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Biomedical subjects

H Fletcher

Publications and source records attributed to H Fletcher.

At least 37 records · Page 2Linked to original sources
PubMed2002

Misoprostol use in obstetrics and gynecology in Brazil, Jamaica, and the United States.

OBJECTIVES: To investigate current clinical use of misoprostol for the treatment of a range of reproductive health indications by providers in Brazil, Jamaica, and the United States. METHODS: Using a 'snowball' sampling technique, we surveyed 228 gynecologists and obstetricians in Brazil (n=123), Jamaica (n=52), and the United States (n=53). RESULTS: Providers use misoprostol for labor induction (46%), postpartum hemorrhage (8%), intra-uterine fetal death (61%), cervical priming (21%), missed abortion (57%), and incomplete abortion (16%) as well as first and second trimester abortion induction (27% and 13%, respectively). CONCLUSIONS: There is considerable variation in the regimens used; moreover, the regimens commonly used in clinical practice often differ from those recommended in the medical literature. While misoprostol is an appealing alternative for many reproductive health indications in developing countries, the varied regimens and lack of registration raise critical medical and policy questions.

Brazil↗
PubMed2002

A randomised controlled trial of outpatient versus inpatient cervical cerclage.

Fifty patients with cervical incompetence were randomised to have cervical cerclage either as inpatients, spending 3 days in hospital post-procedure on supervised bed rest or as outpatients spending the time at home on bed rest. Both groups had a clinical diagnosis of cervical incompetence and both had either McDonald or Shirodkar cerclage with mersilene tape. Both groups were given salbutamol tablets for tocolysis, postoperatively. There were no significant difference in the demographic variables between the groups such as previous cerclage, gestational age at insertion, parity and gestational age at delivery. There were also no significant differences in early complications such as bleeding. Most late complications were also not different, including the spontaneous abortion rate, premature rupture of membranes, cervical dystocia and preterm delivery. However, more patients in the outpatient group had premature contractions (26.1% vs. 4.3% P=0.0479). More patients in the inpatient group had a delivery of a live neonate, 86.9% vs. 78.3%, but the difference was not statistically significant. In conclusion, out patient cerclage appears to be a valid option, the higher rate of premature contraction in this group is not a cause for concern in view of the similar mean gestational age at delivery.

Adult↗
PubMed2002

Operative morbidity and reproductive outcome in secondary myomectomy: a prospective cohort study.

BACKGROUND: This prospective study was designed to evaluate the operative morbidity and reproductive outcome in patients who had secondary myomectomy for recurrent symptomatic uterine fibroids. METHODS: A total of 58 women were subjected to a secondary myomectomy via the abdominal route. The operative morbidity such as blood loss, presence of adhesions and febrile index were estimated and the pregnancy outcome over a 2-4 year period of follow-up. RESULTS: The mean age and standard deviation (+/- SD) of the women was 35 (+/- 2.4) years. Nineteen patients (33%) had a postoperative temperature vertical line 100 degrees F and the estimated blood loss ranged from 159-2500 ml (median 700 ml). Seven patients (12%) required blood transfusion and one had a hysterectomy due to haemorrhage. Nine women (15.5%) became pregnant but only five (56%) had live births. Those with successful pregnancies tended to be younger with a mean age of 31.8 (+/- 2.6) years versus 35 (+/- 1.8) years, (P = 0.08, non-significant) and had fewer uterine leiomyomata; median with range values, 2 (1-6) versus 7 (6-15). The variables which best predicted the postoperative likelihood of pregnancy were; age, presence of tubal adhesions and the number of uterine fibroids. CONCLUSION: This prospective study showed a high operative morbidity and a poor fertility outcome after a repeat myomectomy. The factors affecting successful outcome in a logistic regression model were age, tubal adhesions and number of uterine fibroids.

Adult↗
PubMed2002

HIV infection seroprevalence and risk factor study among pregnant women attending the Antenatal Clinic at the University Hospital of the West Indies, Kingston, Jamaica.

The objectives of this study were to determine the seroprevalence and risk factors for Human Immunodeficiency Virus (HIV) infection among the antenatal clinic population at the University Hospital of the West Indies (UHWI). Pregnant mothers (4186) attending antenatal clinic at the UHWI were screened for HIV infection between September, 1998, and October, 2000. Tests were performed with the use of Abbott enzyme immunoassay (EIA) kits for the detection of antibodies to HIV 1 and 2. Demographic characteristics and risk factor assessments were performed using a questionnaire for all positive cases and four randomly selected negative controls matched by age to each positive case. Twenty-one women were found to be HIV positive. Nineteen of these women were not previously aware that they were HIV-positive. The seroprevalence of HIV infection among antenatal mothers was 0.5%. The mean age of cases was 29.3 +/- 4.6 years. There was no significant difference between cases and controls with regards to parity, socio-economic status and educational achievement. Women residing in urban Kingston and St Andrew (Odds ratio (OR) 5, 95% confidence interval (CI) 1.4, 18), as well as those with a higher number of lifetime sexual partners (OR 1.42, 95% CI 1.13, 1.79) and those with previous sexually transmitted diseases (OR 3.4, 95% CI 1.1, 10.6) were at greater risk for HIV infection. In contrast, women who commenced coitus at a later age were at less risk of becoming infected (OR 0.79, 95% CI 0.6, 0.97). This study demonstrates a low seroprevalence of HIV in the UHWI antenatal population compared to the reported seroprevalence of 2%-8% in pregnant women in Latin America and the Caribbean. The results from this study emphasize the continuing need for voluntary HIV testing and HIV/AIDS educational campaign for this vulnerable group.

Adult↗
PubMed2002

Smooth muscle tumours of the vulva in Jamaica.

Smooth muscle tumours of the vulva are uncommon and their behaviour is unpredictable. A 30-year retrospective analysis of the pathology files and patient records revealed 10 cases diagnosed at the University Hospital of the West Indies, Kingston, Jamaica, with one malignant and one recurrent tumour. Size, infiltrating margins and mitotic count are important parameters to determine prognosis. Although these tumours are of low malignancy, mitotic count may be mandatory in determining their potential for recurrence.

Adolescent↗
PubMed2002

Cervical pregnancy. Case report and literature review.

Cervical pregnancy is an uncommon life threatening form of ectopic pregnancy that is associated with the unexpected occurrence of uncontrollable haemorrhage from the cervix. To avoid hysterectomy and to maintain fertility, several conservative methods of termination have been used. We present herein, one such case which relates to a young woman who had successful conservative management of a cervical pregnancy using vasopressin infiltration of the cervix, a McDonald cerclage and cervical curettage followed by balloon tamponade. Subsequently, she became pregnant again with a normal intra-uterine pregnancy and had a successful vaginal delivery.

Adult↗
PubMed2001

Pentapotassium dodecatungstoborate(III) hexadecahydrate.

The title compound, K(5)[BW(12)O(40)].16H(2)O, contains a [BW(12)O(40)](5-) polyanion of 222 crystallographic symmetry, with a central tetrahedrally coordinated B(III) atom surrounded by four groups of three edge-sharing octahedra (W(3)O(13) subunits), which are linked in turn to each other and to the central BO(4) tetrahedron by shared O atoms at the vertices. There is a crystallographically unique B-O bond of 1.554 (10) A, while the average W-O distances are 2.344 (17) A for four coordinate O atoms, 1.917 (12) and 1.89 (2) A for two coordinate O atoms within and connecting the W(3)O(13) subunits, respectively, and 1.709 (8) A for terminal O atoms. Not all of the K(+) ions and H(2)O groups were located.

Journal Article↗
PubMed2001

Design, synthesis, SAR, and biological evaluation of highly potent benzimidazole-spaced phosphono-alpha-amino acid competitive NMDA antagonists of the AP-6 type.

A series of 2-amino-(phosphonoalkyl)-1H-benzimidazole-2-alkanoic acids was synthesized and evaluated for NMDA receptor affinity using a [3H]CPP binding assay. Functional antagonism of the NMDA receptor complex was evaluated in vitro using a stimulated [3H]TCP binding assay and in vivo by employing an NMDA-induced seizure model. Several compounds of the AP-6 type demonstrated potent and selective NMDA antagonistic activity both in vitro and in vivo. In particular, [R(-)]-2-amino-3-(5-chloro-1-phosphonomethyl-1H-benzoimidazol-2-yl)-propionic acid (1) displayed an IC(50) value of 7.1 nM in the [3H]CPP binding assay and an ED(50) value of 0.13 mg/kg (ip) in the NMDA lethality model. Compound 1, when administered intravenously as a single bolus dose of 3 mg/kg following permanent occlusion of the middle cerebral artery in the rat, reduced the volume of infarcted brain tissue by 45%. These results support a promising therapeutic potential for compound 1 as a neuroprotective agent.

Animals↗
PubMed2001

Adding ketamine to morphine for patient-controlled analgesia after major abdominal surgery: a double-blinded, randomized controlled trial.

UNLABELLED: In this double-blinded, randomized controlled trial we tested if the addition of ketamine to morphine for patient-controlled analgesia (PCA) resulted in improved analgesic efficacy and lower pain scores compared with morphine PCA alone after major abdominal surgery. Seventy-one patients were randomly allocated to receive either morphine 1 mg/mL (Group M) or morphine 1 mg/mL plus ketamine 1 mg/mL (Group MK) delivered via PCA after surgery. No other analgesics or regional blocks were permitted during the 48-h study period. Postoperatively there were no differences between the groups for subjective assessment of analgesic efficacy, pain scores at rest, and on movement, opioid consumption, or adverse events. Group MK patients performed worse in cognitive testing (P = 0.037). There was an increased risk of vivid dreaming in patients who received ketamine (relative risk = 1.8, 95% confidence interval 0.78-4.3). We conclude that small-dose ketamine combined with PCA morphine provides no benefit to patients undergoing major abdominal surgery. IMPLICATIONS: We performed a randomized, controlled trial comparing the use of ketamine and morphine with morphine alone to relieve pain after major abdominal surgery.Ketamine did not improve pain relief and merely increased side effects.

Abdomen↗
PubMed2001

Relation between quality of recovery in hospital and quality of life at 3 months after cardiac surgery.

BACKGROUND: Improved quality of life (QoL) is a desirable outcome of cardiac surgery. The aim of the current study was to measure the association between quality of recovery 3 days after surgery and QoL measured 3 months later. METHODS: After obtaining ethics committee approval and consent, 120 adult cardiac surgical patients were studied. A 40-item quality of recovery score (QoR-40) was used to measure postoperative health status on days 1-3 and 1 month after surgery. QoL was measured using the short-form health survey (SF-36) at 1 and 3 months after surgery. The effect size (delta mean/SD) was used to define responsiveness, a clinically important difference in health. Associations were measured using correlation and reliability coefficients. RESULTS: There was a significant change in the mean QoR-40 for up to 1 month after surgery (P < 0.0005). QoL was improved at 3 months (P < 0.0005) but not 1 month (P = 0.29) after surgery. There was a moderate correlation between day-3 QoR-40 and 3-month SF-36 (r = 0.39; P < 0.0005). A poor-quality recovery in hospital predicted a poor QoL at 3 months (adjusted odds ratio, 4.20; 95% confidence interval, 1.41-12.5; P = 0.01). CONCLUSIONS: The QoR-40 is a valid measure of quality of recovery after surgery and anesthesia. When compared with the SF-36, it is a better measure of early postoperative recovery. A poor-quality recovery on the days after surgery can predict a poor QoL at 3 months after surgery. This may allow earlier and more effective support strategies while patients are still in the hospital (counseling, home assistance, local doctor notification, cardiac rehabilitation).

Anesthesia Recovery Period↗
PubMed2001

Ovarian hormones modulate cocaine-induced locomotor and stereotypic activity.

Interactions between ovarian hormones and cocaine may underlie gender and estrous cycle differences in cocaine-induced behavioral and neurochemical alterations. The aim of this study was to further understand how ovarian hormones modulate cocaine-induced behavioral alterations. Ovariectomized rats received acute or chronic saline or cocaine (15 mg/kg i.p.) administration and were further subdivided into one of four hormone-treatment conditions: cholesterol (vehicle-control), estrogen, progesterone, or estrogen + progesterone. Overall, acute and chronic cocaine administration increased all locomotor measurements (total locomotor, ambulatory, and rearing counts). Estrogen administration augmented cocaine-induced increases in ambulatory and rearing activity. After chronic cocaine administration, rats in the vehicle-control group developed behavioral tolerance (exhibited by a decrease in activity) in rearing and ambulatory activity. Estrogen replacement not only prevented the development of tolerance in ambulatory and rearing activities, but also enhanced total locomotor activity (sensitization) in response to chronic cocaine. Progesterone treatment did not alter the behavioral responses to acute or chronic cocaine administration. Estrogen + progesterone-treated animals had higher counts of locomotor activity in response to chronic cocaine than did vehicle-control or progesterone-treated rats. In stereotypic behaviors, the different hormonal treatments did not affect activity in cocaine- or saline-treated rats after acute or chronic drug administration. Plasma levels of cocaine did not change after different hormonal treatments. Interestingly, animals' coadministered chronic cocaine and estrogen had higher levels of corticosterone than did nonestrogen cocaine-treated rats. Thus, it is likely that alterations in HPA activation may underlie the observed behavioral differences. In summary, these data suggest that there are interactions between ovarian hormones and cocaine-induced behavioral alterations in female rats, and they extend previous results by showing that estrogen and progesterone affect the development of sensitization.

Animals↗
PubMed2001

A retrospective review of pregnancy outcome after misoprostol (prostaglandin E1) induction of labour.

This retrospective study looked at the outcome of using 50-100 micrograms misoprostol once daily to induce labour compared to the outcome of the overall patient population delivered during the same period (1994-1996). During that period 11,255 patients were delivered and 1037 (9.2%) were induced with misoprostol. Results showed a significantly lower mean Caesarean section rate: 9.3% for the misoprostol group versus 13.3% for the overall population (p = 0.002, Odds Ratio (OR) 0.67, 95% CI 0.53, 0.83). The abruption rates were not significantly different: 0.8% for misoprostol versus 0.4% (p = 0.09, OR 1.86, 95% CI 0.81, 4.09). There was more postpartum haemorrhage in the misoprostol group: 5.6% versus 3.5% (p = 0.0006, OR 1.63, 95% CI 1.22, 2.19); a higher incidence of Apgar scores less than 6 at one minute 10.2% versus 7.9% (p = 0.0093, OR 1.33, CI 1.06, 1.65) but not at five minutes 2.9% versus 2.4% (p = 0.674, OR 1.09, CI 0.73, 1.61) and a higher perinatal mortality rate 55/1000 versus 16.3/1000 (p = 0.00, OR 3.5, 95% CI 2.55, 4.80). The rate remained higher but not significantly so when a correction was made to eliminate the high number of intrauterine deaths induced with misoprostol 18/1000 versus 16.3/1000 (p = 0.69, OR 1.11, 95% CI 0.66, 1.84). There were no cases of uterine rupture in either group. In conclusion, there was a significantly lower Caesarean section rate among patients who had once daily misoprostol induction of labour. Close monitoring of the foetus, in patients with misoprostol induction, is needed to detect foetal distress and prophylaxis against postpartum haemorrhage is still mandatory.

Apgar Score↗
PubMed2001

Sex differences in cocaine-induced behavioral sensitization.

To further understand how sex differences affect the development and maintenance of sensitization, 48 adult Fischer rats (24 female and 24 male) received chronic administration (14 days) of cocaine (15 mg/kg, i.p.) or saline or a challenge dose (7 days after chronic cocaine administration). Sex differences were observed in the development and maintenance of cocaine-induced total locomotor, ambulatory and rearing activity. Although, overall cocaine administration increased stereotypic activity in both male and female rats, female rats had significantly higher stereotypic activity than male rats across the three behavioral test days (1, 7 and 14). Female rats had statistically significant higher benzoylecognine levels after acute cocaine administration than male rats. However, no differences between male and female rats in benzoylecognine plasma levels were observed after chronic and challenge doses of cocaine administration. Interestingly, after acute and challenge cocaine administration, corticosterone levels were significantly higher in female rats when compared to male rats. This study confirms previous reports that there are sex differences in the behavioral response to cocaine. Moreover, this study expands previous studies by demonstrating that sex differences occur in only certain aspects of cocaine-induced behavioral activation and the development and maintenance of cocaine-induced behavioral sensitization.

Animals↗
PubMed2000

Part I: propofol, thiopental, sevoflurane, and isoflurane-A randomized, controlled trial of effectiveness.

UNLABELLED: When compared with thiopental and isoflurane, propofol and sevoflurane are associated with a faster return to wakefulness after anesthesia. Yet their wider usage in inpatient surgery has been restrained by concerns regarding their acquisition costs and by lack of studies demonstrating improved patient outcome. We randomly allocated 453 adult surgical inpatients to one of four anesthetic regimens (thiopental-isoflurane, propofol-isoflurane, propofol induction and maintenance, or sevoflurane induction and maintenance) and measured their rate and quality of recovery. We found no significant differences in the rate and quality of recovery between groups. Propofol was associated with more pain on injection (P: < 0. 0005), but less cough during induction (P: = 0.003), and less early postoperative nausea and vomiting (P: = 0.003). We could not detect any significant advantages with propofol and sevoflurane, when compared with thiopental and isoflurane in adults undergoing elective inpatient surgery. IMPLICATIONS: Propofol and sevoflurane do not offer any significant advantages over thiopental and isoflurane in adults undergoing elective inpatient surgery.

Adult↗
PubMed2000

Systemic phaeohyphomycosis in pregnancy and the puerperium.

Systemic fungal infections are rare. In pregnancy, treatment is problematic because of the risk of possible teratogenic effects of the antifungal drugs. We present the case of a 32 year-old woman who presented during pregnancy with a two-month history of painless subcutaneous nodules. Excision biopsy of one lesion showed dematiaceous fungal elements. Anti-fungal treatment was deferred and the pregnancy proceeded uneventfully. The remaining nodules were excised at the time of caesarean section delivery. Three weeks into the puerperium, she developed generalised seizures and investigations indicated systemic fungal infection with positive cultures for Aureobasidium spp which responded to appropriate antifungal therapy of flucytosine and itraconazole.

Adult↗