Dose and side effects of sublingual misoprostol for treatment of postpartum hemorrhage: what difference do they make?

BACKGROUND: Shivering and fever are common side effects of misoprostol. An unexpectedly high rate of fever above 40°C was documented among Ecuadorian women given treatment with 800mcg of sublingual misoprostol to manage postpartum hemorrhage (PPH) (36%). Much lower rates have been reported elsewhere (0-9%). METHODS: From February to July 2010, an open-label pilot study was conducted in Quito, Ecuador to determine whether a lower dose--600mcg sublingual misoprostol--would result in a lower incidence of high fever (≥40°C). Rates of shivering and fever with 600mcg sublingual regimen were compared to previously documented rates in Ecuador following PPH treatment with 800mcg sublingual misoprostol. RESULTS: The 600mcg dose resulted in a 55% lower rate of high fever compared with the 800mcg regimen (8/50; 16% vs. 58/163; 36%; relative risk 0.45 95% CI 0.23-0.88). Only one woman had severe shivering following the 600mcg dose compared with 19 women in the 800mcg cohort (2% vs. 12%; relative risk 0.17 (0.02-1.25)). No cases of delirium/altered sensorium were reported with the 600mcg dose and women's assessment of severity/tolerability of shivering and fever was better with the lower dose. CONCLUSIONS: 600mcg sublingual misoprostol was found to decrease the occurrence of high fever among Ecuadorian women when given to treat PPH. This study however was not powered to examine the efficacy of this treatment regimen and cannot be recommended at this time. Future research is needed to confirm whether other populations, outside of Quito, Ecuador, experience unusually high rates of elevated body temperature following sublingual administration of misoprostol for treatment of PPH. If indeed similar trends are found elsewhere, larger trials to confirm the efficacy of lower dosages may be justified. TRIAL REGISTRATION: Clinical trials.gov, Registry No. NCT01080846.

Oral misoprostol for the management of incomplete abortion in Ecuador.

OBJECTIVE: To assess the feasibility of introducing misoprostol for the treatment of incomplete abortion in Quito, Ecuador. METHODS: In a randomized prospective study conducted at a large tertiary-level maternity hospital and a private secondary-level clinic between November 2006 and November 2007, women with incomplete abortion were treated with either 600 µg of oral misoprostol (n=122) or manual vacuum aspiration (MVA) (n=120). All participants were requested to return for follow-up care on day 7 to determine the success of the treatment and to document their satisfaction with the method and the adverse effects experienced. RESULTS: Sixteen percent of women (39/242) did not return for their follow-up visit and their outcomes are unknown. Among those who did return, 94% (100/106) of women showed successful completion of abortion after treatment with misoprostol, as compared with 100% (97/97) of women treated with MVA. Most women described their adverse effects after treatment as tolerable (misoprostol, 95%; MVA, 91%). Nearly all women reported being satisfied with their treatment (196/203); there were no differences among the women's reports of satisfaction according to treatment received. CONCLUSION: An oral dose of 600 µg of misoprostol was found to be an acceptable and effective non-surgical option for treating incomplete abortion. Clinical trials.gov NCT00674232.

Nova geração dos stents farmacológicos: potencial impacto na segurança tardia / Nova geração dos stents farmacológicos: potencial impacto na segurança tardia

Os stents farmacológicos ditos de primeira geração melhoraram de maneira significativa a eficácia da intervenção coronária percutânea quando comparados aos stents não-farmacológicos, no que diz respeito à quase abolição do fenômeno da reestenose e da necessidade de nova revascularização da lesão-alvo. Entretanto, logo após a sua liberação para clínico nos EUA, alguns estudos sugeriram que esses dispositivos estariam associados a um maior risco de trombose tardia quando comparados aos stents não-farmacológicos, principalmente em situações de maior complexidade...

Lactancia materna y artificial en el Ecuador: aspectos epidemiológicos y morbi-mortalidad / Breast and artificial feeding in Ecuador: epidemiological and morbi-mortality aspects

Se estudia 522 encuestas dirigidas hacia dos áreas periféricas de Quito, y una de Manta, cuyas características comunes son su bajo nivel económico. La encuesta interroga diferentes aspectos que engloban la lactancia materna tanto en el ambiente familiar, socio-cultural y materno. Se enumeran tablas estadísticas concretas de la correlación existente entre morbilidad y lactancia desde el nacimiento hasta el año de edad, encontrándose que mientras se promueva la lactancia, los índices de morbilidad infantil disminuyen. Este estudio fue planteado y realizado en otros países latino-americanos bajo las mismas condiciones