High-dose dexamethasone in the treatment of HELLP syndrome.
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Blood Platelets↗
Biomedical subjects
F Paruk
Publications and source records attributed to F Paruk.
Untoward effects of rapid-acting antihypertensive agents.
Cerebral haemorrhage remains a major cause of hypertensive cerebral mortality. Lowering of raised blood pressure is therefore crucial in the clinical management of hypertensive disorders of pregnancy. This article reviews rapid-acting agents employed in life-threatening situations.
Antihypertensive Agents↗
Severe obstetric morbidity.
Obstetric morbidity is an important marker of the quality of obstetric care. This review explores the definition, incidence and significance of obstetric morbidity. Some topical issues related to obstetric morbidity are discussed. In addition, the importance of long-term morbidity and violence against women is highlighted.
Eclampsia↗
Maternal and neonatal outcome in early- and late-onset pre-eclampsia.
Early-onset pre-eclampsia and late-onset pre-eclampsia, by virtue of their unpredictable nature and prediliction for multi-organ involvement, are associated with substantial maternal and fetal morbidity and mortality. Recent years have seen the introduction of the concepts of care in specialized units, expectant management of pre-eclampsia, conservative management of the HELLP syndrome (haemolysis, elevated liver enzymes, low platelets), usage of magnesium sulphate and improved feto-maternal surveillance. It is important to note that these factors also influence maternal and neonatal outcome.
Antihypertensive Agents↗
Intensive care unit morbidity and mortality from eclampsia: an evaluation of the Acute Physiology and Chronic Health Evaluation II score and the Glasgow Coma Scale score.
OBJECTIVE: To determine the maternal morbidity and mortality in patients with eclampsia admitted to an intensive care unit (ICU), and to establish the efficacy of the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the organ system failure score as defined by Knaus, and the Glasgow Coma Scale (GCS) score in predicting outcome. DESIGN: Retrospective analysis of a 3.5-yr period. SETTING: Surgical ICU in a university hospital. PATIENTS: A total of 105 patients who were admitted with a diagnosis of eclampsia were studied. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The data captured included the reason for admission, maternal age, gestational age, parity, number of seizures, duration of ICU stay, anticonvulsant therapy, drug therapy, GCS score, APACHE II score, and the occurrence of organ failure. Of the 126 patients with eclampsia who were admitted to the ICU, records of 105 patients (83%) were found. The overall mortality was 10.5% (n = 11). The mean age, gestation, parity, number of preadmission seizures, and duration of stay were similar in survivors and nonsurvivors. Although the APACHE II score was significantly higher in nonsurvivors, multiple logistic regression analysis suggested that the goodness-of-fit scores for GCS and APACHE II were similar (38.29 vs. 38.01). The GCS scores of survivors were significantly higher than those of nonsurvivors (10.61 vs. 5.0; p<.001). Respiratory failure was the most common organ failure in both groups. The mean number of organ failures was higher in nonsurvivors compared with survivors (2.9 vs. 1.3; p<.001). An occurrence of more than two organ failures that persisted for >48 hrs was invariably associated with a fatal outcome. Anticonvulsant therapy consisted of magnesium sulfate or phenytoin and a midazolam infusion. Only one patient (0.9%) had a seizure, and this occurred en route to the ICU. No seizures occurred after admission to the ICU. CONCLUSIONS: The organ system failure score and the GCS score are good predictors of outcome in eclampsia. Apart from the GCS score, other variables in the APACHE II score are not valuable for outcome prediction. The low GCS score in nonsurvivors suggests that closer attention to the neurologic management may be beneficial. A prospective study is indicated to validate these findings.
APACHE↗
Major threats to childbirth in developing countries.
Biological, psychological or social elements may constitute a threat to childbirth. In developing countries, major threats to childbirth mainly caused by restricted health service budgets may be overcome by the introduction of appropriate screening tests, implementation of evidence-based medicine protocols, and a primary health-care approach to maternity services.
Developing Countries↗
Screening for proteinuria in hypertensive disorders of pregnancy.
One hundred and fifty patients were recruited to assess the reliability of a random urinary dipstick for protein compared with 24 hour urine analysis and to determine if a shorter interval of collection is reliable in screening for proteinuria in hypertensive disorders of pregnancy. These patients were instructed in the collection technique of a 24 hour urine sample. Aliquots were taken to represent 6 and 12 hour collections. The mean gestational age was 30 weeks and the mean diastolic blood pressure 95 mmHg. Of the patients, 84 had proteinuria and 66 had no proteinuria on random urinary dipstick analysis. The random urinary dipstick showed a sensitivity of 84%, and a specificity of 61%. The urinary dipstick of the hour 6 sample showed a sensitivity of 84.5%, and a specificity of 90.1%. Urine analysis of the 6 hour sample showed a sensitivity of 87.9% and a specificity of 80.4%. Analysis of the 12 hour sample yielded an accuracy of approximately 83%. The random urinary dipstick is unreliable in screening for proteinuria in hypertensive disorders of pregnancy. A 6 hour collection is much more accurate.
Journal Article↗
Ipratropium bromide delivered by metered-dose aerosol to infant wheezers.
Two methods of administration of ipratropium bromide (Atrovent; Boehringer Ingelheim) to wheezing children less than 25 months of age were compared: (i) the conventional nebulisation (15 children); and (ii) a metered-dose aerosol plus spacer and mask (MDA group, 17 children). The drug induced a significant and similar fall in respiratory rate in both groups. Transcutaneous carbon dioxide pressure was also reduced significantly but was more marked in the MDA group. This increase in alveolar ventilation was similar in those less than 12 months as in older children; in those with recurrent or with first time wheezing; and in those with radiological evidence of pneumonia. Clinical assessment of bronchospasm and recession was recorded as improved in over 80% of both groups. The MDA delivery of ipratropium bromide was as effective as nebulisation and was more convenient, since it required less time and equipment. It was also well accepted by the small patients.
Aerosols↗