psychological support should marital conflicts develop during pregnancy.

  14. Oral Corticosteroid Prescribing for Children With Asthma in a Medicaid Managed Care Program.

    Science.gov (United States)

    Farber, Harold J; Silveira, Edwin A; Vicere, Douglas R; Kothari, Viral D; Giardino, Angelo P

    2017-05-01

    Short courses of oral corticosteroid (OCS) medication are recommended for treatment of moderate to severe asthma exacerbations. Concern has been raised about OCS overuse. Our objective is to describe rates of OCS dispensing among children with asthma and factors associated with variation in OCS dispensing. Claims data for children 1 to asthma diagnosis between January 2011 and January 2016 were extracted from the computerized databases of Texas Children's Health Plan. In the years 2011 to 2015, 17.1% to 21.8% of children had an asthma diagnosis. In each of these years 42.1% to 44.2% of these children had ≥1 OCS dispensing. OCS dispensing rates were higher for the children 1 to 4 years of age compared with older children. Repeated OCS dispensing was common, and was most common for children 1 to 4 years of age. Most children with an OCS dispensing (81%-83%) did not have other utilization suggesting poor asthma control (excessive β-agonist refills, emergency department visit, or hospitalization for asthma). OCSs were less commonly prescribed to patients whose primary care provider was a board-certified pediatrician compared with other types of primary care providers. There was large variation in OCS prescribing rates among pediatricians (15%-86%). There were minimal differences in asthma emergency department visits and no differences in hospitalization rates by the pediatrician's OCS dispensing rate quartile. The patterns of dispensing observed suggest substantial overprescribing of OCS for children with an asthma diagnosis. Copyright © 2017 by the American Academy of Pediatrics.

  15. Restored vision in a young dog following corticosteroid treatment of presumptive hypophysitis.

    Science.gov (United States)

    Rzechorzek, Nina Marie; Liuti, Tiziana; Stalin, Catherine; Marioni-Henry, Katia

    2017-02-28

    Hypophysitis is an umbrella term for a group of disorders involving inflammation of the pituitary gland. A rare occurrence in humans, hypophysitis can produce a range of clinical signs including (but not limited to) visual deficits and diabetes insipidus. Only five cases of canine hypophysitis exist in the literature, all presenting in mature dogs with no visual deficits and a grave outcome. This case report describes the clinical and advanced imaging features of blindness-inducing presumptive hypophysitis in a dog, which rapidly resolved with medical management. A 1-year-and-seven-month-old neutered male Standard Poodle presented with subacute blindness, ataxia, and polyuria/polydipsia (PUPD). Magnetic resonance imaging (MRI) detected a contrast-enhancing pituitary mass with perilesional oedema compromising the optic chiasm. Suspecting neoplasia, anti-inflammatory corticosteroid was commenced prior to radiation therapy planning. Complete resolution of neurological and visual deficits occurred within 12 days of starting steroid treatment. Repeated advanced imaging indicated macroscopic resolution of the lesion. An extended thyroid panel with insulin-like growth factor-1 analysis supported a diagnosis of hypophysitis. Resolution of PUPD was achieved with tapering courses of prednisolone and desmopressin; the dog has since been clinically normal for 14 months and treatment-free for 11 months. To the authors' knowledge, this is the first instance in which a canine pituitary mass has demonstrated long-term resolution with palliative medical treatment alone, alongside reversal of associated blindness and presumptive diabetes insipidus. We suspect this lesion to be a form of hypophysitis, which should be included among differential diagnoses for pituitary masses, and for subacute blindness in dogs. Where possible, we advocate biopsy-confirmation of hypophysitis prior to timely intervention with anti-inflammatory treatment.

  16. Social support and intimate partner violence during pregnancy among women attending antenatal care in Moshi Municipality, Northern Tanzania.

    Science.gov (United States)

    Sigalla, Geofrey Nimrod; Rasch, Vibeke; Gammeltoft, Tine; Meyrowitsch, Dan Wolf; Rogathi, Jane; Manongi, Rachel; Mushi, Declare

    2017-03-09

    Intimate Partner Violence (IPV) is a significant public health problem with negative health consequences for women and their pregnancies. While social support has a protective effect against IPV and reduces health consequences of violence, its association with experiencing IPV during pregnancy remain less explored. In our study we aimed to determine the effect of social support on IPV during pregnancy among women attending antenatal care in Moshi, Tanzania METHODS: The study was part of a prospective cohort study that assessed the impact of violence on reproductive health of 1,116 participants. Pregnant women were enrolled below 24 weeks of gestation and followed until delivery. The experiences of social support and IPV during pregnancy were assessed at the 34(th) week of gestation. Logistic regression analysis was performed to assess the relationship between social support and IPV, with adjustment for potential confounders. The prevalence of IPV during pregnancy was 30.3% where the majority (29.0%) experienced repeated episodes of abuse. Regarding practical social support, having no one to help financially was associated with increased odds of IPV and repeated episodes of abuse during pregnancy, AOR 3.57, (95% CI 1.85 - 6.90) and AOR 3.21, (95% CI 1.69 - 6.11) respectively. For social support in terms of communication, talking to a member of the family of origin at least monthly was associated with decreased odds of IPV and repeated episodes of IPV during pregnancy, AOR 0.46 (95% CI 0.26 - 0.82) and AOR 0.41 (95% CI 0.23 - 0.73) respectively. Perceiving that family of origin will not offer support was associated with a increased odds of IPV and repeated episodes of IPV, AOR 2.29, (95% CI 1.31 - 3.99) and AOR 2.14, (95% CI 1.23 - 3.74) respectively. Nearly one third of women experienced IPV during pregnancy. Social support to women is associated with decreased odds of experiencing IPV during pregnancy. The family of origin plays an important role in providing

  17. Misuse of topical corticosteroids over face: A clinical study

    Directory of Open Access Journals (Sweden)

    Kajal Manchanda

    2017-01-01

    Full Text Available Introduction: Topical corticosteroids (TCS have been widely used in various dermatological diseases. However, because of inadvertent use, TCS misuse has become a common problem faced by dermatologists in various parts of the world. Prolonged use over the face can cause various side effects such as steroid rosacea, acneiform eruptions, and hypertrichosis. Aim: To study the effects of TCS misuse and analyze various factors promoting its use on face. Materials and Methods: A total of 100 patients presenting with various facial dermatoses following the misuse of TCS on the face were studied. Detailed history was noted and the various side effects were recorded. Results: Majority of the patients (70% were females with maximum number of patients belonging to the age group of 11–20 years. Eighty-five percent of the patients were applying TCS for medical conditions, with acne being the most common indication, and the rest were applying as a general face cream. Pruritus and acneiform eruptions were the most common side effects observed and the other reported were erythema, photosensitivity, steroid dependent face, and telangiectasia. Conclusion: TCS misuse especially over the face can lead to a multitude of side effects. It is high time to create awareness among the patients as well as doctors regarding the proper usage of this wonder drug.

  18. LOCAL CORTICOSTEROID VS. AUTOLOGOUS BLOOD FOR PLANTAR FASCIITIS

    Directory of Open Access Journals (Sweden)

    Syam Sunder B

    2017-01-01

    Full Text Available BACKGROUND Plantar fasciitis is the most common cause of heel pain for which professional care is sought. Initially thought of as an inflammatory process, plantar fasciitis is a disorder of degenerative changes in the fascia and maybe more accurately termed plantar fasciosis. Traditional therapeutic efforts have been directed at decreasing the presumed inflammation. These treatments include icing, Nonsteroidal Anti-inflammatory Drugs (NSAIDs, rest and activity modification, corticosteroids, botulinum toxin type A, splinting, shoe modifications and orthosis. Other treatment techniques have been directed at resolving the degeneration caused by the disease process. In general, these techniques are designed to create an acute inflammatory reaction with the goal of restarting the healing process. These techniques include autologous blood injection, Platelet-Rich Plasma (PRP injection, nitroglycerin patches, Extracorporeal Shock Wave Therapy (ESWT and surgical procedures. Recently, research has focused on regenerative therapies with high expectations of success. The use of autologous growth factors is thought to heal through collagen regeneration and the stimulation of a well-ordered angiogenesis. These growth factors are administered in the form of autologous whole blood or Platelet-Rich Plasma (PRP. Platelets can be isolated using simple cell-separating systems. The degranulation of the alpha granules in the platelets releases many different growth factors that play a role in tissue regeneration processes. Platelet-derived growth factor, transforming growth factor-P, vascular-derived endothelial growth factor, epithelial growth factor, hepatocyte growth factor and insulin-like growth factor are examples of such growth factors. Injections with autologous growth factors are becoming common in clinical practice. The present study was an attempt to compare the efficacy of autologous blood injection in plantar fasciitis by comparing it with the local

  19. Maternal and feto-placental prostanoid responses to a single course of antenatal betamethasone.

    Science.gov (United States)

    Cho, Steve; Beharry, Kay D A; Valencia, Arwin M; Guajardo, Leonel; Nageotte, Michael P; Modanlou, Houchang D

    2005-12-01

    We tested the hypothesis that antenatal betamethasone alters prostanoid levels in the maternal and feto-placental compartments. Forty-three singleton pregnancies were studied. Group I were women treated with a single course of antenatal betamethasone and who delivered 38 weeks. Maternal and mixed cord blood; and placental samples were collected at delivery and analyzed for PGE2, PGF(2alpha), 6-ketoPGF(1alpha), and TxB2 levels. Antenatal betamethasone decreased maternal PGE2 levels with concomitant increases in the feto-placental compartment. Umbilical cord TxB2 levels in the treated group were significantly lower than the non-treated pre-term and term groups resulting in a higher 6-ketoPGF(1alpha):TxB2 ratio. Considering the regulatory role of PGE2 and PGI2 in fetal lung development and neonatal transition homeostasis, these results suggest a mechanism, at least in part, for the beneficial effects of antenatal steroids on fetal lung maturation and neonatal cardio-pulmonary homeostasis at birth.

  20. Heteronormative communication with lesbian families in antenatal care, childbirth and postnatal care.

    Science.gov (United States)

    Röndahl, Gerd; Bruhner, Elisabeth; Lindhe, Jenny

    2009-11-01

    Heteronormative communication with lesbian families in antenatal care, childbirth and postnatal care. This paper is a report of a study of lesbian parents' experience of antenatal care, childbirth and postnatal care. In a strictly heteronormative-based care system, 'parents' naturally implies a man and a woman, and all communication and routines are based on heterosexual couples. A qualitative interview study was carried out in 2008. Ten mothers, eight of whom were in a relationship with another woman, participated. The participants had experience from several care facilities from three different cities in central Sweden. Most participants had positive experiences but also complained that the focus was not always on the pregnancy and that no parenthood education had been offered. Heteronormativity was communicated by midwives and nursing staff throughout the process - from antenatal care to postnatal care, via forms, journals, verbal communication and orientation visits. This was experienced as embarrassing for the participant parents, and they also described encountering what they interpreted as embarrassment on the part of care providers. Participants called for increased knowledge about lesbian parenting, since they believed this would influence and facilitate communication, not least with midwives in antenatal care. Midwives educated in lesbian issues could ask questions and communicate in a more neutral way at the first meeting, and thereby make prospective parents feel less insecure. Special parenthood education groups for lesbians are recommended so that lesbian couple can meet others with similar experiences and so that the focus will be on prospective parenthood and not on their sexual orientation.

  1. Using the Cascade Model to Improve Antenatal Screening for the Hemoglobin Disorders

    Science.gov (United States)

    Gould, Dinah; Papadopoulos, Irena; Kelly, Daniel

    2012-01-01

    Introduction: The inherited hemoglobin disorders constitute a major public health problem. Facilitators (experienced hemoglobin counselors) were trained to deliver knowledge and skills to "frontline" practitioners to enable them to support parents during antenatal screening via a cascade (train-the-trainer) model. Objectives of…

  2. The Readiness of Students to Learn Interprofessional Teamwork in Antenatal Care

    Directory of Open Access Journals (Sweden)

    Dina Zakiyyatul Fuadah

    2016-09-01

    Full Text Available Introduction: Indonesia as a developing country have a higher Maternal Mortality Rate (MMR. The prevention efforts is developing interprofessional collaborative practice (IPCP in the level of health care. Collaboration attitudes should start from education level through interprofessional education training and simulation for student. The objective of this study was to analyze the effect of interprofessional education training toward the readiness of students to learn interprofessional teamwork in antenatal care. Methods: Quasi-experimental design (pre test and post test without control with Time-Series Design. Participants used in this study were students of five semester in STIKes Karya Husada Kediri year of 2011/2012 and the number of samples are 60 students. Technique sampling using simple random. The data collected by used questionnaires Readiness Interprofessional Learning Scale (RIPLS and checklist observations using Teamwork Score (TWS. Anova, Friedman test, and Kruskal Wallis was used to statistically analyzed the data. Results: Readiness to learn interprofessional teamwork indicates the value of p = 0.001 thats means there are significant differences between the readiness before and after training IPE. Delta test showed that p value > 0.05 so there is no difference between the three programs study on readiness to learn interprofessional teamwork in antenatal care. Discussion: Interprofessional education training using simulation methods can affect the readiness of nursing, midwifery and nutritionist students for learning interprofessional teamwork in antenatal care. Keywords: interprofessional education, readiness, training and simulations, pre clinics students, antenatal care.

  3. Empowerment and use of antenatal care among women in Ghana: a cross-sectional study.

    Science.gov (United States)

    Sipsma, Heather; Ofori-Atta, Angela; Canavan, Maureen; Udry, Christopher; Bradley, Elizabeth

    2014-11-01

    Empowerment among women in the context of a romantic relationship may affect the use of reproductive healthcare services; however, current literature examining this association is limited and inconsistent. We therefore aimed to examine the relationship between several measures of empowerment and use of inadequate antenatal care among women in Ghana. We conducted a cross-sectional study using data from a nationally representative cohort of women in Ghana. Our analytic sample was limited to non-pregnant women who had been pregnant and involved in a relationship within the last 12 months. We used multivariable logistic regression to assess the associations between empowerment and inadequate use of antenatal care and interaction terms to assess moderation by education. Approximately 26% of women received inadequate antenatal care. Multivariable analysis indicated that having experienced physical abuse in the past year was directly associated with inadequate use of antenatal care (OR = 5.12; 95% CI = 1.35, 19.43) after adjusting for socio-demographic characteristics. This effect was particularly pronounced among women with no formal education and was non-significant among women with at least some formal education (P-value for interaction empowerment among women in Ghana and other low-income countries, particularly among those with no formal education. Furthermore, the involvement of male partners will be critical for improving reproductive health outcomes, and increasing education among girls in these settings is likely a strong approach for improving reproductive health and buffering effects of low empowerment among women.

  4. Assessing the extent of adherence to the recommended antenatal care content in Malaysia: Room for improvement

    NARCIS (Netherlands)

    Yeoh, P.L.; Hornetz, K.; Shauki, N.I.A.; Dahlui, M.; Wouwe, J.P. van

    2015-01-01

    Background Recent papers on monitoring of health services affirmed that while antenatal care (ANC) is an effective measure, quality is still a problem. Quality in maternal services "⋯involves providing a minimum level of care to all pregnant women⋯" Yet adherence to a minimum level of recommended

  5. Stigma and Attitudes towards Antenatal Depression and Antidepressant Use during Pregnancy in Healthcare Students

    Science.gov (United States)

    Gawley, Laura; Einarson, Adrienne; Bowen, Angela

    2011-01-01

    Depression in pregnancy or antenatal depression (AD) occurs in approximately one in five women, with potentially deleterious effects to the mother and fetus. People are encouraged to get treatment for depression; however, pregnant women can experience stigma when they reach out for help with depression. Research indicates that healthcare…

  6. Risk factors for RhD immunisation despite antenatal and postnatal anti-D prophylaxis

    NARCIS (Netherlands)

    J.M. Koelewijn; M. de Haas; T.G.M. Vrijkotte; C.E. van der Schoot; G.J. Bonsel

    2009-01-01

    Objective To identify risk factors for Rhesus D (RhD) immunisation in pregnancy, despite adequate antenatal and postnatal anti-D prophylaxis in the previous pregnancy. To generate evidence for improved primary prevention by extra administration of anti-D Ig in the presence of a risk factor. Design C

  7. Using the Cascade Model to Improve Antenatal Screening for the Hemoglobin Disorders

    Science.gov (United States)

    Gould, Dinah; Papadopoulos, Irena; Kelly, Daniel

    2012-01-01

    Introduction: The inherited hemoglobin disorders constitute a major public health problem. Facilitators (experienced hemoglobin counselors) were trained to deliver knowledge and skills to "frontline" practitioners to enable them to support parents during antenatal screening via a cascade (train-the-trainer) model. Objectives of evaluation were to…

  8. Sociodemographic factors associated with anaemia in pregnancy at booking for antenatal care.

    Science.gov (United States)

    Adanikin, A I; Awoleke, J O

    2016-01-01

    Late patronage of antenatal care by women in low-resource areas makes timely intervention at correcting anaemia difficult. This study aimed to identify modifiable sociodemographic factors that predict anaemia before commencing antenatal care and make appropriate recommendation. A survey of sociodemographic features and haemoglobin concentrations of 232 women booking for antenatal care was conducted. Anaemia was diagnosed in 119 (51.3%), of which 87 (37.5%) had mild anaemia and 32 (13.8%) were moderately anaemic. There was no severe anaemia. Anaemia was highest among respondents who were 35 years of age, Muslims, of Igbo ethnicity (64.3%), single (55.0%), student/unemployed (58.8%), nulliparous (57.3%) and those who registered at 21 weeks' gestation (54.2%). Only occupation of the woman showed association with anaemia before antenatal care (p 0.007). A personal source of income may reduce anaemia in pregnancy; and it is advisable to have a social welfare package for unemployed pregnant women.

  9. Stigma and Attitudes towards Antenatal Depression and Antidepressant Use during Pregnancy in Healthcare Students

    Science.gov (United States)

    Gawley, Laura; Einarson, Adrienne; Bowen, Angela

    2011-01-01

    Depression in pregnancy or antenatal depression (AD) occurs in approximately one in five women, with potentially deleterious effects to the mother and fetus. People are encouraged to get treatment for depression; however, pregnant women can experience stigma when they reach out for help with depression. Research indicates that healthcare…

  10. Antenatal diagnosis of mirror-image dextrocardia in association with situs inversus and Turner's mosaicism.

    Science.gov (United States)

    Ortiga, D J; Chiba, Y; Kanai, H; Hosono, T

    2001-10-01

    We describe the antenatal diagnosis of a fetus with mirror-image dextrocardia, complete situs inversus and Turner's mosaicism (45,XO/46,XY) that was artificially terminated at 19 weeks. Autopsy confirmed our initial findings. This case represents an unusual combination of anomalies rarely encountered in clinical practice.

  11. Socio-economic and Demographic Determinants of Antenatal Care Services Utilization in Central Nepal

    Directory of Open Access Journals (Sweden)

    Srijana Pandey, PhD

    2014-09-01

    Full Text Available Background/Objective: The importance of maternal health services in lessening maternal mortality and morbidity as well as neonatal deaths has received substantial recognition in the past decade. The lack of antenatal care has been identified as a risk factor for maternal mortality and other adverse pregnancy outcomes. The purpose of this study was to determine the factors affecting attendance of antenatal care services in Nepal. Methods: This is a cross-sectional descriptive study carried out in Central Nepal. Using semi-structured questionnaire, interviews were conducted with married women aged between 15-49 years, who had delivered their babies within one year. Systematic random sampling method was used to select the sample. Results were obtained by frequency distribution and cross-tabulation of the variables. Results: More than half of the women were not aware of the consequences of lack of antenatal care. Age, education, income, type of family were strongly associated with the attendance at antenatal care service. Conclusions and Public Health Implications: In Nepal and in other developing countries, maternal mortality and morbidity continue to pose challenges to the health care delivery system. Variety of factors including socio-demographic, socio-economic, cultural and service availability as well as accessibility influences the use of maternal health services.

  12. Seroprevalence of HIV in women attending antenatal clinic at KIMS hospital, Narketpally

    Directory of Open Access Journals (Sweden)

    Venna Guru Prasad

    2012-12-01

    Full Text Available Background: To assess seroprevalence of HIV among antenatal women and the extent of utilization of therapeutic interventions to minimize the risk of mother to child transmission. Methods: Pregnant women attending antenatal clinic of a medical college in a rural area of Nalgonda district of Andhra Pradesh, India from August 2006 to July 2009 were tested for HIV by Rapid Test which included pre and post test counseling. Antiretroviral prophylaxis with nevirapine was given to seropositive mother-baby pairs during delivery. Results: Of the 5809 new antenatal booking visits 4848 attended pretest counseling and 4698 accepted HIV testing. Fifty three women were found to be seropositive. Sero-prevalence rate of HIV infection was 1.12%. Ten had opted for pregnancy termination. Out of forty three deliveries four were intrauterine deaths. All the newborns received nevirapine prophylaxis. Conclusions: The seroprevalence of HIV infection among antenatal women is 1.12% which was high as the institute is located in Andhra Pradesh which is a known high prevalence state. Thirty one babies tested after 18 months of age were negative. Nine babies died before they reached 18 months of age. [Int J Reprod Contracept Obstet Gynecol 2012; 1(1.000: 17-21

  13. Associations of life events during pregnancy with longitudinal change in symptoms of antenatal anxiety and depression

    NARCIS (Netherlands)

    Meijer, Judith L; Bockting, Claudi L H; Stolk, Ronald P; Kotov, Roman; Ormel, Johan; Burger, Huibert

    2014-01-01

    OBJECTIVE: to investigate the association of life events during pregnancy with change in antenatal anxiety and depression symptoms. We distinguished pregnancy related and non-pregnancy related events and assessed specificity of these associations for depressive or anxious symptoms. In addition, we i

  14. Antenatal screening for HIV, hepatitis B and syphilis in the Netherlands is effective

    NARCIS (Netherlands)

    E.L.M. op de Coul; S. Hahne; Y.W.M. van Weert; P. Oomen; C. Smit; K.P.B. van der Ploeg; D.W. Notermans; K. Boer; M.A.B. van der Sande

    2011-01-01

    Background: A screening programme for pregnant women has been in place since the 1950s in the Netherlands. In 2004 universal HIV screening according to opting out was implemented. Here, we describe the evaluation of the effectiveness of antenatal screening in the Netherlands for 2006-2008 for HIV, h

  15. Assessing the extent of adherence to the recommended antenatal care content in Malaysia: Room for improvement

    NARCIS (Netherlands)

    Yeoh, P.L.; Hornetz, K.; Shauki, N.I.A.; Dahlui, M.; Wouwe, J.P. van

    2015-01-01

    Background Recent papers on monitoring of health services affirmed that while antenatal care (ANC) is an effective measure, quality is still a problem. Quality in maternal services "⋯involves providing a minimum level of care to all pregnant women⋯" Yet adherence to a minimum level of recommended AN

  16. The effects of antenatal depression and antidepressant treatment on placental gene expression

    NARCIS (Netherlands)

    Olivier, Jocelien D A; Åkerud, Helena; Skalkidou, Alkistis; Kaihola, Helena; Sundström-Poromaa, Inger

    2015-01-01

    The effects of antenatal depression and antidepressant treatment during pregnancy on both mother and child are vigorously studied, but the underlying biology for these effects is largely unknown. The placenta plays a crucial role in the growth and development of the fetus. We performed a gene expres

  17. Preventing female virilisation in congenital adrenal hyperplasia: The controversial role of antenatal dexamethasone.

    Science.gov (United States)

    Heland, Sarah; Hewitt, Jacqueline K; McGillivray, George; Walker, Susan P

    2016-06-01

    Congenital adrenal hyperplasia (CAH) refers to a group of recessively inherited disorders of cortisol production, which in the classical form results in virilisation of female fetuses. Since the 1980s, antenatal treatment with dexamethasone has been recommended in high-risk pregnancies to minimise the risk of virilising the female genitalia of affected fetuses. To be effective, this treatment requires implementation in early pregnancy, prior to the commencement of autonomous fetal adrenal androgen synthesis. Using this approach, seven of eight high-risk pregnancies are treated unnecessarily, prior to establishing the fetal gender or the confirmed diagnosis of a genetically affected pregnancy. In the face of ongoing concerns regarding potential adverse maternal-fetal effects of antenatal dexamethasone exposure, a review of this practice has been advocated by expert advisory groups. In this review, we summarise current controversies, potential improvements and future directions in the management of pregnancies at risk of CAH. In high-risk families, recent genomic advances include early prenatal diagnosis utilising noninvasive genetic techniques to minimise unnecessary dexamethasone exposure to unaffected fetuses. In affected pregnancies when families elect for antenatal treatment, optimal antenatal dosing regimens need to be defined and a standardised treatment and follow-up protocol are recommended. Establishment of a national registry with standardised follow-up will allow future families to be better informed of the risks and benefits of both treated and untreated fetal CAH.

  18. Prevalence of sexually transmitted infections among women attending antenatal clinics in Tanga, north eastern Tanzania

    DEFF Research Database (Denmark)

    Chiduo, M; Theilgaard, Z P; Bakari, V

    2012-01-01

    This study aimed to determine the prevalence of sexually transmitted infections (STIs) among HIV-infected and uninfected pregnant women in Tanga, Tanzania. Retrospective data on syphilis and HIV status during 2008-2010 were collected from antenatal clinic (ANC) records. Prospective data were...

  19. Antenatal screening for HIV, hepatitis B and syphilis in the Netherlands is effective

    NARCIS (Netherlands)

    Coul, E.L.M. op de; Hahné, S.; Weert, Y.M. van; Oomen, P.; Smit, S.; Ploeg, C.P.B. van der; Notermans, D.W.; Boer, K.; Sande1, M.A.B. van der

    2011-01-01

    A screening programme for pregnant women has been in place since the 1950s in the Netherlands. In 2004 universal HIV screening according to opting out was implemented. Here, we describe the evaluation of the effectiveness of antenatal screening in the Netherlands for 2006-2008 for HIV, hepatitis B v

  20. Effects of Antenatal Glucocorticoid Therapy on Hippocampal Histology of Preterm Infants

    NARCIS (Netherlands)

    Tijsseling, Deodata; Wijnberger, Lia D. E.; Derks, Jan B.; van Velthoven, Cindy T. J.; de Vries, Willem B.; van Bel, Frank; Nikkels, Peter G. J.; Visser, Gerard H. A.

    2012-01-01

    Objective: To investigate if antenatal glucocorticoid treatment has an effect on hippocampal histology of the human preterm newborn. Patients and Methods: Included were consecutive neonates with a gestational age between 24 and 32 weeks, who were born between 1991 to 2009, who had died within 4 days

  1. A survey of midwives' views on providing aspects of antenatal care in Estonia

    DEFF Research Database (Denmark)

    Lazarus, Jeffrey V; Rull, Kristiina; Wyn Huws, Dyfed

    2007-01-01

    OBJECTIVE: to survey the views of midwives in Estonia about who they considered should have responsibility for carrying out certain aspects of antenatal care (ANC) in Estonia. DESIGN, SETTING AND STUDY POPULATION: in collaboration with key stakeholder organisations, the authors developed eight...

  2. Impact of antenatal synthetic glucocorticoid exposure on endocrine stress reactivity in term-born children.

    Science.gov (United States)

    Alexander, Nina; Rosenlöcher, Franziska; Stalder, Tobias; Linke, Julia; Distler, Wolfgang; Morgner, Joachim; Kirschbaum, Clemens

    2012-10-01

    Antenatal glucocorticoid (GC) exposure has been discussed as a potent programming factor of hypothalamus-pituitary-adrenal (HPA) axis activity, producing sustained alterations in cortisol secretion throughout life. So far, the assessment of HPA-axis activity in offspring of mothers treated with synthetic GC has been limited to a time period shortly after birth, with prematurity being an important confound in most prior studies. The present study aimed to investigate HPA-axis reactivity of term-born children with antenatal GC exposure in a larger sample, allowing us to further address sex- and drug-specific effects. This was a cross-sectional study comprised of 209 term-born children between 6 and 11 yr of age. Cortisol secretion patterns in response to a standardized laboratory stressor (Trier Social Stress Test for Children) were assessed in children with antenatal GC exposure (a single course of either dexamethasone or betamethasone) and compared to different control groups. We observed significantly increased cortisol reactivity to acute psychosocial stress in 6- to 11-yr-old, term-born children exposed to antenatal synthetic GC treatment compared to controls (F(3.4,345.9)=5.8; Pchildren. These findings may bear important implications regarding the vulnerability for stress-related physical and psychiatric disorders, for which dysregulation of the HPA-axis has been discussed as a potential causal factor.

  3. An instrument for broadened risk assessment in antenatal health care including non-medical issues.

    NARCIS (Netherlands)

    A.A. Vos (Amber); M.J. van Veen (Mieke); E. Birnie (Erwin); S. Denktaş (Semiha); E.A.P. Steegers (Eric); G.J. Bonsel (Gouke)

    2015-01-01

    markdownabstractGrowing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed

  4. Feasibility and reliability of a newly developed antenatal risk score card in routine care

    NARCIS (Netherlands)

    Veen, M.J.; Birnie, E.; Poeran, J.; Torij, H.W.; Steegers, E.A.P.; Bonsel, G.J.

    2015-01-01

    OBJECTIVE: to study in routine care the feasibility and inter-rater reliability of the Rotterdam Reproductive Risk Reduction risk score card (R4U), a new semi-quantitative score card for use during the antenatal booking visit. The R4U covers clinical and non-clinical psychosocial factors and ident

  5. Factors associated with antenatal depression in pregnant Korean females: the effect of bipolarity on depressive symptoms

    OpenAIRE

    Park, Chul Min; Seo, Hye-Jin; Jung, Young-Eun; Kim, Moon-Doo; Hong,Seong-Chul; Bahk, Won-Myong; Yoon, Bo-Hyun; Hur, Min Hee; Song, Jae Min

    2014-01-01

    Background This cross-sectional study sought to identify factors associated with antenatal depression in pregnant Korean females, including sociodemographic parameters, social support, social conflict, and bipolarity. Methods Eighty-four pregnant women were recruited to complete questionnaires on sociodemographic factors, obstetric history, depressive symptoms, and bipolarity. Depressive symptoms were assessed using the Korean version of the Edinburgh Postnatal Depression Scale. Bipolarity wa...

  6. Hypnosis Antenatal Training for Childbirth (HATCh: a randomised controlled trial [NCT00282204

    Directory of Open Access Journals (Sweden)

    Baghurst Peter

    2006-03-01

    Full Text Available Abstract Background Although medical interventions play an important role in preserving lives and maternal comfort they have become increasingly routine in normal childbirth. This may increase the risk of associated complications and a less satisfactory birth experience. Antenatal hypnosis is associated with a reduced need for pharmacological interventions during childbirth. This trial seeks to determine the efficacy or otherwise of antenatal group hypnosis preparation for childbirth in late pregnancy. Methods/design A single centre, randomised controlled trial using a 3 arm parallel group design in the largest tertiary maternity unit in South Australia. Group 1 participants receive antenatal hypnosis training in preparation for childbirth administered by a qualified hypnotherapist with the use of an audio compact disc on hypnosis for re-enforcement; Group 2 consists of antenatal hypnosis training in preparation for childbirth using an audio compact disc on hypnosis administered by a nurse with no training in hypnotherapy; Group 3 participants continue with their usual preparation for childbirth with no additional intervention. Women > 34 and Discussion If effective, hypnosis would be a simple, inexpensive way to improve the childbirth experience, reduce complications associated with pharmacological interventions, yield cost savings in maternity care, and this trial will provide evidence to guide clinical practice.

  7. Assessment and care for non-medical risk factors in current antenatal health care

    NARCIS (Netherlands)

    A.A. Vos (Amber); Leeman, A. (Annemiek); W. Waelput (Wim); G.J. Bonsel (Gouke); E.A.P. Steegers (Eric); S. Denktaş (Semiha)

    2015-01-01

    textabstractObjective: this study aims to identify current practice in risk assessment, current antenatal policy and referral possibilities for non-medical risk factors (lifestyle and social risk factors), and to explore the satisfaction among obstetric caregivers in their collaboration with

  8. A prospective randomized, double-blind, controlled clinical trial comparing epidural butorphanol plus corticosteroid with corticosteroid alone for sciatica due to herniated nucleus pulposus

    Directory of Open Access Journals (Sweden)

    Abhijan Maity

    2012-01-01

    Full Text Available Objective: To compare the efficacy of up to 3 epidural butorphanol plus corticosteroid with corticosteroid alone for sciatica due to herniated nucleus pulposus. Materials and Methods: In a randomized, double-blind controlled clinical trial, we administered up to 3 epidural injections of either 80 mg (2 mL of methylprednisolone acetate and 1 mg (1 mL of butorphanol diluted with 7 mL of isotonic saline or 80 mg (2 mL of methylprednisolone acetate diluted with 8 mL of isotonic saline by a lumbar interlaminar approach under fluoroscopic guidance to 120 patients (60 patients in each group with sciatica due to a herniated nucleus pulposus lasting for 4 weeks to 1 year. All patients had scores higher than 30 mm on visual analog scale (VAS. Information on the use of paracetamol, intensity of pain on a VAS ranging from 0 (no pain to 100 mm (worst pain possible, Schober′s test (cm, Straight Leg Raising test, neurologic examination assessing sensory deficits, motor deficits and reflex changes, and Oswestry Low Back Pain Disability Questionnaire were evaluated at 3 weeks, 6 weeks, and 3 months after the first injection. Results: There were no significant differences between the 2 groups with regard to baseline characteristics, withdrawals, and complication rate. Three weeks, 6 weeks, and 3 months after the first injection, all the outcome measures in the butorphanol plus corticosteroid group were significantly different from that of the corticosteroid group. Conclusions: Epidural butorphanol plus corticosteroid injections, as compared with corticosteroid alone injections, offered marked improvement in pain, reflex, motor and sensory deficits, and functional status and reduced the need for analgesics. Level of Evidence: Therapeutic Level I.

  9. Effects of intracerebral implantation of corticosteroids on extinction of an avoidance response in rats

    NARCIS (Netherlands)

    Wimersma Greidanus, T.B. van; Wied, D. de

    1969-01-01

    Intracerebral implantation of dexamethasone phosphate facilitated the rate of extinction of a pole jumping avoidance response when implanted into various areas in the median and posterior thalamus and in the ventriculus lateralis. Corticosterone, the rat's natural corticosteroid, also facilitated ex

  10. Systemic corticosteroid monotherapy for clinically diagnosed acute rhinosinusitis: a randomized controlled trial

    NARCIS (Netherlands)

    Venekamp, R.P.; Bonten, M.J.; Rovers, M.M.; Verheij, T.J.; Sachs, A.P.

    2012-01-01

    BACKGROUND: Patients with acute rhinosinusitis are frequently encountered in primary care. Although corticosteroids are being increasingly used for symptom control, evidence supporting their use is inconclusive. We conducted a randomized controlled trial to examine the effectiveness of systemic cort

  11. In vitro toxicity of local anaesthetics and corticosteroids on supraspinatus tenocyte viability and metabolism

    Directory of Open Access Journals (Sweden)

    Clayton W. Nuelle

    2017-01-01

    Conclusion: This data confirms that peritendinous injection of commonly used local anaesthetics and corticosteroids results in significant supraspinatus tenotoxicity in vitro. Further in vivo studies are required before making definitive clinical recommendations.

  12. [Opportunistic lung infections in patients with chronic obstructive lung disease; a side effect of inhalation corticosteroids?].

    Science.gov (United States)

    Smeenk, F W; Klinkhamer, P J; Breed, W; Jansz, A R; Jansveld, C A

    1996-01-13

    In four patients, men of 64, 66 and 69 years old and a woman of 65 years, who suffered from chronic obstructive pulmonary disease (COPD) and used inhalation corticosteroids in a relatively high dose (800-1600 micrograms of budesonide per day), a pulmonary infection was diagnosed caused by Mycobacterium malmoense (the first two patients) and Aspergillus (the other two) respectively. Inhalation corticosteroids are of great importance in the treatment of asthmatic patients. Their place in the treatment of patients with COPD is much less clear. The patients did not have an immunological deficiency or anatomical pulmonary or bronchial deformation which could have explained the occurrence of these infections. The high dosages of inhalation corticosteroids may have been involved in the cause of these infections by suppressing the T-cell response locally. In view of this, longterm inhalation corticosteroid treatment should be prescribed in COPD patients only if the efficacy of the medication has been proved in the individual patient involved.

  13. The Effect of an Inhaled Corticosteroid on Glucose Control in Type 2 Diabetes

    OpenAIRE

    2009-01-01

    Objective: To determine the effect of inhaled corticosteroid (ICS) therapy on glucose control in adults with type 2 diabetes mellitus and coexisting asthma or chronic obstructive pulmonary disease (COPD).

  14. Efficacy of Corticosteroids in Community-acquired Pneumonia A Randomized Double-Blinded Clinical Trial

    NARCIS (Netherlands)

    Snijders, Dominic; Daniels, Johannes M. A.; de Graaff, Casper S.; van der Werf, Tjip S.; Boersma, Wim G.

    2010-01-01

    Rationale: Some studies have shown a beneficial effect of corticosteroids in patients with community-acquired pneumonia (CAP), possibly by diminishing local and systemic antiinflammatory host response. Objectives: To assess the efficacy of adjunctive prednisolone treatment in patients hospitalized w

  15. Comparing the effectiveness of small-particle versus large-particle inhaled corticosteroid in COPD

    NARCIS (Netherlands)

    Postma, Dirkje S.; Roche, Nicolas; Colice, Gene; Israel, Elliot; Martin, Richard J.; van Aalderen, Willem M. C.; Grigg, Jonathan; Burden, Anne; Hillyer, Elizabeth V.; von Ziegenweidt, Julie; Gopalan, Gokul; Price, David

    2014-01-01

    Purpose: Small airway changes and dysfunction contribute importantly to airway obstruction in chronic obstructive pulmonary disease (COPD), which is currently treated with inhaled corticosteroids (ICS) and long-acting bronchodilators at Global initiative for Obstructive Lung Disease (GOLD) grades 2-

  16. Investigation of sensitivity of the hypothalamus to corticosteroids at late postradiation stages

    Energy Technology Data Exchange (ETDEWEB)

    Prokudina, E.A.

    1979-03-01

    Corticosteroid receptors have been found in neurons of the hypothalamus, hippocampus, septum and amygdaloid nucleus. Analysis of the effects of corticosteroids on receptor structures of the hypothalamoreticulolimbic complex revealed complex correlations between them and possibility of concurrent effects of corticosteroids on adrenergic, serotoninergic and cholinergic systems. Expressly in these systems of the hypothalamus some substantial disturbances were found at late postradiation stages. In view of the fact that the mechanism of negative feedback is implemented in the centers of regulation of the adrenohypophyseal system, examination of the reaction of this system to corticosteroids could serve as one of the indicators of the state of its centers. We applied this principle to our study of the functional state of the hypothalamus at the long postradiation term.

  17. Withdrawal of inhaled corticosteroids in individuals with COPD - a systematic review and comment on trial methodology

    National Research Council Canada - National Science Library

    Nadeem, Nighat J; Taylor, Stephanie JC; Eldridge, Sandra M

    2011-01-01

    Inhaled corticosteroids (ICS) reduce COPD exacerbation frequency and slow decline in health related quality of life but have little effect on lung function, do not reduce mortality, and increase the risk of pneumonia...

  18. Repeatability of Cryogenic Multilayer Insulation

    Science.gov (United States)

    Johnson, W. L.; Vanderlaan, M.; Wood, J. J.; Rhys, N. O.; Guo, W.; Van Sciver, S.; Chato, D. J.

    2017-01-01

    Due to the variety of requirements across aerospace platforms, and one off projects, the repeatability of cryogenic multilayer insulation has never been fully established. The objective of this test program is to provide a more basic understanding of the thermal performance repeatability of MLI systems that are applicable to large scale tanks. There are several different types of repeatability that can be accounted for: these include repeatability between multiple identical blankets, repeatability of installation of the same blanket, and repeatability of a test apparatus. The focus of the work in this report is on the first two types of repeatability. Statistically, repeatability can mean many different things. In simplest form, it refers to the range of performance that a population exhibits and the average of the population. However, as more and more identical components are made (i.e. the population of concern grows), the simple range morphs into a standard deviation from an average performance. Initial repeatability testing on MLI blankets has been completed at Florida State University. Repeatability of five GRC provided coupons with 25 layers was shown to be +/- 8.4 whereas repeatability of repeatedly installing a single coupon was shown to be +/- 8.0. A second group of 10 coupons have been fabricated by Yetispace and tested by Florida State University, through the first 4 tests, the repeatability has been shown to be +/- 16. Based on detailed statistical analysis, the data has been shown to be statistically significant.

  19. Use of corticosteroids for anorexia in palliative medicine: a systematic review.

    Science.gov (United States)

    Miller, Sarah; McNutt, Louise; McCann, Mary-Ann; McCorry, Noleen

    2014-04-01

    Anorexia is a significant problem in patients approaching the end of life, for which corticosteroids are widely prescribed. It is not clear which regimen is the most safe and effective for this indication. The study objective was to identify the evidence for the use of corticosteroids, and the most safe and effective dosing regimen for management of anorexia in palliative care patients. A search of MEDLINE and CINAHL was carried out to identify original studies relevant to this question. These were reviewed against inclusion criteria and articles for inclusion were identified. Data was extracted and a narrative analysis was carried out. Subjects were adult patients with life-limiting diagnoses prescribed corticosteroids for anorexia in any care setting. Quality of studies was assessed using the system used by the Scottish Intercollegiate Guidelines Network for grading evidence. Eight articles were identified that met the inclusion criteria. The corticosteroid drugs and dosing regimens used were wide ranging, and a variety of tools were used to assess appetite within these studies. All studies showed improvement in appetite with the corticosteroid used, although this did not always reach statistical significance. It was not possible to identify the most effective corticosteroid drug, dose, or duration of treatment from the identified studies: the best quality evidence was for an eight-week course of intravenous methylprednisolone; however the studies using this regimen had the highest attrition rates. Corticosteroids are beneficial in treating anorexia in palliative care patients with malignancies; however there is no evidence for their use in anorexia due to end-stage nonmalignant disease. There is insufficient evidence to recommend any particular corticosteroid drug over another, or to recommend a dosing regimen.

  20. Gene expression changes associated with resistance to intravenous corticosteroid therapy in children with severe ulcerative colitis.

    Directory of Open Access Journals (Sweden)

    Boyko Kabakchiev

    Full Text Available BACKGROUND AND AIMS: Microarray analysis of RNA expression allows gross examination of pathways operative in inflammation. We aimed to determine whether genes expressed in whole blood early following initiation of intravenous corticosteroid treatment can be associated with response. METHODS: From a prospectively accrued cohort of 128 pediatric patients hospitalized for intravenous corticosteroid treatment of severe UC, we selected for analysis 20 corticosteroid responsive (hospital discharge or PUCAI ≤45 by day 5 and 20 corticosteroid resistant patients (need for second line medical therapy or colectomy, or PUCAI >45 by day 5. Total RNA was extracted from blood samples collected on day 3 of intravenous corticosteroid therapy. The eluted transcriptomes were quantified on Affymetrix Human Gene 1.0 ST arrays. The data was analysed by the local-pooled error method for discovery of differential gene expression and false discovery rate correction was applied to adjust for multiple comparisons. RESULTS: A total of 41 genes differentially expressed between responders and non-responders were detected with statistical significance. Two of these genes, CEACAM1 and MMP8, possibly inhibited by methylprednisolone through IL8, were both found to be over-expressed in non-responsive patients. ABCC4 (MRP4 as a member of the multi-drug resistance superfamily was a novel candidate gene for corticosteroid resistance. The expression pattern of a cluster of 10 genes selected from the 41 significant hits were able to classify the patients with 80% sensitivity and 80% specificity. CONCLUSIONS: Elevated expression of several genes involved in inflammatory pathways was associated with resistance to intravenous corticosteroid therapy early in the course of treatment. Gene expression profiles may be useful to classify resistance to intravenous corticosteroids in children with severe UC and assist with clinical management decisions.