eMedinewS Editorial

Health Care 194 Comments

IVF pregnancies are causing rise in maternal mortality rates

Maternal mortality rates are increasing in according to an editorial in the British Medical Journal. The in vitro fertilization–related pregnancies are an additional risk factor for maternal death.

A study conducted in The Netherlands, found there were 42 deaths per 100,000 IVF pregnancies, compared with six deaths seen among 100,000 pregnancies in the general population.

The major causes of maternal death are rare catastrophes, such as hemorrhage and blood clots but the incidence of these problems is increasing, possibly because more pregnant women today have health problems, such as diabetes, obesity or some other chronic condition or also generally older.

One should track IVF–associated risks including ovarian hyperstimulation syndrome to better understand risks associated with IVF.
Dr KK Aggarwal
Editor in Chief

eMedinewS Editorial

Health Care 187 Comments

rtPA may prevent dialysis catheter infections

Replacing heparin with rtPA in dialysis catheters once a week may reduce the incidence of catheter malfunctions and infections. rt–PA is normally used to break up stroke–causing clots in the brain. However, when researchers used this drug in dialysis catheters instead of heparin after one of three dialysis sessions a week, the rate of catheter malfunction dropped from 35% to 20%. In addition, the infection rate was 4.5% in the group that received rt–PA compared to 13% for the group treated only with heparin.

rt–PA reduces the rates of catheter malfunction by about 50% and infections by almost two–thirds reports the study published in the Jan. 27 issue of the New England Journal of Medicine.

Dr KK Aggarwal
Editor in Chief

eMedinewS Editorial

Uncategorized 9 Comments

Managing diabetes

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If no contraindications are present always start with metformin as initial therapy in most patients with type 2 diabetes. However, consider insulin as first–line drug in patients presenting with A1C >10%, fasting sugar >250 mg/dL, random sugar consistently >300 mg/dL, or ketonuria.
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Start with metformin at the time of diabetes diagnosis, along with lifestyle interventions. Titrate its dose to its maximally effective dose (2000–2500 mg/day) over 1 to 2 months.
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If situations predisposing to lactic acidosis are present, avoid metformin and consider a shorter–duration sulfonylurea.
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Star with lifestyle intervention first, at the time of diagnosis. If lifestyle intervention has not produced a significant reduction in symptoms of hyperglycemia or in sugar values after 1 or 2 weeks, add the first drug.
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Those who cannot be given metformin or sulfonylureas, repaglinide is a alternative, particularly in a patient with chronic kidney disease at risk for hypoglycemia.
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Other alternative is a pioglitazone, which may be considered in patients with lower initial A1C values or if there are specific contraindications to sulfonylureas. There is a concern about atherogenic lipid profiles and a potential increased risk for cardiovascular events with rosiglitazone.
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One can consider sitagliptin as monotherapy for those intolerant of or have contraindications to metformin, sulfonylureas, or thiazolidinediones. It is a drug of choice as initial therapy in a patient with chronic kidney disease at risk for hypoglycemia. It is however, less potent than repaglinide, which can also be used safely in patients with chronic kidney disease.
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In patients in whom it is difficult to distinguish type 1 from type 2 diabetes, start with insulin.
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Further adjustments of therapy should be made every three months based on the A1C result aiming it close to the non diabetic range. If A1C values >7%, one need to further adjust the diabetic regimen.
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If A1C remains >7% another drug should be added within 2 to 3 months of initiation of the lifestyle intervention and metformin.

Dr KK Aggarwal
Editor in Chief

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