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In this study, we sought to demonstrate the benefit of postpartum hemorrhage prophylaxis treatment and the superiority of methylergonovine-oxytocin combination over oxytocin in terms of hemodynamic stability and amount of bleeding during cesarean section. In this retrospective study, 400 patients who had a cesarean section in the same clinic were divided into two groups and included in this study. The first group consisted of nulliparous patients (n=141) who gave birth by cesarean for the first time and the second group consisted of multipar patients (n=259) who gave birth by cesarean section before. Then both main groups; women who received only oxytocin infusion in the intraoperative and postoperative periods were divided into (monotherapy group), women who received methylergonovine and oxytocin therapy in the intraoperative and postoperative periods were divided into 2 more subgroups (combined group). For comparison, samples for preoperative and postoperative complete blood counts were obtained from all patients in each group. When the postoperative Hb levels of nulliparous pregnant women were compared, it was seen that the decrease in Hb levels was less in the group that received methylergonovine in addition to oxytocin (p=0.031). Similarly, Hb decrease was observed less in the group given methylergonovine in addition to oxytocin in multiparous pregnant women (p=0.045). The group that received methylergonovine in addition to oxytocin provided more hemodynamic stability in both the nulliparous and multiparous cesarean section groups, which we divided according to the number of cesarean sections, compared to the group that received oxytocin; significantly reduced the level of bleeding. We think that this form of treatment will also reduce the risk of uterine atony; therefore (if there is no coronary disease) we recommend it to be used under spinal anaesthesia. [Med-Science 2022; 11(4.000): 1608-12]

In this study, we sought to demonstrate the benefit of postpartum hemorrhage prophylaxis treatment and the superiority of methylergonovine-oxytocin combination over oxytocin in terms of hemodynamic stability and amount of bleeding during cesarean section. In this retrospective study, 400 patients who had a cesarean section in the same clinic were divided into two groups and included in this study. The first group consisted of nulliparous patients (n=141) who gave birth by cesarean for the first time and the second group consisted of multipar patients (n=259) who gave birth by cesarean section before. Then both main groups; women who received only oxytocin infusion in the intraoperative and postoperative periods were divided into (monotherapy group), women who received methylergonovine and oxytocin therapy in the intraoperative and postoperative periods were divided into 2 more subgroups (combined group). For comparison, samples for preoperative and postoperative complete blood counts were obtained from all patients in each group. When the postoperative Hb levels of nulliparous pregnant women were compared, it was seen that the decrease in Hb levels was less in the group that received methylergonovine in addition to oxytocin (p=0.031). Similarly, Hb decrease was observed less in the group given methylergonovine in addition to oxytocin in multiparous pregnant women (p=0.045). The group that received methylergonovine in addition to oxytocin provided more hemodynamic stability in both the nulliparous and multiparous cesarean section groups, which we divided according to the number of cesarean sections, compared to the group that received oxytocin; significantly reduced the level of bleeding. We think that this form of treatment will also reduce the risk of uterine atony; therefore (if there is no coronary disease) we recommend it to be used under spinal anaesthesia. [ABSTRACT FROM AUTHOR]

The study intends to repurpose FDA drugs and investigate the mechanism of (5HT 2B R) activation by comprehending inter-residue interactions. The 5HT 2B R is a novel thread, and its role in reducing seizures in Dravet syndrome is emerging. The crystal structure (5HT 2B R) is a chimera with mutations; hence 3D-structure is modeled (4IB4: 5HT 2B R M ). The structure is cross-validated to simulate the human receptor using enrichment analysis (ROC: 0.79) and SAVESv6.0. Virtual screening of 2456 approved drugs yielded the best hits that are subjected to MM/GBSA and molecular dynamic (MD) simulations. The 2 top drugs Cabergoline (-53.44 kcal/mol) and Methylergonovine (-40.42 kcal/mol), display strong binding affinity, and ADMET/SAR analysis also suggests their non-mutagenic or non-carcinogenic nature. Methylergonovine has a weaker binding affinity and lower potency than standards [Ergotamine (agonist) and Methysergide (antagonist)] due to its higher K i (1.32 M) and K d (6.44 ×10 -8 M) values. Compared to standards, Cabergoline has moderate binding affinity and potency [K i = 0.85 M and K d = 5.53 × 10-8 M]. The top 2 drugs primarily interact with conserved residues (ASP135, LEU209, GLY221, ALA225, and THR140) as in agonists, unlike the antagonist. The top 2 drugs, upon binding to the 5HT 2B R M, modify the helices VI, V, and III and shift the RMSD 2.48 Å and 3.07 Å. LEU209 forms a latch with residues 207-214 (forms a lid) in the 5HT 2B R M receptor, which enhances agonist binding and prevents drug escape. Methylergonovine and Cabergoline interact more stongly with ALA225 than the antagonist. The post-MD analysis of Cabergoline suggests a better MM/GBSA value (-89.21 kcal/mol) than Methylergonovine (-63.54 kcal/mol). In this study, Cabergoline and Methylergonovine's agonistic mechanism and solid binding properties suggest their strong role in regulating the 5HT 2B R and might target drug-resistant epilepsy., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Vasospastic angina is an infrequent underlying cause of angina and is under-diagnosed. Ergonovine provocation tests can be performed via intravenous or intracoronary injections. Although the safety profile of intracoronary injection has been well documented, no study has yet compared the intracoronary and intravenous injections regarding the positivity rate of the test., Aims: This study sought to compare the positivity rate of intravenous versus intracoronary injection of ergonovine in the diagnosis of vasospastic angina., Methods: Between January 2010 and February 2018, 427 patients with suspected vasospastic angina underwent an ergonovine provocation test in 2 tertiary hospitals in France and were retrospectively included in this study. Injection was performed via the intravenous or the intracoronary route. The primary endpoint was the positivity rate of the test. Propensity score matching was used to account for confounding factors., Results: 427 patients were included in the study. Mean age was 60.3 (+/- 12.4) years. There were 247 (58%) females and 97 (23%) smokers. The intracoronary route was used in 199 (47%) patients. The indication for the test was acute coronary syndrome for 121 (28%). No rhythmic complications or deaths were reported. After propensity-matching, the baseline characteristics of the 2 groups (148 patients in each) were comparable. The positivity rate was 24% in the intracoronary group and 9% in the intravenous group (OR [95%CI]: 3.2 [1.6, 6.4])., Conclusions: Intracoronary injection of ergonovine is safe and associated with a positivity rate of the test three times higher compared to intravenous injection., Competing Interests: Disclosures The authors have no conflicts of interest to declare, (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)