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OBJECTIVE: Preterm rupture of membranes (PROM) is associated with an increased risk of preterm birth and neonatal morbidity. Prophylactic 17-hydroxyprogesterone caproate (17OHP-C) reduces the risk of preterm birth in some women who are at risk for preterm birth. We sought to test whether 17OHP-C would prolong pregnancy or improve perinatal outcome when given to mothers with preterm rupture of the membranes. STUDY DESIGN: This is a multicenter, double-blind, placebo-controlled, randomized clinical trial. The study included singleton pregnancies with gestational ages from 23(0/7) to 30(6/7) weeks at enrollment, documented PROM, and no contraindication to expectant management. Consenting women were assigned randomly to receive weekly intramuscular injections of 17OHP-C (250 mg) or placebo. The primary outcome was continuation of pregnancy until a favorable gestational age, which was defined as either 34(0/7) weeks of gestation or documentation of fetal lung maturity at 32(0/7) to 33(6/7) weeks of gestation. The 2 prespecified secondary outcomes were interval from randomization to delivery and composite adverse perinatal outcome. The planned sample size was 222 total women. RESULTS: From October 2011 to April 2014, 152 women were enrolled; 74 women were allocated randomly to 17OHP-C, and 78 were allocated randomly to placebo. The trial was stopped when results of a planned interim analysis suggested that continuation was futile. The primary outcome was achieved in 3% of the 17OHP-C group and 8% of the placebo group (P = .18). There was no significant between-group difference in the prespecified secondary outcomes, randomization-to-delivery interval (17.1 ± 16.1 vs 17.0 ± 15.8 days, respectively; P = .76) or composite adverse perinatal outcome (63% vs 61%, respectively; P = .93). No significant differences were found in other outcomes, which included rates of chorioamnionitis, postpartum endometritis, cesarean delivery, individual components of the composite outcome, or prolonged neonatal length of stay. CONCLUSION: Compared with placebo, weekly 17OHP-C injections did not prolong pregnancy or reduce perinatal morbidity in patients with PROM in this trial.
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Término Precoce de Ensaios Clínicos , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Idade Gestacional , Hidroxiprogesteronas/uso terapêutico , Progestinas/uso terapêutico , Caproato de 17 alfa-Hidroxiprogesterona , Adulto , Hemorragia Cerebral/epidemiologia , Método Duplo-Cego , Enterocolite Necrosante/epidemiologia , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Injeções Intramusculares , Leucomalácia Periventricular/epidemiologia , Mortalidade Perinatal , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Modelos de Riscos Proporcionais , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Sepse/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Conduta Expectante , Adulto JovemRESUMO
OBJECTIVE: The decision of whether to retain or remove a previously placed cervical cerclage in women who subsequently rupture fetal membranes in a premature gestation is controversial and all studies to date are retrospective. We performed a multicenter randomized controlled trial of removal vs retention of cerclage in these patients to determine whether leaving the cerclage in place prolonged gestation and/or increased the risk of maternal or fetal infection. STUDY DESIGN: A prospective randomized multicenter trial of 27 hospitals was performed. Patients included were those with cerclage placement at ≤23 weeks 6 days in singleton or twin pregnancies, with subsequent spontaneous rupture of membranes between 22 weeks 0 days and 32 weeks 6 days. Patients were randomized to retention or removal of cerclage. Patients were then expectantly managed and delivered only for evidence of labor, chorioamnionitis, fetal distress, or other medical or obstetrical indications. Management after 34 weeks was at the clinician's discretion. RESULTS: The initial sample size calculation determined that a total of 142 patients should be included but after a second interim analysis, futility calculations determined that the conditional power for showing statistical significance after randomizing 142 patients for the primary outcome of prolonging pregnancy was 22.8%. Thus the study was terminated after a total of 56 subjects were randomized with complete data available for analysis, 32 to removal and 24 to retention of cerclage. There was no statistical significance in primary outcome of prolonging pregnancy by 1 week comparing the 2 groups (removal 18/32, 56.3%; retention 11/24, 45.8%) P = .59; or chorioamnionitis (removal 8/32, 25.0%; retention 10/24, 41.7%) P = .25, respectively. There was no statistical difference in composite neonatal outcomes (removal 16/33, 50%; retention 17/30, 56%), fetal/neonatal death (removal 4/33, 12%; retention 5/30, 16%); or gestational age at delivery (removal mean 200 days; retention mean 198 days). CONCLUSION: Statistically significant differences were not seen in prolongation of latency, infection, or composite neonatal outcomes. However, there was a numerical trend in the direction of less infectious morbidity, with immediate removal of cerclage. These findings may not have met statistical significance if the original sample size of 142 was obtained, however they provide valuable data suggesting that there may be no advantage to retaining a cerclage after preterm premature rupture of membranes and a possibility of increased infection with cerclage retention.
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Cerclagem Cervical , Corioamnionite/prevenção & controle , Ruptura Prematura de Membranas Fetais/terapia , Nascimento Prematuro/prevenção & controle , Adulto , Cerclagem Cervical/efeitos adversos , Corioamnionite/etiologia , Feminino , Humanos , Gravidez , Resultado do TratamentoRESUMO
Lipopeptides are medicinally essential building blocks with strong hemolytic, antifungal and antibiotic potential. In the present research article, we are presenting our findings regarding the synthesis of N-alkylated lipopeptides via Ugi four-component approach, their antimicrobial potential against pathogenic (Gram-positive and Gram-negative) bacteria, as well as computational studies to investigate the compounds binding affinity and dynamic behavior with MurD antibacterial target. Molecular docking demonstrated the compounds have good binding ability with MurD enzyme. The FT94, FT95 and FT97 compounds revealed binding affinity scores of -8.585 kcal mol- 1, -7.660 kcal mol- 1 and -7.351 kcal mol- 1, respectively. Furthermore, dynamics analysis pointed the systems high structure dynamics. The docking and simulation results were validated by binding free energies, demonstrating solid intermolecular interactions and in the assay in vitro, the Minimal Inhibitory Concentration (MIC) of FT97 to Staphylococcus aureus (S. aureus) was 62.5 µg/mL. In conclusion, a moderate inhibitory response of peptoid FT97 was observed against the Gram-positive bacteria, S. aureus and B. cereus.
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Anti-Infecciosos , Staphylococcus aureus , Simulação de Acoplamento Molecular , Antibacterianos/farmacologia , Lipopeptídeos/farmacologiaRESUMO
The present study shows porous activated carbon obtained from Chenopodium quinoa Willd and Quillaja saponaria and their use as potential adsorbents to remove three types of dyes from aqueous solutions. The adsorption results were compared with commercial charcoal to check their efficiency. All porous carbon materials were activated using carbon dioxide and steam and fully characterized. Moreover, the steam-activated samples exhibited a high total pore volume with a BET surface area of around 800 m2 g−1. Batch adsorption experiments showed that commercial charcoal is the charcoal that offered the best adsorption efficiency for tartrazine and sunset yellow FCF. However, in the case of crystal violet, all activated carbons obtained from Chenopodium quinoa Willd and Quillaja saponaria showed the best captures, outperforming commercial charcoal. Molecular dockings of the dyes on the commercial charcoal surface were performed using AutoDock Vina. The kinetic results of the three isotherm's models for the present data follow the order: Langmuir~Freundlich > Temkin.
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Pesticides are used worldwide to increase crop yields in agriculture. However, their toxicity and accumulation capacity can make them toxic to the environment, animals and humans. In the case of workers chronically exposed to these substances, they must be sampled continuously, so urine is an excellent option. In this sense, this study proposes to use poly(vinyl alcohol)-malic acid hydrogels, and chitosan-coated calcium alginate as new sorbent phases to be used in pesticide determination processes in urine. To better understand the behavior of these materials in the capture and desorption process, molecular dynamics simulations (MDS) were used, and desorption experiments were performed, using mechanical agitation, ultrasound, and pH variation in the desorption process, in order to optimize the parameters to obtain better recoveries. Under the optimal experimental conditions, the maximum recoveries were of the order of 11% (CFN), 3% (KCF), 53% (DMT), 18% (MTD) and 35% (MTL). Although the recoveries were not exhaustive, they are a first approximation for the use of these new sorbent phases in the determination of this type of compound in aqueous solutions and urine.
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We investigated the potential of two oil extracts from seeds of Colliguaya integerrima (CIO) and Cynara cardunculus (CO) to use as nutritionally edible oils. For this purpose, oil quality was accessed by determining the fatty acid composition, peroxide value, acid value, iodine value, saponification number, phenolic contents, and oxidative stability during thermally induced oxidation of CIO and CO oils and compared to those of extra-virgin olive oil (EVOO). The chemical composition results demonstrated that both oils could be nutritional sources of essential unsaturated fatty acids. Moreover, according to the gravimetric analysis, the main decomposition step occurred in the temperature range of 200-420 °C, showing a similar thermal behavior of EVOO oil. However, CO and EVOO oils showed a higher phenolic content at degradation onset temperature (T0) in contrast with CIO oil. The antioxidant activity of the different studied oils showed a direct correlation with the phenol contents, up to temperatures around 180 °C, where the percentage of free radical scavenging assay for EVOO was higher than CO in contrast with the TPC values. Finally, we analyzed the minor components before and after heating CIO and CO at 180 °C by gas chromatography-mass spectrometry (GC-MS) using library search programs.
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OBJECTIVE: To assess the impact of activity restriction (AR) on the incidence of preterm birth in women treated for preterm labor testing negative for fetal fibronectin (fFN). STUDY DESIGN: Women who were diagnosed with preterm labor and tocolyzed with magnesium sulfate were concurrently screened with fFN for the purpose of subsequent management. Included were consenting patients with negative fFN, gestational age 23 0/7-33 6/7 weeks, cervical dilation < or =3 cm, and minimal vaginal bleeding. Patients were randomized to AR or no AR. Primary study outcome was incidence of preterm delivery and interval from randomization to delivery. RESULTS: A total of 73 women with negative fFN were randomized (36 with AR, 37 without AR). The overall preterm birth rate was 40%, with 44.4% of patients with AR and 35.1% of patients without AR delivering preterm, p=0.478. CONCLUSION: Maternal AR did not impact pregnancy outcome. The incidence of preterm birth in symptomatic women testing fFN negative was higher than previously reported.
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Repouso em Cama , Fibronectinas/análise , Glicoproteínas/análise , Trabalho de Parto Prematuro/prevenção & controle , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Sulfato de Magnésio/administração & dosagem , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Tocolíticos/administração & dosagemRESUMO
OBJECTIVE: The purpose of this study was to evaluate the impact of routine hospitalization for fetal monitoring on the perinatal survival and neonatal morbidity of monoamniotic twins. STUDY DESIGN: This was a multicenter retrospective cohort analysis of 96 monoamniotic twin gestations from 11 university and private perinatal practices. Overall mortality rates were calculated. The risk of intrauterine fetal death and neonatal morbidity was compared among women who were observed as inpatients versus outpatients. RESULTS: The overall mortality rate from enrollment was 19.8% (mean gestational age at enrollment, 17.4 weeks). The perinatal mortality and corrected perinatal mortality rates were 15.4% and 12.6%, respectively. Eighty-seven women had both twins who were surviving at 24 weeks of gestation; 43 women were admitted electively for inpatient surveillance at a median gestational age of 26.5 weeks; the remainder of the women were followed as outpatients and admitted only for routine obstetric indications (median gestational age, 30.1 weeks). No intrauterine fetal deaths occurred in any hospitalized patient. The risk of intrauterine fetal death in women who were followed as outpatients was 14.8% (13/88) versus 0 for women who were followed as inpatients (P < .001). There also were statistically significant improvements in birth weight, gestational age at delivery, and neonatal morbidity for women who were followed as inpatients. CONCLUSION: We observed improved neonatal survival and decreased perinatal morbidity among women who were admitted electively for inpatient fetal monitoring.