Showing posts with label Sildenafil citrate. Show all posts
Showing posts with label Sildenafil citrate. Show all posts

Friday, December 22, 2017

A year in review: Best of 2017


We are already round the corner to 2018, here are the top 10 most read articles from 2017.

News from ACOG 2017: Changing gloves before abdominal closure brings down the rate of wound infection by almost 50% in Cesarean Section

Results of a randomized controlled trial presented at the ACOG 2017 showed that changing the outer gloves before closing the abdomen decreases the wound complication of infection, cellulitis and dehiscence.

Clinical review: Updates on Cesarean Section
Here is a roundup of the latest research on Cesarean Section.

The American Heart Association updates BP guidelines in 14 years: now 130 is the new 140
The American Heart Association (AHA)  and The American College of Cardiology (ACC) has changed the definition of hypertension for the first time in 14 years, moving the number from the old standard of 140/90 to the newly revised 130/80.

According to the new definition, 130 to 139 mm Hg systolic and or 80 to 89 mm Hg will be labelled as stage 1 hypertension.

First US baby born after uterine transplant delivered in Texas
The first birth as a result of a uterine transplant in the United States took place on Friday in Texas at the Baylor University Medical Center in Dallas. The women had undergone a live donor transplant and have received her uterus from Taylor Siler, 36, a registered nurse in the Dallas area.

New use of old drug: Sildenafil Citrate (Viagra) improves amniotic fluid index in oligohydramnios.
Sildenafil Citrate (Viagra) improves amniotic fluid index in pregnancies complicated by oligohydramnios according to a new study published ahead of print on March 6,2017 in Journal of Obstetrics and Gynecology.

WHO updates its guidance on Tranexamic Acid for the Treatment of Postpartum Hemorrhage

WHO has recently updated their guidelines for use of Tranexamic acid for treatment of Postpartum Hemorrhage: TXA should now be included in the treatment regimen for PPH along with other drugs, irrespective of the cause of hemorrhage.  

CDC releases ‘long awaited’ guidelines for preventing surgical site infections.
The Center for Disease Control released its much-awaited update to its 1999 guidelines for the prevention of surgical site infections (SSIs). The guidelines were published online May 3, 2017 in JAMA.

Finally, an oral drug found effective in treatment of Uterine Fibroids following successful phase-3 trial

Relugolix successfully reduced heavy menstrual blood loss among Japanese women in a Multicenter, Randomized, Double-Blind, Parallel-Group, Phase 3 Study to Evaluate the Efficacy and Safety of Oral relugolix 40 mg as compared with injectable leuprolide in the Treatment of Uterine Fibroids.

Now ‘Switch’ the way you suture: Reinventing suturing technique with the new device
Mellon Medical, a Dutch MedTech developer has reinvented suturing by developing a device which enables the surgeon to suture with only one hand, the other hand remaining free to use as needed. The product is named Switch®, a single use precision instrument that allows the surgeon to suture tubular structures or skin with twice the speed of conventional suturing.

A simple, novel solution to identify and protect ureter during surgery

AllotropeMedical, a Houston based medical startup has devised StimSite, a novel, hand-held, single use device that precisely identifies ureter during surgery; thus, eliminating the need for ureteral stenting.


Friday, March 31, 2017

Here are the top 5 posts this month.



New use of old drug: Sildenafil Citrate (Viagra) improves amniotic fluid index in oligohydramnios.
Sildenafil Citrate (Viagra) improves amniotic fluid index in pregnancies complicated by oligohydramnios according to a new study published ahead of print on March 6,2017 in Journal of Obstetrics and Gynecology. [1]




ACOG releases recommendations for management of acute onset, severe hypertension in pregnancy and postpartum period.
It is estimated that ten million women develop preeclampsia each year around the world, with 76,000 deaths due preeclampsia and related hypertensive disorders.  It is also responsible for 50,000 stillbirths and early neonatal deaths in developing nations.

ACOG committee opinion was published online ahead of print in Journal of Obstetrics and Gynecology.




New Single Handed IUD Inserter for LILETTA released easing IUD insertion.
Allergan a leading global pharmaceutical company, and Medicines360, a nonprofit global women's health pharmaceutical company, recently launched the new LILETTA® (levonorgestrel-releasing intrauterine system) 52 mg IUD single-handed inserter (intrauterine device), for use by women to prevent pregnancy for up to three years. The system needs to be replaced after 3 years if continuous protection is desired. 



Ethicon ENSEAL® X1 Large Jaw Tissue Sealer gets FDA approval: Excellent for performing abdominal and vaginal hysterectomies.

Ethicon, today announced the release of its new ENSEAL X1 Large Jaw Tissue Sealer. Designed for use in open surgeries it is an advanced bipolar device that provides less blood loss, less thermal spread, and improved ergonomics compared to as compared to Medtronic’s LigaSure Impact™.


ASCO issues first global resource stratified guidelines for HPV vaccination for the prevention of cervical cancer.
ASCO today issued first guidelines on primary prevention of cervical cancer that can be used by physicians around the globe as it is tailored according to region, social and economic settings and healthcare resources available. The guidelines were published online in Journal of Global Oncology. [1]

The guidelines offer four levels of recommendations: basic, limited, enhanced and maximal based on the country’s healthcare circumstances and were developed by experts from multiple disciplines representing various countries across the globe.





Saturday, March 11, 2017

Here are the top 5 posts this week.


New use of old drug: Sildenafil Citrate (Viagra) improves amniotic fluid index in oligohydramnios.
Sildenafil Citrate (Viagra) improves amniotic fluid index in pregnancies complicated by oligohydramnios according to a new study published ahead of print on March 6,2017 in Journal of Obstetrics and Gynecology.


Ethicon ENSEAL® X1 Large Jaw Tissue Sealer gets FDA approval: Excellent for performing abdominal and vaginal hysterectomies.
Ethicon, today announced the release of its new ENSEAL X1 Large Jaw Tissue Sealer. Designed for use in open surgeries it is an advanced bipolar device that provides less blood loss, less thermal spread, and improved ergonomics compared to as compared to Medtronic’s LigaSure Impact™.


Trichomonas vaginalis Infection: Is it time to reconsider the single dose treatment?
Women receiving the recommended single dose therapy for Trichomonas vaginalis are 1.8 times more likely to have relapse of infection as compared to women receiving multi dose treatment says results of a recent Meta-analysis published in Journal of American Sexually Transmitted Disease Association.

FDA approves Noctiva, the first treatment for frequent nighttime urination.
The U.S. Food and Drug Administration today approved Noctiva (desmopressin acetate) nasal spray for adults who have to go for urination at least two times per night, a condition known as nocturnal polyuria. [1]
Noctiva is the first FDA-approved treatment for this condition. About 200 million people worldwide suffer from nocturia.

Biodegradable sanitary napkins from banana plant: a step towards revolutionizing feminine hygiene in India.
A new healthcare start-up founded by three Massachusetts Institute of Technology graduates have launched a new revolution in women’s hygiene industry by creating biodegradable sanitary napkins from locally sourced banana fibers. They are also hoping to improve waste disposal of pads because it degrades faster if buried. On average, a single woman generates 125 kg of sanitary waste during her menstruating years when she uses disposable sanitary products. [2]


Friday, March 10, 2017

New use of old drug: Sildenafil Citrate (Viagra) improves amniotic fluid index in oligohydramnios.

Pfizer.com 

Sildenafil Citrate (Viagra) improves amniotic fluid index in pregnancies complicated by oligohydramnios according to a new study published ahead of print on March 6,2017 in Journal of Obstetrics and Gynecology.[1]

Viagra, a specific phosphodiesterase-5 inhibitor, has recently been proposed as a potential therapeutic strategy to maintain placental function and increase the amniotic fluid index (AFI).

This was an open-label randomized trial, carried out over a period of one year and recruited a total of 184 women. The study included all women at 30 weeks or more in pregnancy with oligohydramnios detected during routine sonography. No specific cause or etiology was detected for oligohydramnios in all these women.

The women were randomized to receive either Sildenafil Citrate 25 mg three times a day along with intravenous infusion of 2 L isotonic solution (82 women) or just fluids only (84 women). All women were hospitalized for initial 24 hours and received the IV fluids.  

The women were followed up for 6 weeks on the basis of outpatient monitoring with NST, USG and biophysical profile. Patient is readmitted if the AFI drops below 5 for Intravenous fluid therapy. Final assessment of the amniotic fluid volume is done at 6 weeks or before delivery if she went into labor before completing 6 weeks.

It was seen that women who received Sildenafil have considerable good amniotic fluid at follow up with AFI of 11.5 vs 5.4 in the control group. (P=.02).

The women in sildenafil group also went further into pregnancy with mean gestational age of 38.3 weeks as compared to 36 weeks. (P=.001). These women had one third the rate of Cesarean section and one fourth neonatal intensive care admission as compared to placebo group.

The authors concluded that “Sildenafil citrate increases amniotic fluid volume in pregnancies complicated by oligohydramnios.”

The proposed mechanism is vasodilatation of small myometrial vessels, thereby increasing the placental perfusion which leads to improvement in amniotic fluid index, fetal weight, and even uterine and umbilical artery Doppler patterns.

Currently there is no effective therapy for early onset IUGR or oligohydramnios.
Sildenafil citrate in the same dose has also shown promising results in improving the birth outcomes in early and late onset IUGR.[2]

Preliminary studies have also shown that it is effective in early onset preeclampsia to improve fetal growth retardation, but more randomized trials are needed.[3]


The trial is registered with Clinicaltrials.gov number NCT02372487



[1] http://journals.lww.com/greenjournal/toc/publishahead
[2] http://www.ijrcog.org/index.php/ijrcog/article/viewFile/1603/1429
[3] https://obgynupdated.blogspot.com/2016/07/new-use-of-old-drug-sildenafil-citrate.html

Tuesday, July 12, 2016

New Use of old drug: Sildenafil Citrate ( Viagra) in treatment of preeclampsia.



photo courtesy: Avon Pharmacy
Preeclampsia is a leading cause of maternal and neonatal morbidity and mortality, and early-onset preeclampsia is responsible for long lasting consequences for the fetus.

A recent study published online July 07, 2016 in journal of obstetrics and gynecology concluded that treatment with sildenafil citrate prolonged pregnancy by an average of 4 days compared with placebo.

Sildenafil citrate, is a specific phosphodiesterase-5 inhibitor, augments the vasodilatory effects of NO by preventing the degradation of cGMP causing vasodilatation. Phosphodiesterase-5 is present in the human feto-placental circulation and sildenafil mediates vasodilatation and improve fetoplacental circulation by the same mechanism of action.[1]

This randomized, double blind placebo controlled trial recruited 100 patients with preeclampsia between 24 and 33 weeks of gestation, into two groups, one received 50 mg oral sildenafil citrate every 8 hours and other was put on placebo.

The patients also received additional antihypertensive treatment in the form of α-methyldopa (500 - 1500 mg/day) along with pindolol (10 - 30 mg/per day) as needed. Those patients who anticipated to go in labor received full corticosteroid coverage within 72 hours.

Patients in the treatment group on an average gained 4 days (14.4 days) as compared to the placebo group (10.4 days). This group also observed an improvement in blood flow in uterine and umbilical arteries (P< .001). and a significant reduction in Maternal Arterial Pressure within 24 hrs of randomization (P < .05).

Patients in placebo group required increased dose of the primary drug or addition of the new drug (P < .001).

Both groups were comparable in terms of perinatal morbidity, mortality, or adverse effects between groups. Each extra day gained between 24 and 32 weeks of gestations helps to improve the infant mortality statistics.

To confirm the benefits to the infant, "studies with a larger number of patients and an earlier start of medication are required," the authors opined.

The lead author Alberto Trapani Jr, MD, PhD, quoted that "Reduction in maternal [mean arterial pressure], without compromising uterine artery blood flow, provides reassurance that sildenafil may be useful as an antihypertensive drug in the context of placental vascular insufficiency."

Preliminary studies have demonstrated use of sildenafil citrate in early onset preeclampsia to improve fetal growth retardation, but more randomized trials and meta-analysis are needed before a recommendation for its use can be made in clinical practice.  [2] A randomized trial in 2009 demonstrated that although sildenafil does not prolong pregnancy but it was well tolerated without any maternal or fetal adverse effects in the escalating dose regimen 20-80 mg tid.[3]



[1] Maharaj CH, O’Toole D, Lynch T, et al. Effects and mechanisms of action of sildenafil citrate in human chorionic arteries. Reproductive Biology and Endocrinology : RB&E. 2009;7:34. doi:10.1186/1477-7827-7-34.
[2] Sildenafil citrate therapy for severe early-onset intrauterine growth restriction.
P. von Dadelszen, S. Dwinnell, L. A. Magee, B. C. Carleton, A. Gruslin, B. Lee, K. I. Lim, R. M. Liston, S. P. Miller, D. Rurak, et al.
BJOG. 2011 April; 118(5): 624–628. doi: 10.1111/j.1471-0528.2010.02879.x
[3] http://www.ncbi.nlm.nih.gov/pubmed/19843000