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Jayasundara S, Goonewardene M, Dassanayake L. The association between maternal intra-abdominal pressure and hypertension in pregnancy. PLoS One 2023; 18:e0284230. [PMID: 37851647 PMCID: PMC10584176 DOI: 10.1371/journal.pone.0284230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/03/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Pregnancy leads to a state of chronically increased intra-abdominal pressure (IAP) caused by a growing fetus, fluid, and tissue. Increased intra-abdominal pressure is leading to state of Intra-Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome. Clinical features and risk factors of preeclampsia is comparable to abdominal compartment syndrome. IAP may be associated with the hypertension in pregnancy (HIP). OBJECTIVES The study aimed to determine the antepartum and postpartum IAP levels in women undergoing caesarean delivery (CD) and association between hypertension in pregnancy, and antepartum and postpartum IAP levels in women undergoing CD. METHOD Seventy pregnant women (55 normotensive, 15 HIP) undergoing antepartum, non-emergency CD, had their intravesical pressure measured before and after the CD, the intravesical pressure measurements obtained with the patient in the supine position were considered to correspond to the IAP. Multivariable linear regression models were used to study associations between intraabdominal pressure and baseline characteristics in normotensive pregnancies and hypertensive pregnancies. RESULTS In normotensive pregnancies at mean gestation age of 38.2 weeks (95%CI 37.9 to 38.6), mean antepartum IAP was 12.7 mmHg(95%CI 11.6 to 13.8) and the mean postpartum IAP was 7.3 mmHg (95% CI 11.6 to 13.8). Multivariable linear regression models showed HIP group antepartum IAP positively associated with coefficient value of 1.617 (p = 0.268) comparing with normotensive pregnancy group. Postpartum IAP in HIP group positively associated with coefficient value of 2.519 (p = 0.018) comparing with normotensive pregnancy group. IAP difference is negatively associated with HIP (coefficient -1.013, p = 0.179). CONCLUSION In normotensive pregnancies at term, the IAP was in the IAH range of the non-pregnant population. Higher Antepartum IAP and Postpartum IAP are associated with HIP. Reduction of IAP from antepartum period to postpartum period was less with HIP.
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Affiliation(s)
| | - Malik Goonewardene
- Academic Obstetric Unit, Teaching Hospital, Galle, Sri Lanka
- Department of obstetrics and gynaecology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Lanka Dassanayake
- Academic Obstetric Unit, Teaching Hospital, Galle, Sri Lanka
- Department of obstetrics and gynaecology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Kemper JI, Li W, Goni S, Flanagan M, Weeks A, Alfirevic Z, Bracken H, Mundle S, Goonewardene M, Ten Eikelder M, Bloemenkamp K, Rengerink KO, Kruit H, Mol BW, Palmer KR. Foley catheter vs oral misoprostol for induction of labor: individual participant data meta-analysis. Ultrasound Obstet Gynecol 2021; 57:215-223. [PMID: 33258514 DOI: 10.1002/uog.23563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compare the effectiveness and safety of Foley catheter and oral misoprostol for induction of labor (IOL). METHODS The Cochrane Review on Mechanical Methods for Induction of Labour and Ovid MEDLINE, EMBASE via Ovid, Ovid Emcare, CINAHL Plus, ClinicalTrials.gov and Scopus, from inception to April 2019, were searched for randomized controlled trials (RCTs) comparing Foley catheter to oral misoprostol for IOL in viable singleton gestations. Eligible trials for which raw data were obtained were included and individual participant data meta-analysis was performed. Primary outcomes were vaginal birth, a composite of adverse perinatal outcome (including stillbirth, neonatal death, neonatal seizures, admission to the neonatal intensive care unit, severe respiratory compromise or meconium aspiration syndrome) and a composite of adverse maternal outcome (including admission to the intensive care unit, maternal infection, severe postpartum hemorrhage, maternal death or uterine rupture). The quality of the included RCTs was assessed using the Cochrane Risk of Bias 2 tool and the certainty of evidence was evaluated using the GRADE approach. A two-stage random-effects model was used for meta-analysis according to the intention-to-treat principle and interactions between treatment and baseline characteristics were assessed. RESULTS Of seven eligible trials, four provided individual participant data for a total of 2815 participants undergoing IOL, of whom 1399 were assigned to Foley catheter and 1416 to oral misoprostol. All four trials provided data for each of the primary outcomes in all 2815 women. Compared with those receiving oral misoprostol, Foley catheter recipients had a slightly decreased chance of vaginal birth (risk ratio (RR), 0.95 (95% CI, 0.91-0.99); I2 , 2.0%; moderate-certainty evidence). A trend towards a lower rate of composite adverse perinatal outcome was found in women undergoing IOL using a Foley catheter compared with oral misoprostol (RR, 0.71 (95% CI, 0.48-1.05); I2 , 14.9%; low-certainty evidence). Composite adverse maternal outcome did not differ between the groups (RR, 1.00 (95% CI, 0.97-1.03); I2 , 0%; moderate-certainty evidence). Meta-analyses of effect modifications did not show significant interactions between intervention and parity or gestational age for any of the primary outcomes. CONCLUSIONS For women undergoing IOL, Foley catheter is less effective than oral misoprostol, as it was associated with fewer vaginal births. However, while we found no significant difference in maternal safety, Foley catheter induction may reduce adverse perinatal outcomes. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J I Kemper
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - W Li
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - S Goni
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - M Flanagan
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
| | - A Weeks
- Department of Women's & Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, UK
| | - Z Alfirevic
- Department of Women's & Children's Health, University of Liverpool, Liverpool Women's Hospital, Liverpool, UK
| | - H Bracken
- Gynuity Health Projects, New York, NY, USA
| | - S Mundle
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Nagpur, India
| | - M Goonewardene
- Department of Obstetrics & Gynaecology, University of Ruhuna, Galle, Sri Lanka
| | - M Ten Eikelder
- Leiden University Medical Center, Leiden, The Netherlands
| | - K Bloemenkamp
- Wilhelmina Children's Hospital Birth Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - K O Rengerink
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Kruit
- Department of Obstetrics & Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - B W Mol
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
- Monash Women's, Monash Health, Melbourne, Australia
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - K R Palmer
- Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia
- Monash Women's, Monash Health, Melbourne, Australia
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Nguyen P, Vo N, Goonewardene M, Huang T, Ricciardo P, Vujcich N, Le H. An adult with severe hyperdontia: surgical challenges in a developing country. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Silva G, Furukan R, Goonewardene M. Validation of the Sinhala translation of the International Consultation on Incontinence Modular Questionnaire for female lower urinary tract symptoms among women in Sri Lanka. Int Urogynecol J 2017; 28:1895-1899. [DOI: 10.1007/s00192-017-3329-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/27/2017] [Indexed: 11/30/2022]
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Withanathantrige M, Goonewardene M, Dandeniya R, Gunatilake P, Gamage S. Comparison of four methods of blood loss estimation after cesarean delivery. Int J Gynaecol Obstet 2016; 135:51-5. [PMID: 27451396 DOI: 10.1016/j.ijgo.2016.03.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/18/2016] [Accepted: 06/22/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess agreement between four different methods of blood loss estimation after lower-segment cesarean delivery (LSCD). METHODS A secondary analysis was undertaken of a randomized controlled trial of three timings of cord clamping during LSCD performed at a center in Sri Lanka between January 21 and April 30, 2013. Eligible women underwent prepartum LSCD at 37-39weeks of pregnancy. Estimated blood loss (EBL) was assessed by a combined method (direct measurements of spilled blood and sucker bottle volumes, and weighing of surgical towels and drapes before and after use), according to visual assessments by the surgeon and by anesthesiologists, and by measurement of preoperative and postoperative hemoglobin levels. RESULTS Among 156 participants, mean EBL was 502mL (95% CI 370-618) from the combined method, 506mL (412-643) calculated from hemoglobin levels, 484mL (367-621) by the surgeon's estimation, and 491mL (361-612) by anesthesiologists' estimation (P=0.32). Visual assessment of EBL by anesthesiologists had the best intraclass correlation (0.713) and limits of agreement with the combined method. There were no significant differences between the proportion of cases in which anesthesiologists and the surgeon underestimated or overestimated the EBL when compared with the combined method. CONCLUSION EBL should be ideally obtained by the combined method.
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Affiliation(s)
- Manoj Withanathantrige
- Academic Obstetrics and Gynaecology Unit, Teaching Hospital, Mahamodara, Galle, Sri Lanka
| | - Malik Goonewardene
- Academic Obstetrics and Gynaecology Unit, Teaching Hospital, Mahamodara, Galle, Sri Lanka; Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
| | - Ranmalie Dandeniya
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Pabashani Gunatilake
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Sasini Gamage
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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Riley G, Hopkins S, Piccini I, Brown N, Fabritz L, Kirchhof P, Raju H, Bevan S, Sheppard MN, Behr ER, Ng FS, Sulkin MS, Peters NS, Efimov IR, Vanheusden FJ, Li X, Chu GS, Almeida TP, Schlindwein FS, Ng GA, Crockford CJ, Ahmed O, Kaba R, Berry R, Dhillon OS, Ullah W, Hunter R, Lovell M, Dhinoja M, Sporton S, Earley MJ, Diab IG, Schilling RJ, Goonewardene M, Heck PM, Begley DA, Fynn S, Virdee M, Grace A, Agarwal SC, Wilson DG, Ahmed N, Nolan R, French A, Frontera A, Duncan ER, Thomas G. MODERATED POSTERS, SESSION 1, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Goonewardene M, Shehata M, Hamad A. Anaemia in pregnancy. Best Pract Res Clin Obstet Gynaecol 2011; 26:3-24. [PMID: 22138002 DOI: 10.1016/j.bpobgyn.2011.10.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 10/19/2011] [Accepted: 10/19/2011] [Indexed: 11/16/2022]
Abstract
Anaemia in pregnancy, defined as a haemoglobin concentration (Hb) < 110 g/L, affects more than 56 million women globally, two thirds of them being from Asia. Multiple factors lead to anaemia in pregnancy, nutritional iron deficiency anaemia (IDA) being the commonest. Underlying inflammatory conditions, physiological haemodilution and several factors affecting Hb and iron status in pregnancy lead to difficulties in establishing a definitive diagnosis. IDA is associated with increased maternal and perinatal morbidity and mortality, and long-term adverse effects in the new born. Strategies to prevent anaemia in pregnancy and its adverse effects include treatment of underlying conditions, iron and folate supplementation given weekly for all menstruating women including adolescents and daily for women during pregnancy and the post partum period, and delayed clamping of the umbilical cord at delivery. Oral iron is preferable to intravenous therapy for treatment of IDA. B12 and folate deficiencies in pregnancy are rare and may be due to inadequate dietary intake with the latter being more common. These vitamins play an important role in embryo genesis and hence any relative deficiencies may result in congenital abnormalities. Finding the underlying cause are crucial to the management of these deficiencies. Haemolytic anaemias rare also rare in pregnancy, but may have life-threatening complications if the diagnosis is not made in good time and acted upon appropriately.
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Affiliation(s)
- Malik Goonewardene
- Department of Obstetrics and Gynaecology, University of Ruhuna, Faculty of Medicine, Galle, Sri Lanka.
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Senanayake H, Goonewardene M, Ranatunga A, Hattotuwa R, Amarasekera S, Amarasinghe I. Achieving Millennium Development Goals 4 and 5 in Sri Lanka. BJOG 2011; 118 Suppl 2:78-87. [PMID: 21951505 DOI: 10.1111/j.1471-0528.2011.03115.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sri Lanka has an exemplary record in maternal and child health care. Provision of free education for over 60 years has helped to empower women. Medical care is accessible and provided free of charge. The maternal mortality ratio and the other indices of maternal and neonatal health have shown uninterrupted improvement since 1930. Midwives and the policy to increase their presence has been the key to success. Public health midwives provide care at the doorstep. Institutional midwives carry out the vast majority of deliveries, of which 99% occur in hospitals. Although on target with the Millennium Development Goals, some challenges that still remain are maternal death from postpartum haemorrhage and unsafe abortion, and perinatal deaths due to congenital abnormalities and prematurity.
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Affiliation(s)
- H Senanayake
- Faculty of Medicine, University of Colombo, Sri Lanka.
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Haththotuwa R, Goonewardene M, Desai S, Senanayake L, Tank J, Fraser IS. Management of abnormal uterine bleeding in low- and high-resource settings: consideration of cultural issues. Semin Reprod Med 2011; 29:446-58. [PMID: 22065330 DOI: 10.1055/s-0031-1287668] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
In non industrialized countries the incidence of heavy menstrual bleeding (HMB) appears to be similar to that of industrialized countries, although data is scanty. In low-resource settings, women with abnormal uterine bleeding (AUB) often delay seeking medical care because of cultural beliefs that a heavy red menstrual bleed is healthy. Efforts to modify cultural issues are being considered. A detailed history and a meticulous examination are the important foundations of a definitive diagnosis and management in low-resource settings but are subject to time constraints and skill levels of the small numbers of health professionals. Women's subjective assessment of blood loss should be combined, if possible, with a colorimetric hemoglobin assessment, if full blood count is not possible. Outpatient endometrial sampling, transvaginal sonography, and hysteroscopy are available in some non industrialized countries but not in the lowest resource settings. After exclusion of serious underlying pathology, hematinics should be commenced and antifibrinolytic or nonsteroidal anti-inflammatory drugs considered during menses to control the bleeding. Intrauterine or oral progestogens or the combined oral contraceptive are often the most cost-effective long-term medical treatments. When medical treatment is inappropriate or has failed, the surgical options available most often are myomectomy or hysterectomy. Hysteroscopic endometrial resection or newer endometrial ablation procedures are available in some centers. If hysterectomy is indicated the vaginal route is the most appropriate in most low-resource settings. In low-resource settings, lack of resources of all types can lead to empirical treatments or reliance on the unproven therapies of traditional healers. The shortage of human resources is often compounded by a limited availability of operative time. Governments and specialist medical organizations have rarely included attention to AUB and HMB in their health programs. Local guidelines and attention to training of doctors, midwives, and traditional health workers are critical for prevention and improvement in management of HMB and its consequences for iron deficiency anemia and postpartum hemorrhage, the major killer of young women in developing countries.
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Affiliation(s)
- E Chen
- School of Dentistry, The University of Western Australia, Perth, WA, Australia
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Goonewardene M. Detection of the small for gestational age fetus. Ceylon Med J 2003; 48:39-41. [PMID: 12971204 DOI: 10.4038/cmj.v48i2.3366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Malik Goonewardene
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Ruhuna
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Affiliation(s)
- Malik Goonewardene
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Ruhuna, Karapitiya, Galle.
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Abstract
RATIONALE It has been suggested that in pregnant women weekly iron supplements are as effective as daily supplements in preventing iron deficiency anaemia (IDA). OBJECTIVE To compare the effectiveness of prophylactic antenatal oral iron supplements given weekly, thrice weekly and daily in preventing IDA in pregnancy. DESIGN A randomised control trial. SETTING University antenatal clinic, (UANC) Galle. SUBJECTS AND METHOD An oral iron supplement containing 100 mg of elemental iron was randomly given weekly (n = 26) thrice weekly (n = 35) and daily (n = 31) to 92 women who were 14 to 24 weeks pregnant. Haemoglobin (Hb), serum ferritin (SF) and haematocrit (Hct) were assessed before and after 12 to 20 weeks of supplementation and a logistic regression analysis carried out. RESULTS The risk of developing anaemia was significantly higher in the weekly (odds ratio 15, 95% CI 1.4-165.6, p < 0.03) and possibly higher in the thrice weekly (odds ratio 3, 95% CI 0.3-30.3, p = 0.3) groups. The risk of developing iron deficiency (SF < 12 micrograms/l) was also significantly higher in the weekly (odds ratio 18, 95% CI 2.8-115.5, p < 0.003) and thrice weekly (odds ratio 10, 95% CI 1.6-64.8, p < 0.02) groups. CONCLUSION Prophylactic oral iron supplements when given intermittently were not effective in preventing iron deficiency anaemia in pregnancy.
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Affiliation(s)
- M Goonewardene
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Ruhuna, Galle.
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Goonewardene M, Seekkuge J, Liyanage C. Iron stores and its correlation to haemoglobin levels in pregnant women attending an antenatal clinic. Ceylon Med J 1995; 40:67-9. [PMID: 7656363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To determine the rate of iron deficiency in women coming for antenatal care and to asses whether the haemoglobin concentration is a good index in its detection. DESIGN A cross sectional cohort study. SETTING University antenatal clinic, Teaching Hospital, Galle. SUBJECTS Haemoglobin (Hb), haematocrit (HC) and serum ferritin (SF) were estimated in 236 women. RESULTS Only 7(3%) women had satisfactory iron stores as shown by SF of over 60 ng/ml. SF levels of less than 10 ng/ml indicating complete depletion of iron stores were found in 135(57%). An Hb level of 11 g/dl, which is the recommended cut off point for the diagnosis of anaemia, had a sensitivity of 63% and a negative predictive value of 41% in the detection of iron deficiency in the study population. The SF was poorly correlated to the Hb at Hb levels of more than 11 g/dl. (r2 = 0.000342, P > 0.5). CONCLUSION In women attending for antenatal care the rate of iron deficiency is high (69%). The haemoglobin concentration is not a good index to detect this.
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Affiliation(s)
- M Goonewardene
- Department of Obstetrics and Gynaecology, Faculty of Medicine Galle, University of Ruhuna, Sri Lanka
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Goonewardene M, Amaratunga K. Pure choriocarcinoma of ovary, probably non-gestational in origin. Ceylon Med J 1995; 40:49-50. [PMID: 7781102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Havas HF, Axelrod RS, Burns MM, Murasko D, Goonewardene M. Clinical results and immunologic effects of a mixed bacterial vaccine in cancer patients. Med Oncol Tumor Pharmacother 1993; 10:145-58. [PMID: 7513036 DOI: 10.1007/bf02989663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A biological response modifier, mixed bacterial vaccine (MBV), derived from Streptococcus pyogenes and Serratia marcescens was used as a single agent in the treatment of 11 patients with refractory malignancies. MBV's effect on interleukin-2 (IL-2) production, plasma interferon (IFN) and tumor necrosis factor (TNF) levels was monitored. Most patients' peripheral blood mononuclear cells continued to produce baseline to elevated levels of IL-2, in spite of age and disease status. Several patients maintained moderate to high IFN levels. In general there was little correlation between IL-2 and IFN levels or with the response to therapy. One of 11 patients had minor response, 1 of 11 had partial response, 4 of 11 had temporary stabilization of disease, and 5 of 11 had progressive disease. A patient with AIDS and Kaposi's sarcoma experienced a dramatic improvement in performance status and disease stabilization. In all patients side effects occurred only following i.v. and not i.m. administration and included fever and chills. No adverse hepatic, renal or hematologic effects were observed. MBV is a well-tolerated biological response modifier with modest activity in advanced human tumors.
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Affiliation(s)
- H F Havas
- Department of Microbiology and Immunology, Temple University School of Medicine, Philadelphia, PA 19140
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