Comparative evaluation of isosorbide mononitrate and alendronate in management of postmenopausal osteoporosis

BACKGROUND

Osteoporosis, a skeletal disorder that adversely affects bone strength , is common among postmenopausal women primarily due to reduced ovarian estrogens.

PURPOSE

The present study was taken up to evaluate the role of isosorbide mononitrate (IMN) in the management of postmenopausal osteoporosis and to compare its efficacy with that of alendronate.

METHODS

This prospective systematic randomized study was conducted on 90 postmenopausal women with lumbar spine BMD >2.5 SD below the young adult reference range. The participants received either Tab Alendronate 70 mg orally, once weekly (Group I) or Tab IMN 40 mg orally once daily (Group II) for 9 months, in addition to 500 mg of oral calcium daily. The BMD of the lumbar spine was measured using DEXA scan at enrolment and after 9 months. The data was analyzed by Student's t test and Chi-square test.

RESULTS

The mean baseline BMD was 0.67 + 0.097 and 0.68 + 0.067 g/cm(2) in Group I and II, respectively. An increase of 11.94% in the mean BMD was noted after 9 months of treatment with alendronate as against 8.82% with IMN. Headache, flushing and palpitations in Group II and nausea, epigastric pain and heart burn in Group I were the most common adverse effects.

CONCLUSION

IMN has a beneficial effect on bone turnover in cases of postmenopausal osteoporosis and that the effect is comparable to that of alendronate. IMN is a promising and safe alternative to alendronate for the management of postmenopausal osteoporosis.

Use of 24-hour urinary protein and calcium for prediction of preeclampsia

OBJECTIVE

To assess the efficacy of 24-hour urinary protein and calcium for the prediction of preeclampsia.

MATERIALS AND METHODS

Two hundred normotensive women at 20-28 weeks' gestation were enrolled in the study. All women were asked to collect a 24-hour urine sample. Urinary protein and calcium were measured and expressed as milligrams per 24 hours. Sensitivity, specificity and predictive values were calculated for each test, and cutoff values were calculated using receiver operating characteristic curves.

RESULTS

Twenty-one of the 200 women developed preeclampsia, including eight who developed severe preeclampsia and 13 who developed mild preeclampsia. Compared with the normotensive women (n = 179), the hypertensive patients (n = 21) had significantly lower urinary calcium excretion (167.23 +/- 80.63 mg vs. 277.43 +/- 60.38 mg) and higher proteinuria (351.14 +/- 41.58 mg vs. 296.33 +/- 30.03 mg).

CONCLUSION

A decrease in 24-hour urinary calcium and increase in protein between 20-28 weeks' gestation are risk factors for preeclampsia.

Efficacy of hyoscine-N-butyl bromide (Buscopan) suppositories as a cervical spasmolytic agent in labour

OBJECTIVE

To evaluate the efficacy and safety of hyoscine-N-butyl bromide (Buscopan) suppositories in the active phase of labour, i.e. once the labour is established.

METHODS

A non-randomised controlled prospective study was carried out on 200 women in labour. In the active phase of labour, at 3 cm or more cervical dilatation, 100 women were administered Buscopan via suppository and 100 women (control) were not given any drug.

RESULTS

The duration of first stage of labour was 123.86 +/- 68.89 (mean(+)-standard deviation) minutes in the study group and 368.05 +/- 133.0 min in the control group. These differences were statistically significant. There were no differences in the duration of the second and third stages of labour. There was no increased incidence of operative deliveries in the study group. No adverse effects were noted on the mother or fetus.

CONCLUSION

Hyoscine-N-butyl bromide (HBB, Buscopan) suppositories were highly effective in shortening the duration of the first stage of labour.

Pregnancy in asymmetric blind hemicavity of Robert's uterus--a previously unreported phenomenon

An 18-year-old primigravida presented following recurrent failed attempts at pregnancy termination for intra-uterine fetal death. Clinical examination aroused suspicion of non-communicating uterine horn with bicornuate uterus. Examination under anaesthesia and laparotomy revealed a partial vaginal septum, complete septate uterus with septum deviated to one side and fetus lying in the non-communicating right blind hemicavity (Robert's uterus). Hysterotomy and ipsilateral tubal ligation were performed.