Emergency contraception (EC)

Despite many highly effective methods of contraception are available nowadays, many pregnancies are unintended. Emergency contraception (EC) is the use of drug or device after unprotected intercourse to prevent an unwanted pregnancy. It is a woman's last chance to prevent unintended pregnancy. Nevertheless the confusion about mechanisms of action, side effects, clinical efficacy and contraindications makes the intervention underused in every setting investigated.
So far levonorgestrel (LNG) has been considered the gold standard for oral EC. Today, a new type of second generation progesterone receptor modulator, ulipristal acetate (UPA) has been proposed as a more effective drug than LNG in prevention of unwanted pregnancies by delaying or inhibiting ovulation;
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The 4 Principles of Hand Awareness

Possible New Route To Fight Dengue Virus

Researchers have identified enzymes and biochemical compounds called lipids that are targeted and modified by the dengue virus during infection, suggesting a potential new approach to control the aggressive mosquito-borne pathogen.

Findings also suggest that medications used to treat high cholesterol and other lipid-related conditions might also inhibit dengue's replication and could represent a potential new therapy. The researchers have identified how infected mosquito cells undergo changes to certain lipids in membranes and in biochemical sensors that alert cells of invading viruses.

"The virus reorganizes the internal architecture of the cell to support its own needs," said Purdue University research scientist Rushika Perera. "Many details are unknown. This is our first attempt to understand how the virus alters lipids as part of the infection process. Part of what we looked at in this work was how the virus changes the cell, and the next step will be to figure out why."

The researchers uncovered new details of how the virus alters lipids in membranes surrounding structures inside cells called organelles, including the mitochondria, which provide energy critical for a cell to function, and the endoplasmic reticulum, where proteins and lipids are synthesized.

"Findings also show that important host enzymes are used by the virus and may be targets for future antiviral drugs," said Richard J. Kuhn, a professor and head of Purdue's Department of Biological Sciences and director of the Bindley Bioscience Center. "It turns out, the pills you take to control your cholesterol might have some capability to control dengue."

The work was led by Perera in collaboration with researchers at Purdue's Bindley Bioscience Center and the Pacific Northwest National Laboratory. Findings are detailed in a research paper in the journal PLoS Pathogens

Eye can see a nest of worms!

In October, 2010, a 38-year-old woman presented with creeping sensation in her right eye, but without any systemic or visual symptoms. Her medical history was notable only for an unknown insect flying into her right eye during farm work about 3 months earlier. On examination, a live worm was seen moving out from the nasal upper eyelid of the right eye above the conjunctiva (figure A). This was further viewed with anterior segment optical coherence tomography (figure B). When proxymetacaine eye-drops were administered, preparing the eye for surgical exploration, more than two worms were seen moving (figure C, D).

Haotian Lin, Xiaoling Liang

Diclofenac-tramadol vs. diclofenac-acetaminophen combinations for pain relief after caesarean

Mitra S, Khandelwal P, Sehgal A;

compared the analgesic efficacy of diclofenac-acetaminophen combination with diclofenac-tramadol combination to optimize multimodal post-operative analgesia in women undergoing caesarean section. METHODS: In this randomized, double-blind, parallel-group controlled trial, 204 women undergoing caesarean section under spinal anaesthesia with bupivacaine received rectal suppository diclofenac 100 mg (8 hourly till 24 h) plus either intravenous acetaminophen (1 g 6 hourly) or tramadol (75 mg 6 hourly) post-operatively. The primary outcome measure was the summed pain intensities during the entire observation period, calculated as the sum of time-weighted pain intensity scores as an area under the curve (AUC). Secondary outcome was the use of rescue analgesic, administered if the patient's numeric rating scale (NRS) scores ≥ 4. RESULTS: The overall pain score for the entire observation period measured as AUC was significantly lower in the diclofenac-tramadol group. However, diclofenac-tramadol combination produced Bonferroni-corrected statistically significant lower NRS pain scores only on movement at 24 h. Rescue analgesic consumption was comparable between the groups (13% vs. 12%, P = 0.872). Overall, the pain scores were low in both of the groups across various time intervals (median NRS scores 0-2 for pain both at rest and on movement), indicating satisfactory pain control in both groups. Side effects were few and comparable, except nausea (significantly more in tramadol group than acetaminophen group, 15% vs. 2%, P = 0.001). CONCLUSION: Both diclofenac-tramadol and diclofenac-acetaminophen combinations can achieve satisfactory post-operative pain control in women undergoing caesarean section. The diclofenac-tramadol combination was overall more efficacious but associated with higher incidence of post-operative nausea.

When Unneeded, Induced Labor May Increase Complications Mother, child fare best with spontaneous labor at 38 to 39 weeks' gestation, study finds

FRIDAY, March 9 (HealthDay News) -- Inducing labor when it's not necessary increases the risk of cesarean section delivery and other childbirth complications, a new study says.
The Australian researchers noted that induced labor is common and increasing in many countries. In many cases, labor is induced for "social" and other "non-recognized" reasons, they added.
For the study, the investigators analyzed data from more than 28,000 women with spontaneous onset of labor, induction of labor for known medical reasons, and induction of labor for non-recognized reasons.
Compared with spontaneous labor, inducing labor for non-recognized reasons was associated with a 67 percent increased risk of cesarean section delivery, a 64 percent increased risk that an infant would require care in the neonatal intensive care unit (NICU), and a 44 percent increased risk that an infant would require treatment in the NICU.
The researchers also found that mothers who gave birth at or after 41 weeks' gestation had the lowest likelihood of requiring epidural or spinal analgesia for pain relief. Those who gave birth after 37 weeks had the lowest risk of severely tearing the perineum during childbirth, they said, and those who gave birth after 38 weeks had the lowest risk of labor complications.
Overall, the lowest risk of mother and infant complications occurred with birth between 38 and 39 weeks and with the spontaneous onset of labor.
The study was published in the February issue of the journal Acta Obstetricia et Gynecologica Scandinavica.
"Our research relates to the optimal timing and management of labor and birth at term for women with an uncomplicated pregnancy," study leader Rosalie Grivell, of the University of Adelaide's Robinson Institute, said in a journal news release. "We hope our findings will increase awareness of potential complications related to the common use of induction of labor in situations where there is no serious maternal or fetal problem."