Thermoregulatory effects of resiniferatoxin in the rat.

When administered acutely, the vanilloid (capsaicin) receptor agonist resiniferatoxin induces marked hypothermia in the ferret, rat and mouse. The aim of this study was to further characterise the thermoregulatory effects of resiniferatoxin in the rat in an attempt to understand the mechanism by which resiniferatoxin induces this hypothermic effect. Three doses of resiniferatoxin were administered (50, 100, 200 micrograms/kg s.c.) in separate animals at an ambient temperature (Ta) of 20 degrees C but there was no apparent dose-related effect on the decrease in colonic temperature over this range. Resiniferatoxin (50 micrograms/kg s.c.) decreased whole body oxygen consumption when measured below thermoneutrality (Ta = 20 degrees C) but not at thermoneutrality (Ta = 29 degrees C); likewise there was no hypothermic response to resiniferatoxin when measured at a Ta of 29 degrees C. Operant responding for radiant heat in a cold environment (-8 degrees C) was also measured in resiniferatoxin-treated (50 micrograms/kg s.c.) rats. These experiments showed that resiniferatoxin-treated rats attempted to defend body temperature by lever pressing for more radiant heat. However, this was not sufficient to reverse the hypothermia. Two repeat doses, 1 week apart, had little or no effect on colonic temperature, oxygen consumption or operant responding in the cold. Resiniferatoxin (50 micrograms/kg s.c.) also produced hypothermia (Ta = 20 degrees C) in neonatally capsaicinized adult rats. The exact site and mode of action is still under investigation, but it is postulated that resiniferatoxin activates, and then destroys or desensitizes warm thermoreceptors.

Clinical course of malaria in pregnancy--a prospective controlled study from India.

A prospective hospital-based study was conducted from June 1984 to November 1985 in northern India to study the morbidity pattern of malaria in pregnant women. 78 pregnant and 22 non-pregnant women with malarial infection (60% Plasmodium vivax and 40% P. falciparum) were included in the study. The results were analysed according to period of gestation, parity and type of infection. Severity of clinical illness was significantly higher in pregnant patients for both P. vivax and P. falciparum infections. Some striking differences were found in our study when compared with those from African countries. Multigravidas had a slightly higher morbidity than primigravidas, though the difference was not statistically significant. Even though only a small proportion (1.4%) of our pregnant patients were affected by malaria, cerebral malaria, maternal deaths, intrauterine foetal deaths and pre-term labours were much more common.

Pathological changes in fallopian tubes following three different kinds of occlusive techniques in primates.

A comparative evaluation of three different techniques (Madlener's, Wood's and Filshie Clip Mark IV) for female sterilization was carried out in adult female rhesus monkeys with the aim of finding out the efficacy and the extent of tissue damage in the fallopian tube. The severity of pathological changes would indicate the chances of future successful reversal. The experiment was carried out in two phases. In Phase-I, no post-operative antibiotics were given whereas in Phase-II in addition to post-operative antibiotics, two sham-operated controls were also kept. This study revealed that the Filshie's clip is associated with significantly (p less than 0.01-0.001) greater tissue damage of the fallopian tubes with formation of dense adhesions as compared to the Madlener's or Wood's technique. Further, Filshie's clip had slipped off from 4 tubes out of 14 tubes where it was applied.

Randomized comparison of different prostaglandin analogues and laminaria tent for preoperative cervical dilatation. World Health Organization Special Programme of Research, Development and Research Training in Human Reproduction: Task Force on Prostaglandins for Fertility Regulation.

In an eleven-centre study, 627 nulliparous subjects in the 8th to 12th week of gestation admitted for termination of pregnancy were allocated to one of five treatments to induce pre-operative cervical dilatation. The treatments were: 0.5 mg PGE2 methyl sulphonylamide; 1.0 mg PGE1 methyl ester; 30 mg 9-methylene PGE2 free acid, 0.5 mg 15-methyl PGF2 alpha; a single medium-sized laminaria tent. The results indicate that the three PGE analogues are at least equally effective as one medium sized laminaria tent and more effective than 0.5 mg 15-methyl PGF2 alpha in producing adequate pre-operative cervical dilatation prior to vacuum aspiration. It is concluded that both pre-treatment with prostaglandin analogues and laminaria tent are effective methods for preoperative cervical dilatation and both types of treatment are associated with a low incidence of side effects. Prostaglandin analogue treatment can be administered by paramedical personnel but laminaria tent insertion has to be performed by medical staff.

Phase III-clinical trial with Norplant-2 (covered rods). Report of a 24-month study. National Programme of Research in Human Reproduction. Division of Human Resource Development Research Indian Council of Medical Research Ansari Nagar, New Delhi, India.

In a phase III multicentre clinical trial, the subdermal implant NorplantR-2 was studied for its clinical use effectiveness, safety and bleeding pattern. A total of 1466 healthy volunteers, with no contraindication to steroid use, were observed for 29,669 woman-months of use. One method failure was reported at 18 months of NorplantR-2 use. The method was associated with altered menstrual pattern with a trend towards reduced blood loss. The continuation rates were 88.1 and 73.5 per 100 users at 12 and 24 months of use, respectively. Menstrual disturbance, mainly prolonged bleeding, accounted for the majority of the discontinuations. Removal of NorplantR-2 due to local infection was rare (0.4 per 100 users at 24 months). In similar clinical trial conditions, the continuation rate with NorplantR-2 is significantly higher than those observed with LNG IUD and injectable contraceptives, norethisterone oenanthate 200 mg given every 60 +/- 5 days, and is comparable to that of CuT 200 IUD.

Vaginal tubal ligation concurrent with medical termination of pregnancy.

PIP: Morbidity after vaginal tubal ligation with or without medical termination of pregnancy at the same sitting is reported, based on a series of 619 vaginal tubal ligations, 422 of which were concurrent with abortion (Group 1) and 196 of which had interval sterilizations by tubal ligation. All concurrent abortion/tubal ligations were performed on pregnancies less than 13 weeks of gestation. No statistically significant difference in duration of postoperative stay of the 2 patient groups was found. 13 cases (3%) of Group 1 patients required reevacuation; 2 cases from Group 2 were readmitted with vaginal bleeding, the result of the vaginal wound. Total complication rates in the 2 groups were 12.4 and 6%, respectively. Therefore, the total immediate and late morbidity rates in the 2 groups (after correction) were 9.4 and 6%, respectively; this is not statistically significant.^ieng

Hysteroscopic removal of intrauterine contraceptive devices with missing threads.

PIP: 23 women underwent hysteroscopy at the Obstetrics and Gynaecology Outpatient Department, at the Postgraduate Institute for Medical Education and Research, Chandigarh, for removal of their IUDs with missing threads. 13 had Lippes Loops, 4 had Copper-7s, 3 had copper-Ys, and 3 had copper-Ts. In 21 cases, the device was found in the uterine cavity. 17 devices were found with threads but the threads were short. In 1 patient the device was absent and the endometrium gave evidence of incomplete abortion after unnoticed expulsion. In another patient fitted with an IUD for 10 years and complaining of a vague pain in the right side of the abdomen for 5-6 years, the IUD was found near the right costal argin and removed at laparotomy.^ieng

Primary causes of perinatal mortality-autopsy study of 134 cases.

PIP: The methodology and results of 134 neonatal autopsies performed over a 2-year period are presented. The causes of perinatal mortality, in descending order, were: 43% by extrinsic perinatal hypoxia; 18% by infection; 12% by respiratory distress syndrome; and 10.5% by congenital abnormlities. These 4 factors accounted for 84% of the total cases. Perinatal mortality is strongly associated with obstetrical factors, respiratory distress syndrome, and prematurity. In addition, iatrogenic infections play a large contributory role in perinatal mortality. Since about 77% of the perinatal deaths occurred in low-birth-weight babies, the reduction of perinatal mortality can be promoted by reducing prematurity rates and by early detection and intervention in cases of intrauterine growth retardation. In addition, adequate and systematic antenatal care is warranted, since none of the participants in this series had received such care. In 10 cases the primary cause of death could not be determined despite complete autopsy. Briefly the methodology entailed collecting autopsy data, and then assigning primary cause of death from a previously prepared and defined list of primary causes of death, after taking into consideration clinical data in each case. Primary causes of death were, according to this methodology: extrinsic perinatal hypoxia, infection, respiratory distress syndrome, congenital anomalies, hematological disorders, idiopathic massive pulmonary hemorrhage, birth trauma, other specific causes, extreme prematurity, intrauterine growth retardation, and unexplained.^ieng

Morbidity following vaginal tubal ligation.

PIP: The results of a study of 618 cases of vaginal tubal ligations performed in 3 years at the Postgraduate Institute of Medical Education in India are reported. 60% of the women were older than 29 years. 76% had living children. Only 1 woman had no children. Thee was a significant difference in the percentage of women with 5 or more living children between the rural and urban population (P .01). In only 9.5% of women, pregnancy had advanced beyond 10 weeks. No prophylactic antibiotics were given, and follow-ups occurred at 2 weeks, 6 weeks, 3 months, and 12 months. Only 9.5% of cases received antibiotics while in the hospital; 73 cases (11.8%) received antibiotics during follow-up because of late complications such as pelvic infection, granulation tissue, and tuboovarian disease. The total complication rate was 15%. Rectal injury occurred in 6 cases (.95%). 17 cases were labeled as vaginal route failures. 2 cases with serious complications, 1 pelvic abscess with fistula and 1 pelvic peritonitis, were noted. Pain during defecation, a common complaint at 2-week follow-up, was not encountered at the 6-week follow-up. About 5.5% did not show up for follow-up; 37.2% were followed for more than 12 months. No significant difference in morbidity was noted between rural and urban patients.^ieng

Quantitative measurement of blood loss in medical termination of pregnancy.

PIP: 100 women 7-12 weeks pregnant undergoing medical termination of pregnancy by suction evacuation at the Nehru Hospital in Chandigarh, India, from October 1981-June 1982 were included in a study to measure blood loss during the procedure. The women ranged in age from 19-34 and 21 had 3 or more living children. The suction evacuation was performed under 10 mg of intravenous diazepam and paracervical block. The blood loss was estimated by the automatic extraction method of Newton et al. Among 9 women with gestational age of 49-55 days, mean blood loss was 19.06 ml, ranging from 8.4-30.5; among 65 women with gestational ages of 56-69 days, mean blood loss was 21.53 ml, ranging from 8.0-46.0; and among 26 women with gestational ages of 70-84 days, mean blood loss was 49.92 ml, ranging from 14.39-96.4 ml. Blood loss was more than 80 ml in 4 cases. The study showed somewhat less blood loss at later periods of gestation than did some earlier studies using different methodologies.^ieng

Histamine bronchoprovocation tests in subjects with gastro-oesophageal reflux disease.

The relationship of gastro oesophageal reflux (GER) with bronchial asthma has already been well documented in asthmatic subjects and it has been postulated that their asthma might have been caused by GER disease. Thus, it was planned to establish an association, if any, between GER and increased bronchial reactivity by histamine broncho provocation. The study was done in 25 GER disease patients and 15 controls. The difference in bronchial reactivity between the two groups was found to be significant (p less than 0.01). It was concluded that GER subjects expressed greater bronchial reactivity and it has been discussed that at a later stage of life they may be more prone to develop asthma.