amphotericin-b and Uterine-Hemorrhage

To investigate whether the use of an antibacterial vaginal pessary containing tetracycline and amphotericin B would reduce complications from large loop excision of the transformation zone (LLETZ).. Prospective randomised controlled trial.. Department of Obstetrics and Gynaecology, University of Hong Kong.. A total of 321 women who underwent LLETZ.. Women were randomised to either receiving an antimicrobial vaginal pessary twice a day for 14 days after LLETZ or no medication. Before LLETZ, endocervical and high vaginal swabs were taken for the detection of Chlamydia and other pathogens. All women were given a diary to record the degree of symptoms, such as vaginal discharge, bleeding and pain for 3 weeks. These were then compared between the two groups.. Bleeding, vaginal discharge and pain after LLETZ.. There was no significant difference in the total bleeding, vaginal discharge and pain scores between the two groups. However, for women who had positive endocervical or high vaginal swabs, the treatment group had significantly less bleeding in the second week (Z=-2.083, P= 0.037) and less overall vaginal discharge (Z=-2.024, P= 0.043).. An antimicrobial vaginal pessary containing tetracycline and amphotericin B did not provide any significant benefit after LLETZ, except for a subgroup of women with positive vaginal or endocervical swabs. Given that this group of women cannot be identified before the procedure since swabs are not routinely taken, the use of routine prophylactic topical antibiotics cannot be recommended for the general population.

Topics: Abdominal Pain; Administration, Intravaginal; Adult; Amphotericin B; Anti-Bacterial Agents; Antibiotic Prophylaxis; Chlamydia Infections; Female; Humans; Pessaries; Postoperative Complications; Prospective Studies; Tetracycline; Treatment Failure; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Uterine Hemorrhage; Vaginal Discharge

The advancement of neonatology over the past 20 years has allowed a greater number of ELBW infants to survive. However, these advancements have contributed to the increased incidence of acute kidney injury (AKI) seen in this population. Understanding the risk factors for AKI in this population of ELBW infants is imperative for the successful survival of these infants since the morbidity and mortality rates from this disease are increasing.. 1) to determine the prevalence of AKI in ELBW (<  750 grams). 2) to compare the mortality rate of ELBW infants (<  750 grams) with and without AKI; and 3) to identify the associated risk factors of AKI in ELBW infants (<  750 grams).. A retrospective chart review of all infants with AKI as defined by AKIN criterias, admitted to the NICU between 1998 and 2008 was conducted. Case-controls were matched for BW, gestational age and date of birth, (SPSS v17.0 software, using Student's t test, X2 test, and Mann-Whitney U test were used for statistical analysis.. The prevalence rate of ELBW infants (<  750 grams) with AKI admitted at CHMCA NICU from 1998 to 2008 was 26% . The mortality rate of ELBW infants (<  750 grams) with AKI was 54% , compared to 20% in those ELBW infants who did not have AKI. The associated risk factors of AKI in the ELBW infants (<  750 grams) were as follows: presence of maternal placental abruption/bleeding, grade III or IV IVH, PDA, positive culture/s, NEC, use of steroid, nephrotoxic drugs, and longer use of the ventilator and TPN.

Topics: Abruptio Placentae; Acute Kidney Injury; Adult; Amphotericin B; Anti-Bacterial Agents; Case-Control Studies; Cefotaxime; Clindamycin; Creatinine; Diuretics; Ductus Arteriosus, Patent; Enterocolitis, Necrotizing; Female; Furosemide; Humans; Hydrochlorothiazide; Infant, Extremely Low Birth Weight; Infant, Newborn; Infections; Intracranial Hemorrhages; Ohio; Parenteral Nutrition, Total; Pregnancy; Prevalence; Respiration, Artificial; Retrospective Studies; Risk Factors; Steroids; Survival Rate; Time Factors; Uterine Hemorrhage; Vancomycin; Young Adult