Sodas, Other Sweet Drinks Tied to Higher Risk for Endometrial Cancer Study of 23,000 older women saw odds for a tumor rise as daily intake went up

FRIDAY, Nov. 22, 2013 (HealthDay News) -- Older women who drink lots of soda and other sugary beverages may be at higher risk for endometrial cancer, a new study suggests.
Endometrial cancer involves tumors in the lining of the uterus, and typically affects women in their 60s or 70s, according to the U.S. National Cancer Institute (NCI).
In the new NCI-funded study, researchers looked at data from more than 23,000 postmenopausal women in Iowa who were followed from 1986 to 2010.
They found that those who drank the largest amounts of sugar-sweetened beverages had a 78 percent higher risk for a tumor known as estrogen-dependent type I endometrial cancer.
The more sugar-sweetened beverages a woman drank, the greater her risk, according to the study published online Nov. 22 in the journal Cancer Epidemiology, Biomarkers & Prevention.
There was no link between endometrial cancers and consumption of sugar-free soft drinks, sweets/baked goods and starch.
In a journal news release, study author Maki Inoue-Choi said she wasn't surprised that increased intake of sugary drinks was tied to this estrogen-linked cancer.
"Other studies have shown increasing consumption of sugar-sweetened beverages has paralleled the increase in obesity," explained Inoue-Choi, who was a research associate at the University of Minnesota School of Public Health when the study was conducted. "Obese women tend to have higher levels of estrogens and insulin than women of normal weight, [and] increased levels of estrogens and insulin are established risk factors for endometrial cancer."
Inoue-Choi is currently a postdoctoral fellow at the NCI and the U.S. National Institute on Minority Health and Health Disparities.

Prediction of preeclampsia by uterine artery doppler at 20-24 weeks gestation

This study by Gallo DM, et al. –  aims to determine maternal characteristics affecting uterine artery pulsatility index (PI) in normal pregnancies at 20–24 weeks' gestation and examine in pregnancies with preeclampsia (PE) the relation between uterine artery PI multiple of the median (MoM) and severity of disease. In a normal pregnancy, uterine artery PI is affected by maternal characteristics, and in PE, uterine artery PI MoM is related to the severity of the disease.
Methods

• Uterine artery PI was measured at 20–24 weeks in 50,490 singleton pregnancies, including 1,442 (2.9%) that developed PE.
• Uterine artery PI was expressed as MoM after adjustment for maternal characteristics and corrected for adverse pregnancy outcomes.
• In PE, the correlation between uterine artery PI MoM with gestational age at delivery and birth weight Z–score was determined.

Results

• In the normal group there were significant independent contributions to uterine artery PI from gestational age, racial origin and prior history of PE, and/or small for gestational age (SGA).
• In the PE group, there was an inverse significant association between uterine artery PI MoM and both gestational age at delivery and birth weight Z–score (p < 0.0001).
• Uterine artery PI was above the 95th percentile (1.509 MoM) in 72.7, 36.1 and 14.9% of cases of PE requiring delivery at <34 34="" 37.4="" 55.6="" 80.2="" and="" for="" li="" pe="" percentages="" respectively="" sga="" the="" weeks="" were="" with="">

ACOG/SMFM: Replace Phrase 'Term Pregnancy' With 4 Categories

Using the general phrase "term pregnancy" to refer to births between 3 weeks before the estimated date of delivery and 2 weeks after does not convey the distinction of health benefits and risks for each week of gestation in that window, according to the nation's obstetricians and gynecologists.
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) wrote a joint opinion published in the November issue of Obstetrics & Gynecology discouraging use of the general label "term pregnancy" and replacing it with these categories:

• early term: 37 weeks to 38 weeks, 6 days;
• full term: 39 weeks to 40 weeks, 6 days;
• late term: 41 weeks to 41 weeks, 6 days; and
• post-term: 42 weeks and beyond.

"Until recently, doctors believed that babies delivered in this 5-week window had essentially the same good health outcomes," Jeffrey L. Ecker, MD, chair of the college's Committee on Obstetric Practice, said in a news release. "This terminology change makes it clear to both patients and doctors that newborn outcomes are not uniform even after 37 weeks."
The committee noted in the opinion that outcomes are best for delivery at "full term" (39 weeks - 40 weeks, 6 days). ACOG and SMFM are encouraging physicians, researchers, and public health officials to adopt the new terms to improve data collection and reporting and clinical research, as well as provide the highest-quality pregnancy care.
Peter Bernstein, MD, MPH, obstetrician/gynecologist and maternal-fetal medicine specialist at Montefiore Medical Center in New York City, said the committee's recommendations will formalize a push in the medical community in the last few years to stop scheduling elective deliveries before 39 weeks, a practice that had become more common as families and physicians set the dates for convenience.
"Literature has become very clear that babies born at 37 weeks don't do as well as babies born at 38 weeks, and babies born at 38 weeks don't seem to do as well as those born at 39 weeks, so this arbitrary line saying a baby born at 37 weeks is full-term has led to this normalization of deviance," Dr. Bernstein told Medscape Medical News.
He said it is also important to note that babies thought to be 37 weeks may actually be misdated and at even more risk, at a younger stage of gestation.
Although sometimes delivery before 39 weeks is unavoidable, planned deliveries before 39 weeks should occur only when there are significant health risks to a woman and/or the fetus in continuing the pregnancy, Dr. Ecker said in the news release.
That view is reflected in a related committee opinion, published in April. In that statement, the committee emphasized that the risk for adverse outcomes is greater for neonates delivered in the early-term period compared with those delivered at 39 weeks.
Mortality rates are also higher among neonates and infants delivered in the early term compared with full-term births.
For example, a study published in September also found that compared with term infants born from 39 to 41 weeks' gestation, early-term infants born between 37 and 38 weeks' gestation had a 7-fold higher risk for neonatal morbidity and were at greater risk for admission to the neonatal intensive care unit or neonatology service.
Dr. Bernstein said the committee's latest recommendations will add weight to the push against electing to deliver before 39 weeks without a medical reason.
"I think it's a really good thing. This is something that's been gathering steam," he said.
Obstet Gynecol. 2013;122:1139-1140.

Use of Oral Fluconazole during Pregnancy and the Risk of Birth Defects.

Molgaard–Nielsen D et al. – Case reports suggest that long–term, high–dose fluconazole treatment for severe fungal infections during pregnancy causes a pattern of birth defects. It is unclear whether commonly used lower doses increase the risk of specific birth defects. Oral fluconazole was not associated with a significantly increased risk of birth defects overall or of 14 of the 15 specific birth defects of previous concern. Fluconazole exposure may confer an increased risk of tetralogy of Fallot.
Results

• The majority of fluconazole–exposed pregnancies were in women who received common therapeutic doses of 150 mg (56% of pregnancies) or 300 mg (31%).
• Oral fluconazole exposure was not associated with an increased risk of birth defects overall (210 birth defects among 7352 fluconazole–exposed pregnancies [prevalence, 2.86%] and 25,159 birth defects among 968,236 unexposed pregnancies [prevalence, 2.60%]; adjusted prevalence odds ratio, 1.06; 95% confidence interval [CI], 0.92 to 1.21).
• In addition, oral fluconazole exposure was not associated with a significantly increased risk of 14 of 15 types of birth defects previously linked to azole antifungal agents: craniosynostosis, other craniofacial defects, middle–ear defects, cleft palate, cleft lip, limb defects, limb–reduction defects, polydactyly, syndactyly, diaphragmatic hernia, heart defects overall, pulmonary–artery hypoplasia, ventricular septal defects, and hypoplastic left heart.
• A significantly increased risk of tetralogy of Fallot was observed (7 cases in fluconazole–exposed pregnancies [prevalence, 0.10%] as compared with 287 cases in unexposed pregnancies [prevalence, 0.03%]; adjusted prevalence odds ratio, 3.16; 95% CI, 1.49 to 6.71).

 New England Journal of Medicine, 09/03/2013  Evidence Based Medicine  Clinical Article

First Do No Harm: Guidelines Define a Nonviable Pregnancy

New criteria for the use of ultrasonography to assess prenatal viability, introduced by the Society of Radiologists in Ultrasound, will help ensure obstetricians are not too hasty in determining that an embryo has ceased developing. The guidelines were published as a review article in the October 10 issue of the New England Journal of Medicine.
Detection of serum human chorionic gonadotropin (hCG) concentration and transvaginal ultrasound imaging have enabled ever-earlier detection of pregnancy. However, previous guidelines may allow false-positives, designating an embryo as absent or nonviable when waiting a few days and repeating tests may reveal that it is neither.
The new, more stringent, diagnostic criteria are:

• "Crown–rump length of ≥7 mm and no heartbeat
• Mean sac diameter of ≥25 mm and no embryo
• Absence of embryo with heartbeat ≥2 [weeks] after a scan that showed a gestational sac without a yolk sac
• Absence of embryo with heartbeat ≥11 days after a scan that showed a gestational sac with a yolk sac."

The report also lists 8 findings that are "suspicious for, but not diagnostic of, pregnancy failure":

• "Crown–rump length of <7 ad="" beat="" heart="" mm="" no="">
• Mean sac diameter of 16–24 mm and no embryo
• Absence of embryo with heartbeat 7–13 days after a scan that showed a gestational sac without a yolk sac
• Absence of embryo with heartbeat 7–10 days after a scan that showed a gestational sac with a yolk sac
• Absence of embryo ≥6 wk after last menstrual period
• Empty amnion (amnion seen adjacent to yolk sac, with no visible embryo)
• Enlarged yolk sac (>7 mm)
• Small gestational sac in relation to the size of the embryo (<5 and="" between="" crown="" diameter="" difference="" length.="" mean="" mm="" rump="" sac="">

If a physician sees 1 or more of these findings, they should investigate further but not immediately reach the conclusion that the pregnancy is not viable, the authors say. "Because none of these signs have been extensively studied, they are considered to be suspicious for, though not diagnostic of, failed pregnancy," the authors write.(N Engl J Med. 2013;369:1443-1451.)

FDA Contraindicates Migraine Treatments for Pregnant Women

The US Food and Drug Administration (FDA) has announced that the children of mothers who took medications including or related to valproate(Drug information on valproate) sodium during pregnancy show decreased IQ scores, and that these drugs are now contraindicated for pregnant women.



Contraindicated valproate products include valproate sodium (Depacon), divalproex sodium(Drug information on divalproex sodium) (Depakote, Depakote CP, and Depakote ER), valproic acid (Depakene and Stavzor), and their generics.

While valproate-containing medicines already have a boxed warning for fetal risk, the FDA’s strengthened recommendations are based on the results of the Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study, which showed that children exposed to valproate products in utero had decreased IQ at age 6 when compared to children who were exposed to other antiepileptic drugs. The IQ difference varied between 8 and 11 points.
Valproate products have several FDA-approved uses, including the prevention of migraine headaches, treatment of epilepsy seizures, and treatment of manic episodes associated with bipolar disorder (manic-depressive disorder). For bipolar disorder and seizures valproate may have value in pregnant women, but it should only be taken if other medications have not controlled the symptoms or are otherwise unacceptable.
“Valproate medications should never be used in pregnant women for the prevention of migraine headaches because we have even more data now that show the risks to the children outweigh any treatment benefits for this use,” said Russell Katz, MD, director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research.
The FDA is working with manufacturers to make changes to the drug labels to reflect the new information and change the pregnancy category for prevention of migraine headaches to category X (the drug’s risks outweigh the drug’s benefits for this use) from category D (the drug’s benefits outweigh the drug’s risks for this use). Valproate products will remain category D for the other two approved indications—epilepsy and manic episodes associated with bipolar disorder.
 http://hcp.obgyn.net/pregnancy-and-birth/content/article/1760982/2141651

Planned Cesarean No Safer Than Vaginal Delivery for Twins

A planned cesarean delivery in twin pregnancy does not increase or decrease risks to the unborn fetuses when compared with a planned vaginal delivery, according to the results of a randomized controlled trial. The study, published in the October 3 issue of the New England Journal of Medicine, shows that among pregnant mothers of twins between 32 weeks 0 days and 38 weeks 6 days of gestation and whose first twin is in the cephalic presentation, choosing to have a planned cesarean delivery does not affect the risks for fetal or neonatal death or serious neonatal morbidity when compared with choosing to deliver the twins vaginally.

"These results do not indicate that all sets of twins should be delivered vaginally." Michael Greene, MD, notes in an accompanying editorial. "Obstetricians exercising their best clinical judgment delivered both twins by cesarean section in nearly 40% of the women assigned to planned vaginal delivery, which undoubtedly contributed to the salutary outcomes," he writes. "However, the results of this study suggest that a plan to deliver appropriately selected sets of twins vaginally is a reasonably safe choice in skilled hands."
"Given the trends in patient demographic characteristics and preferences, the virtual disappearance of vaginal delivery in cases of breech presentation, and the dramatic reduction in instrumented vaginal delivery (and the associated gradual disappearance of the skills necessary to perform these procedures among obstetricians), it seems unlikely that we will see a major change in use of cesarean delivery for twins nationwide," he concludes. 

How Doctors Think

On average, a physician will interrupt a patient describing her symptoms within eighteen seconds.
In that short time, many doctors decide on the likely diagnosis and best treatment.
Often, decisions made this way are correct, but at crucial moments they can also be wrong -- with catastrophic consequences.
In this myth-shattering book, Jerome Groopman pinpoints the forces and thought processes behind the decisions doctors make.
Groopman explores why doctors err and shows when and how they can -- with our help -- avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health.
This book is the first to describe in detail the warning signs of erroneous medical thinking and reveal how new technologies may actually hinder accurate diagnoses.
How Doctors Think offers direct, intelligent questions patients can ask their doctors to help them get back on track.
For more information about the title How Doctors Think, 

Irritability, Anger Indicators of Complex, Severe Depression

Symptoms of irritability and anger during a major depressive episode (MDE) appear to be clinical markers for a significantly more complex, chronic, and severe form of major depressive disorder, a new study indicates.

http://maxcdn.scienceblog.com/wp-content/uploads/2012/05/depressed_in_paris.jpg

Results from the longitudinal observational investigation of patients with unipolar MDEs showed that those with current overt irritability/anger were significantly more likely to have increased depressive severity, longer duration of the index MDE, poorer impulse control, and a more chronic and severe long-term course of illness.
Overt irritability and anger were also associated with higher rates of lifetime co-morbid substance abuse and anxiety disorder, more antisocial and personality disorders, greater psychosocial impairment, reduced life satisfaction, and a higher rate of bipolar II disorder in relatives.
The study findings strongly suggest that "concurrent anger/irritability symptoms are important indicators of increased severity, chronicity, and complexity of unipolar major depression," the authors, led by Lewis L. Judd, MD, University of California, San Diego, write.

Why is yawning contagious?

Rather than being a precursor to sleep, yawning is designed to keep us awake, say US researchers. But why does seeing someone else yawn make you to do the same? Yawning is an involuntary action that everyone does. We start before we are born and most creatures on the planet do it - even snakes and fish.
New research suggests rather than being a precursor to sleep, the purpose of yawning is to cool the brain so it operates more efficiently and keeps you awake.
The theory could explain a puzzling question about subconscious human behaviour - why many of us yawn when we see or hear another person doing it, or even read about it or even just think about it?

sleeping times

The brain cooling theory says that when we contagiously yawn we are participating in an ancient, hardwired ritual that evolved to help groups stay alert and detect danger.
It's not copying another person's sleepiness, say scientists at the University of Albany in New York, who are behind the latest research.
"We think contagious yawning is triggered by empathic mechanisms which function to maintain group vigilance," says Dr Gordon Gallup, a leading researcher at the university.
'Herding behaviour'
The belief is further supported by the observation of University of Maryland's Robert Provine that paratroopers report yawning before jumping.
But there are other theories. It's been suggested contagious yawning could be a result of an unconscious herding behaviour - a subtle way to communicate to those around us, similar to when flocks of birds take flight at the same time.
Another theory suggests contagious yawning might have helped early humans communicate their alertness levels and co-ordinate sleeping times.
Basically, if one decided it was time to sleep they would tell the others by yawning and they would do it in return to show they agreed.
Chimpanzees also suffer from contagious yawning, according to researchers at Kyoto University in Japan. They are thought to be the only other creatures, apart from humans, who do so.
The rest of the animal kingdom - including birds, snakes and hippos - yawn for other reasons. Dogs yawn to stay calm in certain situations, says Turid Rugaas, author of On talking Terms with Dogs.
Anyone who gets to the end of this article without yawning may wish to think of themselves as a medical aberration. In fact, only about half of adult humans are prone to contagious yawning.

Fluconazole Linked to Increased Risk for Rare Birth Defect

An examination of nearly 1 million birth records revealed a 3-fold increased risk for tetralogy of Fallot among infants whose mothers took fluconazole in the first trimester, according to a study published in the August 29 issue of the New England Journal of Medicine.
The study showed no association between the antifungal and 14 other birth defects previously linked to it. However, Ditte Mølgaard-Nielsen, MSc, from the Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark, and colleagues showed that common therapeutic doses of fluconazole in the first trimester resulted in an adjusted odds ratio of 3.16 (95% confidence interval [CI], 1.49 - 6.71) for tetralogy of Fallot. The absolute risk for tetralogy of Fallot remains small, with an estimated 6.5 excess cases per 10,000 infants exposed to the antifungal (95% CI, 1.5 - 17), the authors report.

transcervical hysteroscopic approach for tubal occlusion with ESSURE and ADRINA devices

Over the past 10 years the transcervical hysteroscopic approach to tubal occlusion has proven to be an excellent option for women seeking permanent contraception. This technique takes advantage of recent innovations, such as miniaturization of endoscopes, continuous flow systems, and advanced cardiovascular technology, to facilitate access and improve the ability to accurately catheterize the fallopian tubes with  the Essure device (Conceptus, Inc) and the Adiana device (Hologic, Inc). (In May 2012, Hologic, Inc withdrew the Adiana Device from the market.) The Essure device has been approved by the US Food and Drug Administration (FDA) since November 2002;

Wiping Mouth and Nose at Birth as Effective as Oronasopharyngeal Suctioning

By Brian Hoyle
BOSTON -- May 3, 2012 -- Comparison of the traditional neonatal
oronasopharyngeal suctioning (ONPS) versus wiping of the mouth and nose has
demonstrated the equivalent outcome in terms of respiratory rate in the first
day after birth, according to a study presented here at the 2012 Pediatric
Academic Societies (PAS).
“Suctioning of neonates is a common procedure throughout the world. It can
reduce airway resistance, stimulate breathing, and prevent aspiration.
Nevertheless, adverse effects of suctioning include apnoea and bradycardia,”
explained John Kelleher, MD, Department of Pediatrics, University of Alabama,
Birmingham, Alabama, on April 29. “Wiping of the mouth and nose as an
alternative to suctioning has been recommended by the [AAP] beginning in 2005.
However, large randomised trials comparing wiping and suctioning have not been
done,” he continued.
The driving hypothesis of this trial was that wiping is equivalent to ONPS in
terms of mean respiratory rate, as judged by a difference of <4 br="" breaths="" min=""> during the first 24 hours after birth. A mean difference of ≥4 breaths/min
would indicate nonequivalence of the approaches.
All newborns aged ≥35 weeks who were delivered at the participating hospital
from October 2010 to November 2011 were eligible for inclusion. Infants were
excluded if they had known congenital anomalies or were not vigourous with
meconium-stained amniotic fluid.
After consent for participation, 503 women were randomised before delivery to
treatment by wiping (intervention group, n = 256) or ONPS (control group, n =
247). The primary outcome was mean respiratory rate recorded manually over 60
seconds at 1, 8, 16, and 24 hours during the first 24 hours after birth. It was
impossible to completely blind those doing the measurements to the study arms.
Secondary outcomes were Apgar scores, delivery room resuscitation, number of
newborns with a respiratory rate >60 breaths/min anytime during the first 24
hours post partum, and admission to the neonatal intensive care unit. Analysis
was by intention to treat.
The mean respiratory rate of the neonates receiving the wipe treatment was
equivalent to the ONPS group of neonates (51 vs 50 breaths/min, respectively;
difference of means = 1 breath/min, 95% confidence interval, -2.2 to 0.2;
P <.001). There was no significant difference between the groups
regarding any of the aforementioned secondary outcomes.
“Our results shown that wiping is equivalent to traditional bulb-and-syringe
suctioning with respect to the mean respiration rate over the first 24 hours
after birth. Wiping avoids the potential adverse effects of suctioning,” said
Dr. Kelleher, adding, “There is no difference regarding prespecified secondary
clinical outcomes,”
“I am perplexed by the use of respiratory rate as the primary outcome,”
commented attendee Lucky Jain, MD, Emory University School of Medicine,
Atlanta, Georgia. “Why not the difference in heart rate or the frequency of
cardiac episodes or something else that is related to the effects of suctioning
or wiping?”
Dr. Kelleher explained that other primary outcomes would have necessitated a
much larger and more expensive study and that the choice reflected these
considerations.
The use of ONPS as the control, rather than no treatment, was also questioned,
in light of the recognition of the adverse effects of ONPS.
“The lung fluid or the fluid that we see in the nares or the oropharynx is not
important in terms of suctioning. I hope that future trials would be wiping
versus no wiping instead of wiping versus suctioning,” said Dr. Jain.
While acknowledging the latter criticism, Dr. Kelleher argued that the study
reflects the reality, at least in the United States, of the delivery room.
“I agree that previous publications have shown that suctioning can have
deleterious consequences,” said Dr. Kelleher. “Nevertheless, it’s been my
experience that in the United States, suctioning is still firmly ingrained in
neonatal care. That is why we chose to use it in comparison with wiping,” he
explained.
The Pediatric Academic Societies (PAS) is cosponsored by the American Pediatric
Society (APS), the Society for Pediatric Research (SPR), the Academic Pediatric
Association (APA), and the American Academy of Pediatrics (AAP).

[Presentation title: A Randomized Controlled Equivalency
Trial of Oronasopharyngeal Suctioning Versus Wiping the Mouth. Abstract 2170.5]

Oronasopharyngeal suction versus wiping of the mouth and nose at birth:

Oronasopharyngeal suction versus wiping of the mouth and nose at birth: a randomised equivalency trial.

Kelleher J, Bhat R, Salas AA, Addis D, Mills EC, Mallick H, Tripathi A, Pruitt EP, Roane C, McNair T, Owen J, Ambalavanan N, Carlo WA.

Source

Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.

BACKGROUND:

Wiping of the mouth and nose at birth is an alternative method to oronasopharyngeal suction in delivery-room management of neonates, but whether these methods have equivalent effectiveness is unclear.

METHODS:

For this randomised equivalency trial, neonates delivered at 35 weeks' gestation or later at the University of Alabama at Birmingham Hospital, Birmingham, AL, USA, between October, 2010, and November, 2011, were eligible. Before birth, neonates were randomly assigned gentle wiping of the face, mouth (implemented by the paediatric or obstetric resident), and nose with a towel (wipe group) or suction with a bulb syringe of the mouth and nostrils (suction group). The primary outcome was the respiratory rate in the first 24 h after birth. We hypothesised that respiratory rates would differ by fewer than 4 breaths per min between groups. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01197807.

FINDINGS:

506 neonates born at a median of 39 weeks' gestation (IQR 38-40) were randomised. Three parents withdrew consent and 15 non-vigorous neonates with meconium-stained amniotic fluid were excluded. Among the 488 treated neonates, the mean respiratory rates in the first 24 h were 51 (SD 8) breaths per min in the wipe group and 50 (6) breaths per min in the suction group (difference of means 1 breath per min, 95% CI -2 to 0, p<0 p="">

INTERPRETATION:

Wiping the nose and mouth has equivalent efficacy to routine use of oronasopharyngeal suction in neonates born at or beyond 35 weeks' gestation.
Lancet. 2013 Jul 27;382(9889):326-30. doi: 10.1016/S0140-6736(13)60775-8. Epub 2013 Jun 3.

Sildenafil citrate in the treatment of pain in primary dysmenorrhea: RCT

Human Reproduction, 08/16/2013  Clinical Article

Dmitrovic R et al. – A number of medications have been investigated to improve the treatment options for PD, but most have proven unsuccessful or to have an unfavorable risk/benefit ratio. Since PD is a condition that most women suffer from and seek treatment for at some point in their lives, this study offers hope that vaginal sildenafil citrate is a safe and effective option for patients who do not desire or are unresponsive to treatments now available on the market.
Methods

• A double–blind, randomized, controlled trial comparing vaginal preparation of sildenafil citrate (100 mg single dose) to a placebo in 62 PD patients at the time of painful menstruation was conducted.
• The primary outcome was total pain relief over 4 consecutive hours (TOPAR4) comparing sildenafil citrate to placebo, where higher TOPAR4 scores represent better pain relief.
• Secondary outcomes were pain relief as measured by the visual analog scale (VAS) and uterine artery pulsatility index (PI).
• Subjects were recruited from December 2007 to January 2011.
• The trial was stopped due to closeout of the funding for the study.
• Participants were women in good health, were aged 18–35 years and suffered from moderate to severe PD.
• They were randomized to either vaginal placebo or 100 mg vaginal sildenafil citrate in a 1:1 ratio using random permuted blocks having a block size of 4.
• At baseline and 1, 2, 3, and 4 h post–treatment, patients were asked to provide assessment of their degree of pain using two scales: (i) pain on the 5–level ordinal scale used for TOPAR4 calculation and (ii) pain level on the VAS.
• The study ended 4 h after treatment initiation.

Results

• Twenty–five subjects completed the study.
• Using the TOPAR4 score, the sildenafil citrate group had significantly better pain relief compared with the placebo group [mean (SD): 11.9 (3.2) versus 6.4 (2.1), respectively; difference in means = 5.3; 95% CI: (2.9,7.6); P < 0.001)].
• On the VAS, sildenafil citrate provided better pain relief than placebo at each time point.
• At the 2–h time point, the PI was significantly lower in the sildenafil citrate group compared with the placebo group [mean (SD): 1.6 (0.6) versus 2.3 (0.5), respectively; difference in means = –0.7; 95% CI: (–1.2, –0.1); P = 0.01)].

Mifepristone to treat uterine myoma:

Mifepristone versus placebo to treat uterine myoma: a double-blind, randomized clinical trial                                                                           Esteve Carbonell JL et al. – This study aimed to evaluate the efficacy, safety, and quality of life of 5 mg mifepristone per day compared with a placebo in treating uterine fibroids. The 5 mg dosage of mifepristone presented significantly superior efficacy compared to the placebo.

Methods

• A randomized, double–blind clinical study.
• Eusebio Hernández Gynecology and Obstetrics Teaching Hospital, Havana, Cuba.
• One hundred twenty–four subjects with symptomatic uterine fibroids.
• One daily capsule of 5 mg mifepristone or a mifepristone placebo over 3 months.
• Changes in fibroid and uterine volumes, changes in symptom prevalence and intensity, and changes in quality of life.

Results

• Three months into treatment, fibroid volume was reduced by 28.5% in the mifepristone group with an increase of 1.8% in the placebo group (P = 0.031).
• There were significant differences between the groups with respect to pelvic pain prevalence (P = 0.006), pelvic pressure (P = 0.027), rectal pain (P = 0.013), hypermenorrhea (P < 0.001), and metrorrhagia (P = 0.002) at the end of treatment.
• Amenorrhea was 93.1% and 4.3% in the mifepristone and placebo groups, respectively (P < 0.001).
• Treatment side effects were significantly greater in the mifepristone group.
• Estradiol levels did not differ significantly between the placebo and mifepristone groups at the end of treatment.
• Improvement in quality of life was significantly greater in the categories of "symptoms" (P = 0.004) and "activity" (P = 0.045) in the mifepristone group.

Healthcare most dangerous place for workplace injuries

Healthcare is the most dangerous industry for injuries and illnesses, with 653,000 nurses, aides, orderlies and others injured or falling ill every year, according to a new Public Citizen Report.
Forty-five percent of all workplace violence incidents in the USA that result in lost workdays occur in the health care sector. Among attendants, orderlies, and nursing aides in 2011, the incidence rate of injuries requiring days off work was 486 cases per 10,000 employees, over four times higher than the national average for all workers.
Even though health care workplaces are more dangerous than anywhere else, OSHA (the Occupational Safety and Health Administration) carries out relatively few inspections of health care facilities. The authors added that even when it does find safety problems, there is often not much OSHA can do because of "an absence of much needed safety standards".
Co-author, Keith Wrightson, a worker safety and health advocate for Public Citizen, said "OSHA is required by law to ensure safe conditions for every employee in the United States. The record is clear that the government has broken its promise to health care workers."
More musculoskeletal injuries are suffered by orderlies, attendants, nurses and nursing aides than workers in any other industry. Back injuries in the health care industry are estimated to cost over $7 billion every year.
Dr. L. Toni Lewis, chair of the health care division of the Service Employees International Union, which advised Public Citizen on the report, said:
In 2010, there were 152,000 workplace injuries and illnesses in the manufacturing sector, compared to a whopping 653,000 in health care.
The industry with the most inspections, construction, has been criticized for not having enough OSHA inspections and enforcements.

Stem-Cell Therapy Wipes out HIV in Two Patients

LONDON (Reuters) Jul 03 - Two men with HIV have been off AIDS drugs for several months after receiving stem-cell transplants for cancer that appear to have cleared the virus from their bodies, researchers reported on Wednesday.
Both patients, who were treated in Boston and had been on long-term drug therapy to control their HIV, received stem-cell transplants after developing lymphoma, a type of blood cancer.
Since the transplants, doctors have been unable to find any evidence of HIV infection, Timothy Henrich of Harvard Medical School and Brigham and Women's Hospital in Boston told an International AIDS Society conference in Kuala Lumpur.
While it is too early to say for sure that the virus has disappeared from their bodies altogether, one patient has now been off antiretroviral drug treatment for 15 weeks and the other for seven weeks.
Last July Dr. Henrich first reported that the two men had undetectable levels of HIV in their blood after their stem-cell treatment, but at that time they were still taking medicines to suppress HIV.

Using stem-cell therapy is not seen as a viable option for widespread use, since it is extremely expensive, but the latest cases could open new avenues for fighting the disease, which infects about 34 million people worldwide.
The latest cases resemble that of Timothy Ray Brown, known as "the Berlin patient," who became the first person to be cured of HIV after receiving a bone marrow transplant for leukemia in 2007. There are, however, important differences.
While Brown's doctor used stem cells from a donor with a rare genetic mutation, known as CCR5 delta 32, which renders people virtually resistant to HIV, the two Boston patients received cells without this mutation.
"Dr. Henrich is charting new territory in HIV eradication research," Kevin Robert Frost, chief executive officer of the Foundation for AIDS Research, which funded the study, said in a statement.
The latest antiretroviral AIDS drugs can control HIV for decades. But many people still do not get therapy early enough, prompting the World Health Organization to call for faster roll-out of medicines after patients test positive.
Reuters Health Information

MISOPRISTOL IN OBSTETRICS

In settings with limited access to health care, misoprostol is an important intervention that could reduce maternal deaths both directly and through the more cost-effective use of health services. Misoprostol is, however, a powerful drug that needs to be used with care. Evidence-based information about the safest regimens should be widely disseminated so as to prevent its inappropriate use.View at http://www.slideshare.net/drsujnanendra/misoprostol-in-obstetrics

FDA Warning: Don’t Use Magnesium Sulfate to Stop Pre-term Labor

The FDA has changed the Pregnancy Category of magnesium sulfate(Drug information on magnesium sulfate) from ‘A’ to ‘D,’ indicating that there is “positive evidence of human fetal risk” when the drug is used during pregnancy. The agency cautions that the drug should not be used for more than 5 to 7 days to stop preterm labor, and using it for longer periods of time could cause hypocalcemia, ostopenia, and fractures in the newborn.

The change comes on the heels of a review of epidemiologic data, along with 18 cases of skeletal abnormalities in newborns exposed to magnesium sulfate. While data shows that lab results in newborns return to normal shortly after birth, the long-term effects on bone health are unknown.

The average length of exposure in newborns with skeletal abnormalities was 10 weeks. Journal Watch’s Allison Bryant wrote that, “There are no data suggesting value to using magnesium sulfate for tocolysis for longer than 48 hours, for neuroprotection beyond when delivery is felt to be imminent, or for seizure prophylaxis in the setting of preeclampsia beyond 24 hours postpartum. Therefore, this FDA warning is unlikely to greatly alter current clinical practice."

C-sections tied to child obesity

Among cesarean born babies 83 percent more likely to be overweight or obese than their vaginally-born peers once other related factors - such as their mother's weight and how long they were breastfed - were taken into account.
The findings are in line with a recent review of nine earlier studies that also found a link between C-sections and childhood obesity (see Reuters Health story of December 12, 2012 here: http://reut.rs/TV6GwC).
With C-sections, "there may be long-term consequences to children that we don't know about," said Dr. Jan Blustein, who led the new study at the New York University School of Medicine.
The rate of C-sections in the U.S. has been rising, leading to concerns about possible complications for mothers and babies. According to the Centers for Disease Control and Prevention, C-sections accounted for almost 1 in 3 births in 2010 - up from 1 in 5 in 1996.
For women, the procedure increases the chance of bowel or bladder injuries as well as future pregnancy complications.
Blustein said the size of the obesity risk for kids is "not great," and shouldn't come into play for women who need a C-section for medical reasons.
But, "a woman who's considering C-section electively should probably know about those risks," she told Reuters Health.

Research Conclusion:

Caesarean delivery is associated with increased body mass in childhood and adolescence. Research is needed to further characterize the association in children of normal weight women. Additional work is also needed to understand the mechanism underlying the association, which may involve relatively enduring changes in the intestinal microbiome.

Tribute to Jean Henry Dunant, founder of the Red Cross.

Jean Henri Dunant was born in Geneva on 8 May 1828.

On 24 June 1859, Dunant arrived at Solferino where he witnessed one of the fiercest battles of the 19^th century. 

The Battle of Solferino lasted for more than 15 hours and more than 40,000 were wounded. With the help of the villagers at Castiglione, he worked tirelessly, giving comfort and what medical care he could to the injured men.

Back at Geneva, Dunant published a book entitled "A Memory of Solferino” in 1862, which he put forward his ideas to foster the creation in every country of a society for the relief of the military wounded and capable of helping the army medical services to carry out their tasks.

In his effort to establish the Red Cross, Dunant neglected his business and he was declared bankrupt in 1867. Deprived of his citizenship, Dunant resigned from the ICRC and left Geneva to live in Paris.

In 1872, Dunant left Paris and went to London to pursue his ideas to convince people of the need for an international treaty for protection of prisoners-of-war.

Dunant left England in 1874 and wandered from place to place for the next twelve years, living in poverty and obscurity.

In 1887, Dunant returned to Heiden where he spent the rest of his days.

In 1895, one young journalist discovered Dunant warded in District Hospital.  Dunant became famous again after his story was published.

Dunant was awarded the first Nobel Peace Prize for humanitarian work in December 1901.

Dunant died on 30 October 1910 (82 years old).