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Biomedical subjects

K Devendra

Publications and source records attributed to K Devendra.

15 recordsLinked to original sources
PubMed2006

Tocolytic treatment for the management of preterm labour: a systematic review.

Spontaneous preterm labour and delivery accounts for approximately one-third of preterm births, which is the predominant cause of perinatal mortality and morbidity. This review aims to evaluate the evidence on the benefits and harms of five classes of tocolytic therapy, namely: betamimetics, calcium channel blockers, magnesium, non-steroidal anti-inflammatory agents, and atosiban. We performed a systematic review of the effectiveness of tocolytics to stop uterine contractions (first-line therapy). Reports of randomised controlled trials from searches of MEDLINE, bibliographies of review articles, Cochrane Collaboration and its Pregnancy and Childbirth Review Group between 1966 and 2003 were identified, using the search terms "randomised controlled trial" (RCT), "preterm labor", "tocolysis", "betamimetics", "ritodrine", "prostaglandin synthetase inhibitors", "indomethacin", "calcium channel blockers", "nifedipine", "oxytocin receptor blockers", "atosiban", and "magnesium sulphate". Studies on women with preterm labour comparing the effects of a tocolytic with a placebo or no treatment that met our inclusion criteria, were included. To our knowledge, the trials were conducted mainly before 1999 and there were no placebo-controlled trials after that. Of the 86 articles identified and evaluated, 14 first-line studies met more stringent requirements for meta-analyses. Tocolytics were associated with significant decreases in the odds of delivery within 24 hours (odds-ratio [OR] 0.54, 95 percent confidence interval [CI] 0.32-0.91) and 48 hours (OR 0.47, 95 percent CI 0.30-0.75). These effects were significant for beta-agonists, atosiban and indomethacin, but not magnesium sulphate. Maternal side-effects significantly associated with betamimetics were pulmonary oedema, cardiac arrhthymias and hypokalaemia. Although calcium antagonists have not been evaluated against placebo, comparative trials with beta-agonists have shown more favourable neonatal outcomes and better prolongation of gestation. In conclusion, the management of threatened preterm labour with first-line tocolytic therapy can prolong gestation. However, the time gained in-utero need to be optimised. There is no clear first-line tocolytic agent. The use of tocolytic agents should be individualised and based on maternal condition, potential side-effects and gestational age.

Female↗
PubMed2006

Intrapartum maternal sinus bradycardia with spontaneous resolution following delivery.

Pregnancy is a normal physiological state that is characterised by significant adaptive changes, many of which take place in the cardiovascular system. These adaptations are believed to be the cause for the increased incidence in cardiac arrhythmias in pregnancy and particularly, in labour. We report an unusual case of a healthy 32-year-old primigravida who developed profound intrapartum bradycardia which persisted throughout labour. Spontaneous recovery to pre-labour baseline heart rate occurred following spontaneous vaginal delivery. Maternal and foetal statuses remained satisfactory during labour. This case report underscores the importance of recognising that arrhythmias in various forms are common in labour. In the absence of detectable underlying cardiac disease or maternal and foetal compromise, continuation of the labour with a view to vaginal delivery should be the goal.

Adult↗
PubMed2003

Recurrent tracheoesophageal fistula after foreign body impaction.

We describe a case of recurrent tracheoesophageal fistula in a child previously operated for esophageal atresia and tracheoesophageal fistula following impaction of a foreign body. After extracting the foreign body, the diagnosis of recurrence was confirmed by esophagogram and bronchoscopy. The fistula was approached through transpleural thoracotomy and repair effected without significant difficulty. The possibility of unrecognized foreign body impactions as the etiological factor for late recurrence of tracheoesophageal fistula is discussed.

Bronchoscopy↗
PubMed2003

Changing trends in indications for caesarean sections in a tertiary hospital.

OBJECTIVES: To study the caesarean section rate and the trends in indications for caesarean delivery at the Singapore General Hospital (SGH) during two study periods of 6 months each. MATERIALS AND METHODS: The percentages of caesarean sections attributable to specific indications were computed for the first 6 months of 1998 and the last 6 months of 2001. Subgroup analysis of "less common indications" was performed. RESULTS: In the first half of 1998, 170 caesarean sections were performed giving a rate of 16.77%. 54.12% of women were multiparous. The main indication for caesarean section was dystocia (4.24% of deliveries). Two hundred and sixty caesarean sections were performed in the later half of 2001 giving a caesarean section rate of 25.10%. 53.46% of women were multiparous. The main indication for caesarean section was dystocia (5.41% of deliveries). Increase in caesarean section rate in 2001 was attributed to statistically significant increase in caesarean section for previous caesarean section and placenta previa major. Other changes in practice included shorter operating time which may be related to decision not to perform peritoneal closure. CONCLUSION: Studying indications for caesarean section are useful for hospitals, clinicians and researchers in determining strategies to lower primary and repeat caesarean section rate.

Adult↗
PubMed2003

Metastatic carcinoma of the cervix presenting as a psoas abscess in an HIV-negative woman.

A case of advanced carcinoma of the cervix presenting as a psoas abscess is described. This unusual presentation has been reported in association with AIDS but is extremely rare in HIV-negative women. This case report emphasises the importance of awareness of unusual causes of the psoas abscess in an era when the classical tuberculous abscess is fast disappearing.

Adult↗
PubMed2003

Should doctors perform an elective caesarean section on request?

The incidence of caesarean sections performed on request without medical indications is rising. The reasons for this are not only for perceived medical benefit, but are also due to social, cultural and psychological factors. Despite dramatic improvements in the safety of anaesthesia and surgery, mortality and morbidity are greater for elective caesarean sections compared to vaginal deliveries. An association exists between pelvic floor damage and childbirth, but this cannot be attributed entirely to vaginal deliveries and does occur even after a caesarean birth. The incidence of late intrauterine deaths is unlikely to be reduced by a policy of universal elective caesarean section, as these procedures carry a risk of iatrogenic fetal morbidity and mortality. The legal and ethical issues of request caesarean sections are complex. The validity of informed consent for non-indicated surgery is unclear. An individual has his/her rights and so does society. When society's rights are judged to have priority, the individual's right becomes a privilege. Based on this principle, maternal request caesarean sections must not compromise the provision of care to women requiring medically-indicated caesarean sections or should not dent the resources of public healthcare. In dealing with requests for caesarean sections, obstetricians should establish the reasons for the request and provide clear, unbiased information based on the best available evidence. Individualized modifications to the management of labour may allow some women to have vaginal deliveries. A second opinion from a colleague may help the patient to reconsider the request and make a more informed choice.

Cesarean Section↗
PubMed2002

Laparoscopically-assisted vaginal hysterectomy (LAVH)--an alternative to abdominal hysterectomy.

AIM: To study the outcomes of 42 consecutive patients who were scheduled for a laparoscopically-assisted vaginal hysterectomy (LAVH) between I January 1994 to 31 December 1999. METHOD: Retrospective study RESULTS: Two patients required conversion to an abdominal hysterectomy. The range of uteri removed was from six to 16 weeks' size. Menorrhagia was the commonest presenting complaint and uterine fibroids was the commonest diagnosis. The mean duration of surgery (+/- SD) was 131.0 +/- 31.7 minutes. Mean blood loss (+/- SD) was estimated at 417 +/- 169 mls. Six percent of patients required a perioperative blood transfusion. Fifty-five percent of patients did not require any injectable analgesics and 45% were able to ambulate on the day of surgery. The mean duration of hospital stay (+/- SD) was 4.2 +/- 2.3 days;The commonest complication was post-operative fever. CONCLUSIONS: LAVH patients have a quick postoperative recovery with less pain at the expense of a long duration of surgery. LAVH is a feasible option in a selected group of patients who would otherwise require an abdominal hysterectomy.

Adult↗
PubMed2002

Pregnancy in women with idiopathic thrombocytopaenic purpura.

INTRODUCTION: Idiopathic thrombocytopaenic purpura (ITP) is a common haematological disorder in young women. The management of ITP in pregnancy is controversial, particularly with regards to the mode of delivery. To date, there is no systematic study of the outcome of these pregnancies in Singapore. AIM: To study the outcomes of pregnancies in Asian women with a proven diagnosis of ITP. MATERIALS AND METHODS: Retrospective study of 27 pregnancies in 18 women managed at the Singapore General Hospital from 1 January 1994 to 30 June 2001. RESULTS: The mean age of the women was 30 years (range, 20 to 41 years) and the mean parity was 1 (range, 0 to 3). Thrombocytopaenia (platelet count < 150 x 10(9)/L) occurred in 18 pregnancies (67%). There were 3 first trimester missed abortions (11%), 1 termination of pregnancy (4%), 1 stillbirth (4%) and 22 livebirths (81%) in this series. The mode of delivery was spontaneous vaginal in 14 women (64%), vacuum extraction in 2 women (9%), elective caesarean section in 5 women (23%) and emergency caesarean section in 1 woman (4%). All liveborn neonates were delivered in good condition at term. Neonatal thrombocytopaenia occurred in 4 neonates (18%). Two neonates had cord platelet counts of less than 50 x 10(9)/L and 1 required therapy with corticosteroids and intravenous immune globulins. No bleeding complications occurred in any of the neonates. CONCLUSION: Our experience supports the increasingly prevalent practice of managing pregnancies in women with ITP with a conservative approach to investigations and treatment. Caesarean sections should be performed for obstetric indications only, given the rarity of bleeding complications in the offspring of these women and the lack of evidence to support its role in the prevention of neonatal intracranial haemorrhage.

Abortion, Spontaneous↗
PubMed2002

Four pregnancies in two patients with essential thrombocythaemia--a case report.

INTRODUCTION: We report our experience of 4 pregnancies in 2 patients who had essential thrombocythaemia (ET). CLINICAL PICTURE: Two patients with ET were managed with a variety of therapeutic approaches including the use of low-dose aspirin, plateletpheresis, hydroxyurea and alpha-interferon in the course of their 4 pregnancies. TREATMENT AND OUTCOME: One patient had 2 successful pregnancies despite having platelet counts in excess of 1000 x 10(9)/L antenatally. The second patient had an intrauterine fetal death during the third trimester of her first pregnancy but had a successful second pregnancy. CONCLUSION AND CLINICAL IMPLICATIONS: Management of ET in pregnancy is still very much individualized. The impact of various treatment modalities on the pregnancy outcome remains to be proven but a favourable pregnancy outcome is possible.

Adult↗
PubMed2002

Introducing routine external cephalic version for the management of the malpresenting fetus near term.

BACKGROUND: The aim of this study was to assess the efficacy and safety of external cephalic version (ECV) when its use was introduced in the routine management of breech presentation and transverse lie after 36 weeks by obstetricians with limited prior experience with the procedure. The influence of various factors on the outcome of ECV was also studied. METHODS: Retrospective study of 44 consecutive cases of ECV which were analysed with respect to outcome, parity, type of breech, placental site and birth weight. RESULTS: ECV was successful in 45% of women, 80% of women with successful ECV delivered vaginally while 10% underwent spontaneous reversion to a non-cephalic presentation. In contrast, only 15% of women with failed ECV delivered vaginally. Parity, type of breech presentation and placental location did not significantly affect the outcome of ECV although there was a trend towards better success rate of ECV with multiparity, flexed breech presentation, transverse lie and posteriorly-located placentae. The mean birth weight of fetuses of women with successful ECV was significantly heavier than those of women who failed ECV (p < 0.001). No significant fetal or maternal morbidity occurred as a result of ECV in this study. CONCLUSION: ECV is a safe and effective procedure that is useful in the management of breech presentation and transverse lie near term. The lack of prior experience with the procedure does not appear to influence the success rate or morbidity.

Breech Presentation↗
PubMed2001

Studies on toxicity, anti-stress and hepato-protective properties of Kombucha tea.

OBJECTIVE: The objective of the study was to evaluate toxicity, anti-stress activity and hepato-protective properties of Kombucha tea. METHOD: Kombucha tea was fed orally for 15 days using three different doses i.e. normal dose, five and ten times the dose. Rats were then sacrificed and various biochemical, and histological parameters were estimated. Anti-stress activity was evaluated either by 1) by exposing animals to cold and hypoxia and estimating the levels of malondialdehyde and reduced glutathione in plasma/blood or 2) by subjecting the animals to restraint stress and recording faecal output. Hepato-toxicity was induced by challenging the animals to an acute dose of paracetamol (1 gm/kg) orally and determining the plasma levels of SGPT, SGOT and MDA. RESULTS: The effect of oral administration of different doses of K-tea to albino rats was examined and the results indicate that K-tea has no significant toxicity as revealed by various biochemical and histopathological parameters. K-tea has been found to prevent lipid peroxidation and fall in reduced glutathione level when rats were exposed to cold and hypoxia in simulated chamber. Further, K-tea has also been found to decrease the Wrap-restraint faecal pellet output in rats. K-tea has also been found to decrease paracetamol induced hepatotoxicity significantly. CONCLUSION: The study shows that K-tea has anti-stress and hepato-protective activities.

Administration, Oral↗
PubMed2000

Anti-microbial activity of a new vaginal contraceptive NIM-76 from neem oil (Azadirachta indica).

Efficacy of NIM-76, a spermicidal fraction from neem oil, was investigated for its antimicrobial action against certain bacteria, fungi and Polio virus as compared to whole neem oil. The NIM-76 preparation showed stronger anti-microbial activity than the whole neem oil. It inhibited growth of various pathogens tested including Escherichia coli and Kleibsiella pneumoniae which were not affected by the whole neem oil. NIM-76 also exhibited antifungal activity against Candida albicans and antiviral activity against Polio virus replication in vero cell lines. It also protected mice from systemic candidiasis as revealed by enhanced % survival and reduced colony forming units of C. albicans in various tissues. This shows that NIM-76 has a potent broad spectrum anti-microbial activity.

Animals↗
PubMed1998

Effect of hypobaric hypoxia on immune function in albino rats.

The effect of exposure to hypoxia on macrophage activity, lymphocyte function and oxidative stress was investigated. Hypoxia enhanced peritoneal macrophage activity as revealed by enhanced phagocytosis and free radical production. There was no significant change in antibody titres to sheep red blood cells in either serum or spleen during hypoxia. However, there was a considerable reduction in the delayed-type hypersensitivity response to sheep red blood cells, indicating the impairment of T-cell activity. Hypoxia decreased the blood glutathione (reduced) level and increased plasma malondialdehyde by a factor of about 2. It is therefore speculated that hypoxia imposes an oxidative stress leading to decreased T-cell acivity.

Animals↗
PubMed1996

Mechanism of action of NIM-76: a novel vaginal contraceptive from neem oil.

The present study was undertaken to elucidate the mechanism of spermicidal action of NIM-76, a fraction isolated from neem oil. The spermicidal activity of NIM-76 was confirmed using a fluorescent staining technique. NIM-76 was found to affect the motility of the sperm in a dose-dependent manner. Supplementation of pentoxifylline, which is known to enhance the motility of the sperm, could not prevent the spermicidal action of NIM-76. There was a gradual leakage of cytosolic LDH from the sperm in the presence of NIM-76. Electron microscopic studies revealed the formation of pores and vesicles over the sperm head, indicating the damage to the cell membrane. Membrane fluidization studies did not reveal any significant change in the fluidity of sperm cell membrane structure.

Animals↗