AIM:Aim of the study was to compare outcomes of pregnancy in gestational diabetes mellitus (GDM) treated with metformin, insulin, or diet.MATERIAL AND METHODS:The study included 48 women with GDM treated with metformin, 101 with insulin, and 200 women on a diet from the Outpatient Department of Endocrinology and University Clinic of Obstetrics and Gynecology in Skopje.RESULTS:The groups were comparable in age, smoking cigarettes and positive family history of diabetes. Mean glycosylated haemoglobin (HbA1c) at 37 gestation week, mean fasting, postprandial glycaemia, and gestational age at delivery were lower in diet and metformin than insulin group. No differences in mode of delivery were observed between the metformin and insulin group. Women in metformin group had a significantly lower incidence of LGA newborns than diet and insulin groups. The percent of SGA new-borns was higher in insulin group than diet and metformin groups. The incidence of neonatal hypoglycemia was statistically significantly higher in the insulin group than in the metformin and diet group.CONCLUSION:Metformin in women with GDM can improve maternal and neonatal outcomes compared with those treated with diet or insulin.
Significantly higher adiponectin levels were found in AGA neonates compared to SGA neonates. Leptin and adiponectine levels were positively correlated with birth weight. These findings suggest that these adipocytokines may be involved in fetal growth regulation.
ObjectiveThere is a global call for formulations, which are better suited for children of different age categories and in a variety of settings. One key public health area of interest is age-appropriate paediatric antibiotics. We aimed to identify clinically relevant paediatric formulations of antibiotics listed on pertinent formularies that were not on the WHO Essential Medicines List for Children (EMLc).MethodsWe compared four medicines lists versus the EMLc and contrasted paediatric antibiotic formulations in relation to administration routes, dosage forms and/or drug strengths. The additional formulations on comparator lists that differed from the EMLc formulations were evaluated for their added clinical values and costs.ResultsThe analysis was based on 26 EMLc antibiotics. Seven oral and two parenteral formulations were considered clinically relevant for paediatric use. Frequently quoted benefits of oral formulations included: filling the gap of unmet therapeutic needs in certain age/weight groups (phenoxymethylpenicillin and metronidazole oral liquids, and nitrofurantoin capsules), and simplified administration and supply advantages (amoxicillin dispersible tablets, clyndamycin capsules, cloxacillin tablets, and sulfamethoxazole+trimethoprim tablets). Lower doses of ampicillin and cefazolin powder for injection could simplify the dosing in newborns and infants, reduce the risk of medical errors, and decrease the waste of medicines, but may target only narrow age/weight groups.ConclusionsThe identified additional formulations of paediatric antibiotics on comparator lists may offer clinical benefits for low-resource settings, including simplified administration and increased dosing accuracy. The complexity of both procuring and managing multiple strengths and formulations also needs to be considered.
BACKGROUND: Acute gastroenteritis is one of the most common infections in childhood and it can be especially dangerous in the first 6 months of life with a higher risk of moderate and severe dehydration, especially in infants who are not exclusively breastfed. Secretory immunoglobulin A (sIgA) is the first line of defense on the intestinal epithelium from pathogenic microorganisms and intestinal toxins. AIM: The aim of this study was to determine whether breast milk sIgA has some protective effect on the intestinal epithelium as well as on the severity and duration of the clinical signs in infants with acute gastroenteritis depending on the type of nutrition. MATERIALS AND METHODS: A total of 23 infants with acute gastroenteritis divided into two groups based on the feeding patterns (type of milk) were included in the study. Investigated indicators were severity of symptoms, dehydration degree, and the need for parenteral rehydration. RESULTS: We identified a statistically significant association between group affiliation and the sIgA levels in stool between the first and the second groups (p = 0.001346). The most common cause of acute gastroenteritis in infants was Rotavirus. Our study has shown that exclusive breastfeeding reduces the risk of Rotavirus infection, especially in the first 6 months of life, OR = 0.0758, 95% confidence interval (CI) (0.0071–0.8074). CONCLUSION: The presence of breast milk sIgA in infants has an effect on the severity of the clinical picture of acute gastroenteritis by reducing the frequency of vomiting, the number and severity of diarrheal episodes, the risk of moderate and severe dehydration, and fever frequency.
Despite all efforts to improve the on-label use of licensed medicines for neonates, there is still high percentage and demands of offlabel and unlicensed medicines use in neonatal therapy. Therefore, the general objective of this survey is to provide a description of off-label and unlicensed medicines use within the neonatal therapeutic areas in a Department of Neonatology, University Clinic for Gynecology and Obstetrics, in Skopje, Republic of Macedonia. All analyzed prescriptions were given in accordance with the Evidence Based Guidelines applied in the Department. During the three months’ period in 2015, there were given 1595 prescriptions, comprising 3.99 prescriptions per newborn during the hospital stay. Out of them, 532 (33.3%) were on-label medicine uses, 1052 (66%) were off-label medicines, and 11 prescriptions (0.7%) were unlicensed medicines. The results from this study show the high level of off-label medicine use in neonatal therapy. These results present only the “top of the iceberg” and require more comprehensive analysis that will gradually evolve in a National Guideline on off-label use areas in pediatric medicine, especially for critically ill newborns who are prescribed much more life-saving medicines.
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