Achieving Millennium Development Goals 4 and 5 in Pakistan

Pakistan is a signatory of many international development strategies including the Millennium Development Goals, and the government is committed to achieving a reduction in infant mortality rate from 72 to <55 per 1000 live births, the newborn mortality rate from 55 to <40 per 1000 live births and the maternal mortality rate from 276 per 100,000 to 140 per 100,000 live births by 2015. Maternal, newborn and child health play a key role in reducing poverty and promoting social and economic development. Improvement in maternal and child health is a priority agenda of the Government of Pakistan.

Calcium and magnesium infusions for prevention of oxaliplatin-induced peripheral neuropathy

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Background: Oxaliplatin plays an important role in chemotherapy regimens for colorectal and other GI malignancies. Debilitating peripheral neuropathy (PN) often develops with use of this drug. One study (Grothey A et al, ASCO 2009, abst #4025) has shown that pre- and post-oxaliplatin infusions with calcium (Ca) and magnesium (Mg) may reduce this toxicity. To confirm this in an unselected indigent minority population, a retrospective review was performed comparing development of PN in oxaliplatin exposed patients treated with or without Ca/Mg.

Methods: Records of patients who received oxaliplatin from 1/2008 to 12/2009 at MetroHealth Medical Center, a large safety net hospital in Cleveland, OH, were reviewed. 47 patients received Ca/Mg + oxaliplatin and 46 oxaliplatin alone. Data collected included age, race, gender, insurance status, performance status, tumor type, stage, concomitant diseases (DM and EtOH), number of cycles and cumulative dose of oxaliplatin. PN was determined using the Common Terminology Criteria of Adverse Events (CTCAE) version 3.0. Patients were followed 6 months after completion of oxaliplatin.

Results: Demographic data was similar between the two groups. Colorectal cancer compromised 77% of the treatment group and 85% of control group. Patients who received Ca/Mg had significantly less PN in all three grades (1-3) compared with the control group (grade 1 89.4% vs. 71.7%, grade II 10.6% vs. 19.6%, grade 3 0% vs. 8.7%, respectively). The cumulative dose of oxaliplatin did not differ between the two groups (Ca/Mg median 1,143 range 260-2,169; control median 1,425 range 137-2,635). The combined total grades 2 and 3 in both the treatment and control (10.6% vs. 28.3%, p = 0.038) favored use of Ca/Mg.

Conclusions: This small, retrospective study confirms that Ca/Mg infusions reduce the incidence of clinically significant (grade 2/3) PN in pts receiving oxaliplatin.

No significant financial relationships to disclose.

Maternal and perinatal complications in multiple versus singleton pregnancies: a prospective two years study

OBJECTIVE

To test the hypothesis that women with multiple gestations are at increased risk of adverse maternal and perinatal outcomes when compared with singletons.

DESIGN

From January 1999 to December 2000, all multiple pregnancies delivering > 28 weeks gestation in the labour ward of Mother and Child Health (MCH) Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, were taken as cases. Singleton pregnancy > or = 28 weeks gestation period delivered immediately after each case was chosen as control. Prenatal complications, gestation at delivery, mode of delivery, birth weight and perinatal morbidity and mortality of the two groups were compared.

RESULTS

There were 6831 deliveries including 120 twins and 2 triplets. The data of the two triplets are presented separately and further comparison is between 120 twins and singleton controls. Pretem labour was the commonest prenatal complication in twin pregnancies (21 vs 62) followed by anaemia (11 Vs 39). The mean gestational age of singletons was 38.3 weeks compared to 35.9 weeks for twins. The mean birth weight of singletons was 2.9 kg vs 2.1 kg for twins. Six (4.9%) singletons and 46 (19.2%) twins had caesarean section. Thirty one (13%) of the twins and I (1.6%) singleton had vaginal breech delivery. Five (4%) singleton infants and 40 (17%) twins required admission. Ten singletons and 26 twins died perinatally resulting in a PNMR/1000 births of 82 and 108 respectively.

CONCLUSION

Women with multiple gestations are at a higher risk of antepartum and intrapartum complications and their infants require special care. There is need to identify these cases early in order to provide good prenatal care and deliver them in hospitals with facilities for neonatal and maternal intensive care.

A controlled assessment of the in vitro fertilization performance of British women of Indian origin compared with white women

OBJECTIVE

To compare the reproductive performance of Indian versus white women in IVF.

DESIGN

Controlled comparative clinical study.

SETTING

In vitro fertilization center based in university department in large tertiary level hospital.

PATIENTS

Results from first IVF treatment cycles in 44 Indian patients were compared with results from 88 white patients, matched by age and body mass index, over the same treatment year. The patients were selected from a prospectively collected IVF databank.

INTERVENTIONS

Standard luteal-phase start long GnRH analogue regime. Ovarian stimulation with FSH and hMG. Transvaginal ultrasound-guided oocyte recovery. In vitro fertilization and ET following established protocols.

MAIN OUTCOME MEASURES

Rates of abandoned cycles, egg retrievals, ETs, clinical pregnancies, miscarriages, and live births were compared in the first IVF treatment cycle. Cumulative pregnancy rates (PRs) over three cycles in the two groups of patients were also compared.

RESULTS

More cycles were abandoned in the Indian than in the white group: 22.7% versus 9.1%. The Indian live birth rate per cycle was worse: 9.1% versus 22.7%. The performance of the two groups was otherwise similar: ovarian stimulation with hMG and FSH required 26.0 required 26.0 ampules in the Indian group versus 24.6 ampules in the white group, mean number of follicles on the day of egg retrieval 8.7 versus 8.7, mean number of eggs 5.9 versus 5.8, fertilization rate 82.4% versus 82.5%; ET rate 73.5% versus 82.5, mean number of embryos transferred 2.1 versus 1.8, and clinical PR per cycle started 18.2% versus 27.3%.

CONCLUSIONS

Under the same IVF regime, Indians performed worse than whites at the stage of ovarian stimulation (higher rate of abandoned cycles for poor response) and in live birth rate. Cumulative conception and live birth rates also tended to be worse in Indians than in whites.