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Liang Y, Hou X, Chen H, Yang R, Wang R, Mao R, Zhao J, Chen H, Cheng J. Assisted Reproductive Technology Outcomes in Women with Normal Ovarian Response Receiving Recombinant Luteinizing Hormone/Human Menopausal Gonadotropin: An Observational Study. Int J Womens Health 2024; 16:1103-1111. [PMID: 38895039 PMCID: PMC11185249 DOI: 10.2147/ijwh.s454410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Objective Additive human menopausal gonadotropin (HMG)/recombinant luteinizing hormone (r-LH) to follicle-stimulating hormone (FSH) can improve pregnancy outcomes in patients with poor ovarian response during assisted reproductive procedures. However, their effects on patients with normal ovarian response during such procedures are unclear, which formed the aim of this study. Methods This retrospective study enrolled 456 infertile women who underwent in vitro fertilization or intracytoplasmic sperm injection treatment. Group 1 received FSH; Group 2 received FSH+HMG/r-LH; Group 3 received FSH+HMG+r-LH. Results The age and Body Mass Index were significantly greater in Group III. The endometrial thickness was greater in Groups II and III, suggesting better endometrial receptivity. Better pregnancy and birth outcomes were seen in Group 3. In sub-cohorts of women older than 32 years old or with overweight/obesity, pregnancy and birth outcomes were also much better in Group 3, albeit without statistical significance. Conclusion The addition of both HMG and r-LH to FSH may improve the chance of infertile women with normal ovarian responses to have more success in having live birth babies, specifically in those over 32 years of age or with overweight/obese patients who typically face challenges in conceiving and sustaining a pregnancy.
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Affiliation(s)
- Yingxiu Liang
- Reproductive Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325088, People’s Republic of China
| | - Xiaohong Hou
- Reproductive Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325088, People’s Republic of China
| | - Haoying Chen
- Reproductive Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325088, People’s Republic of China
| | - Ruqing Yang
- Reproductive Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325088, People’s Republic of China
| | - Ruina Wang
- Reproductive Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325088, People’s Republic of China
| | - Ruotong Mao
- Reproductive Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325088, People’s Republic of China
| | - Junzhao Zhao
- Reproductive Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325088, People’s Republic of China
| | - Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, New South Wales, 2007, Australia
| | - Jing Cheng
- Reproductive Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, 325088, People’s Republic of China
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Tran EL, England LJ, Park Y, Denny CH, Kim SY. Systematic Review: Polysubstance Prevalence Estimates Reported during Pregnancy, US, 2009-2020. Matern Child Health J 2023; 27:426-458. [PMID: 36752906 PMCID: PMC10521102 DOI: 10.1007/s10995-023-03592-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The objective of this systematic review is to describe polysubstance studies and their prevalence estimates among pregnant people in the US. METHODS This review was not subject to protocol preparation or registration with the International Prospective Register of Systematic Reviews (PROSPERO) because outcome data were not reported. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist was followed. Four scientific literature databases were used to identify articles published from January 1, 2009 to June 3, 2020 reporting prenatal exposure to two or more substances in the US. A standardized process of title and abstract screening followed by a two-phase full-text review was used to assess study eligibility. RESULTS A total of 119 studies were included: 7 case-control studies, 7 clinical trials, 76 cohort studies, and 29 cross-sectional studies. Studies varied with respect to study design, time period, region, sampling and participant selection, substances assessed, and method of exposure ascertainment. Commonly reported polysubstance prevalence estimates among studies of pregnant people included combinations with alcohol, marijuana, and/or tobacco/nicotine. The range of prevalence estimates was wide (alcohol 1-99%; marijuana 3-95%; tobacco/nicotine 2-95%). DISCUSSION Polysubstance use during pregnancy is common, especially with alcohol, marijuana, and/or tobacco/nicotine. Future research to assess polysubstance use during pregnancy could help better describe patterns and ultimately help mitigate its effects on maternal and infant health outcomes.
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Affiliation(s)
- Emmy L Tran
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA.
- Eagle Global Scientific, LLC, 2835 Brandywine Rd, Suite 200, Atlanta, GA, 30341, USA.
| | - Lucinda J England
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
| | - Youngjoo Park
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Clark H Denny
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
| | - Shin Y Kim
- Division of Birth Defects and Infant Disorders, National Center On Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, NE MS S106-3, Atlanta, GA, 30341, USA
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Rafati S, Baniasadi T, Dastyar N, Zoghi G, Ahmadidarrehsima S, Salari N, Rafati F. Prevalence of self-medication among the elderly: A systematic review and meta-analysis. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:67. [PMID: 37113410 PMCID: PMC10127510 DOI: 10.4103/jehp.jehp_630_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/14/2022] [Indexed: 06/19/2023]
Abstract
BACKGROUND Self-medication is the use of unprescribed drugs to treat a disease. Elderly self-medication can be more dangerous compared to other age groups because of changes in organ functions that occur due to senescence. This study aimed to estimate the prevalence of self-medication in the elderly, its related factors, and common drugs used in this regard. MATERIALS AND METHODS Electronic databases such as PubMed, Scopus, and Web of Science were searched between January 2016 and June 2021. The search strategy was built on two core concepts: "self-medication" and "aged". The search was limited to original articles in the English language. A random effect model was used to estimate the pooled prevalence of self-medication. Heterogeneity among studies was assessed using both the I2 statistic and the χ 2 test. Also, a meta-regression model was used to investigate the potential sources of heterogeneity of the studies. RESULTS Out of 520 non-duplicate studies, 38 were included in the meta-analysis. Self-medication in the elderly ranged from 0.3% to 82%. The pooled proportion of self-medication was 36% (95% CI: 27%-45%). The result of the χ 2 test and the I2 index (P < 0.001, I2= 99.90%) revealed notable heterogeneity among the included studies in the meta-analysis. The meta-regression showed a significant association between the sample size (adjusted β = -0.01; P = 0.043) and the pooled proportion of self-medication. CONCLUSION The prevalence of self-medication in the elderly is high. Education through mass media to raise awareness about the dangers of self-medication can help solve this problem.
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Affiliation(s)
- Shideh Rafati
- Social Factors in Health Promotion Research Center, Hormozgan Health Research Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Tayebeh Baniasadi
- Department of Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Neda Dastyar
- Department of Midwifery, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Ghazal Zoghi
- Endocrinology and Metabolism Research Center, Hormozgan Univesity of Medical Sciences, Bandar Abbas, Iran
| | - Sudabeh Ahmadidarrehsima
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Nasibeh Salari
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Foozieh Rafati
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
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Jiang K, Feng J, Qi X, Ran L, Xie L. Antiviral Activity of Oridonin Against Herpes Simplex Virus Type 1. Drug Des Devel Ther 2022; 16:4311-4323. [PMID: 36573068 PMCID: PMC9789684 DOI: 10.2147/dddt.s387885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose In search of new potent treatment of herpes simplex keratitis (HSK), inhibitory effect of oridonin (Ori) on herpes simplex virus type 1 (HSV-1) was validated by experiments. Methods For evaluating inhibitory effect of oridonin on herpes simplex virus type 1, a series of in-vivo and in-vitro studies were carried out. Mouse HSV-1 infection model was used in the in-vivo experiments. Experimental mice were classified in five different groups: Mock (mock-infected), HSV-1+ DMSO, HSV-1+ Ori, HSV-1+ ACV, combined Ori and ACV+HSV-1. Corneas of Mock, HSV-1+ DMSO, HSV-1+ Ori group were sent for mRNA-sequencing after 3 days post infection (dpi). The expression of virus and host-related genes was evaluated by quantitative real-time polymerase chain reaction (qPCR). Vero cells HSV-1 infection models were used in the in-vitro experiments. Results The application of ACV, Oridonin alone or a combination of both could alleviate HSV-1 severity and inhibit HSV-1 virus replication in C57BL/6 mice models. qPCR showed that compared with mock group, the expression of interleukin-6 (il-6), interleukin-1α (il-1α), and Tumor-necrosis factor-alpha (tnf-α) was up-regulated in DMSO+HSV-1 group and suppressed in other three group. Moreover, the expression of nod-like receptor protein (nlrp3), caspase 1 and interleukin-1β (il-1β) were depressed in the oridonin-treated group. Oridonin significantly inhibits HSV-1 replication, HSV-1 related gene expression, and the production of progeny HSV-1 viruses in vitro. Besides, oridonin affect the replication phase but not HSV-1 entry or penetration and cannot inactivate HSV-1. Conclusion Oridonin alleviates herpes simplex keratitis infection in mouse, which may be attributed to inhibition of the NLRP3-inflammasome-IL-1β pathway. Our study illustrates that Oridonin has potential promise for application in treating HSK and other diseases caused by HSV-1 infection.
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Affiliation(s)
- Kai Jiang
- Department of Ophthalmology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China,Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University, Qingdao, People’s Republic of China
| | - Jing Feng
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University, Qingdao, People’s Republic of China
| | - Xia Qi
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University, Qingdao, People’s Republic of China
| | - Lili Ran
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University, Qingdao, People’s Republic of China
| | - Lixin Xie
- Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University, Qingdao, People’s Republic of China,Correspondence: Lixin Xie, Shandong Eye Institute, 5 Yan’erdao Road, Qingdao, 266071, Tel +8613335026472, Email
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Yousefian S, Abbasabadi-Arab M, Saberian P, Kolivand P, Mobini A, Amin SM, Sahebi A. Risk Assessment of Arbaeen Mass Gathering in the Covid-19 Pandemic. DIALOGUES IN HEALTH 2022; 1:100061. [PMID: 36785640 PMCID: PMC9613783 DOI: 10.1016/j.dialog.2022.100061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/25/2022]
Abstract
Introduction Arbaeen is a religious ceremony held annually with the participation of a large number of pilgrims. During the pandemic of Covid-19, a mass gathering of Arbaeen pilgrims can strengthen the transmission of this disease and put more pressure on the health care system of countries. The aim of the study is to evaluate the risk of Arbaeen ceremony in the Covid-19 pandemic in 2021. Materials and methods A mixed method was performed to perform the study using qualitative and quantitative methods. A national risk assessment tool was used that consisted of hazard identification and assessment, scenario development, exposure assessment, vulnerability assessment and risk estimation. The national risk assessment tool was completed through a focused group discussion and the opinions of 20 representatives of the health system and the level of risks were estimated. Data were collected, analyzed, and integrated by the research team. Results Based on the results of risk matrix analysis, factors such as the increase in the number of new cases of COVID-19, the probability of exposure to a new variant of COVID-19, the probability of arrival of a new variant of COVID-19 to the country, the probability of increasing referrals to healthcare facilities (score 16), the probability of getting respiratory diseases, and the environmental contamination (score 12) occupied the red area of the matrix and were found to have the highest risk (unbearable risk), that needs immediate action. Conclusion Preparing for a mass gathering such as Arbaeen is very important in order to reduce the risk of communicable disease, and the first step in improving preparedness is risk assessment and its continuity in the various stages of the ceremony. Therefore, policy makers and planners of such events should conduct risk assessments with the participation of local and national public health authorities regularly.
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Affiliation(s)
- Shiva Yousefian
- National Medical Emergency Organization, Ministry of Health & Medical Education, Tehran, Iran
| | - Masoumeh Abbasabadi-Arab
- National Medical Emergency Organization, Ministry of Health & Medical Education, Tehran, Iran,Corresponding author
| | - Peyman Saberian
- National Medical Emergency Organization, Ministry of Health & Medical Education, Tehran, Iran
| | - Pirhossein Kolivand
- National Medical Emergency Organization, Ministry of Health & Medical Education, Tehran, Iran
| | - Atieh Mobini
- National Medical Emergency Organization, Ministry of Health & Medical Education, Tehran, Iran
| | - Sara Mehran Amin
- National Medical Emergency Organization, Ministry of Health & Medical Education, Tehran, Iran
| | - Ali Sahebi
- Clinical Research Development Unit, Shahid Mostafa Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
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Liu Z, Huang J, Jiang Q, Li X, Tang X, Chen S, Jiang L, Fu G, Liu S. miR-125a attenuates the malignant biological behaviors of cervical squamous cell carcinoma cells through Rad51. Bioengineered 2022; 13:8503-8514. [PMID: 35332852 PMCID: PMC9161904 DOI: 10.1080/21655979.2022.2051827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 11/02/2022] Open
Abstract
Cervical squamous cell carcinoma (CSCC), the most common cervical malignancy, is more likely to invade and metastasize than other cervical cancers. miR-125a, a tumor suppressor gene, has been confirmed to be associated with cancer metastasis. However, the role of miR-125a in CSCC and the underlying mechanism are unknown. miR-125a expression was confirmed by real-time quantitative PCR (RT-qPCR), and the Rad51 expression level was measured by western blotting analysis. CSCC cell proliferation, migration and invasion were assessed with functional assays, including CCK-8, colony formation, wound healing and Transwell assays. Our data confirmed that miR-125a is expressed at low levels in CSCC tissues and cells. Functionally, the overexpression of miR-125a greatly prevented the proliferation, migration and invasion of CSCC cells, and the inhibition of miR-125a expression strongly enhanced these behaviors in CSCC cells. Moreover, the expression of Rad51, a miR-125a target gene, greatly reversed the miR-125-mediated inhibition of CSCC cell proliferation, migration and invasion. In addition, we discovered that miR-125a downregulated the levels of phosphorylated PI3K, AKT and mTOR through Rad51 in CSCC cells. miR-125a, a tumor suppressor, can attenuate the malignant behaviors of CSCC cells by targeting Rad51. Therefore, the miR-125a/Rad51 axis might be a target for CSCC therapy.
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Affiliation(s)
- Zeping Liu
- Department of Pathology, The Second Hospital of Longyan, Longyan, China
| | - Jinchang Huang
- Department of Pathology, Ganzhou People’s Hospital, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
| | - Qiuju Jiang
- Department of Pathology, The Second Hospital of Longyan, Longyan, China
| | - Xiaoling Li
- Department of Pathology, The Second Hospital of Longyan, Longyan, China
| | - Xiaohui Tang
- Department of Pathology, The Second Hospital of Longyan, Longyan, China
| | - Shasha Chen
- Department of Pathology, The Second Hospital of Longyan, Longyan, China
| | - Liling Jiang
- Department of Gynaecology and Obstetrics, The Second Hospital of Longyan, Longyan, China
| | - Genghua Fu
- Department of Gynaecology and Obstetrics, The Second Hospital of Longyan, Longyan, China
| | - Sijun Liu
- Department of Pathology, The First Affiliated Hospital of Gannan Medical University, Gannan, China
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Mehrabian A, Vakili-Ghartavol R, Mashreghi M, Shokooh Saremi S, Badiee A, Arabi L, Alavizadeh SH, Moosavian SA, Jaafari MR. Preparation, characterization, and biodistribution of glutathione PEGylated nanoliposomal doxorubicin for brain drug delivery with a post-insertion approach. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2022; 25:302-312. [PMID: 35656188 PMCID: PMC9148397 DOI: 10.22038/ijbms.2022.60306.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/23/2022] [Indexed: 11/06/2022]
Abstract
Objectives Brain cancer treatments have mainly failed due to their inability to cross the blood-brain barrier. Several studies have confirmed the presence of glutathione (GSH) receptors on BBB's surface, as a result, products like 2B3-101, which contain over 5% pre-inserted GSH PEGylated liposomal doxorubicin, are being tested in clinical trials. Here we conducted the PEGylated nanoliposomal doxorubicin particles that are covalently attached to the glutathione using the post-insertion technique. Compared with the pre-insertion approach, the post-insertion method is notably simpler, faster, and more cost-effective, making it ideal for large-scale pharmaceutical manufacturing. Materials and Methods The ligands of the DSPE PEG(2000) Maleimide-GSH were introduced in the amounts of 25, 50, 100, 200, and 400 on the available Caelyx. Following physicochemical evaluations, animal experiments such as biodistribution, fluorescence microscopy, and pharmacokinetics were done. Results In comparison with Caelyx, the 200L and 400L treatment arms were the most promising formulations. We showed that nanocarriers containing 40 times fewer GSH micelles than 2B3-101 significantly increased blood-brain barrier penetrance. Due to the expressed GSH receptors on tissues as an endogenous antioxidant, doxorubicin will likely concentrate in the liver, spleen, heart, and lung in comparison with Caelyx, according to other tissue analyses. Conclusion The post-insertion technique was found a successful approach with more pharmaceutical aspects for large-scale production. Moreover, further investigations are highly recommended to determine the efficacy of 5% post-inserted GSH targeted nanoliposomes versus 2B3-101 as a similar formulation with a different preparation method.
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Affiliation(s)
- Amin Mehrabian
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran, Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran, Warwick Medical School, University of Warwick, Coventry, UK
| | - Roghayyeh Vakili-Ghartavol
- Department of Medical Nanotechnology, Shiraz University of Medical Sciences, Shiraz, Iran, Biosun Pharmed Pharmaceuticals Company, Tehran, Iran
| | - Mohammad Mashreghi
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran, Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Shokooh Saremi
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran, Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Badiee
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran, Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Arabi
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran, Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Hoda Alavizadeh
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran, Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Alia Moosavian
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran, Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran,Corresponding authors: Mahmoud Reza Jaafari. Nanotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran; Tel.:+98-51-38823255; Fax: +98-51-38823251; ; Seyedeh Alia Moosavian. Nanotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mahmoud Reza Jaafari
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran, Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran, Biotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran,Corresponding authors: Mahmoud Reza Jaafari. Nanotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran; Tel.:+98-51-38823255; Fax: +98-51-38823251; ; Seyedeh Alia Moosavian. Nanotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Reno JL, Kushelev M, Coffman JH, Prasad MR, Meyer AM, Carpenter KM, Palettas MS, Coffman JC. Post-Cesarean Delivery Analgesic Outcomes in Patients Maintained on Methadone and Buprenorphine: A Retrospective Investigation. J Pain Res 2021; 13:3513-3524. [PMID: 33408510 PMCID: PMC7779306 DOI: 10.2147/jpr.s284874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/03/2020] [Indexed: 12/30/2022] Open
Abstract
Background Despite the increasing prevalence of opioid use disorder (OUD) in pregnant women, there are limited studies on their anesthesia care and analgesic outcomes after cesarean delivery (CD). Methods Patients with OUD on either buprenorphine or methadone maintenance therapy who underwent CD at our institution from 2011 to 2018 were identified. Anesthetic details and analgesic outcomes, including daily opioid consumption and pain scores, were compared between patients maintained on buprenorphine and methadone. Analgesic outcomes were also evaluated according to anesthetic type (neuraxial or general anesthesia) and daily buprenorphine/methadone dose to determine if these factors impacted pain after delivery. Results A total of 146 patients were included (buprenorphine n=99 (67.8%), methadone n=47 (32.2%)). Among all patients: 74% had spinal/CSE, 15% epidural, and 11% general anesthesia. Anesthesia types were similar among buprenorphine and methadone patients. For spinal anesthetics, intrathecal fentanyl (median 15 µg) and morphine (median 100 µg) were commonly given (97.2% and 96.3%, respectively), and dosed similarly between groups. Among epidural anesthetics, epidural morphine (median 2 mg) was commonly administered (90.9%), while fentanyl (median 100 µg) was less common (54.5%). Buprenorphine and methadone groups consumed similar amounts of oxycodone equivalents per 24 hours of hospitalization (80.6 vs 76.3 mg; p=0.694) and had similar peak pain scores (8.3 vs 8.0; p=0.518). Daily methadone dose correlated weakly with opioid consumption (R=0.3; p=0.03), although buprenorphine dose did not correlate with opioid consumption or pain scores. General anesthesia correlated with greater oxycodone consumption in the first 24 hours (median 156.1 vs 91.7 mg; p=0.004) and greater IV PCA use (63% vs 7%; p<0.001) compared to neuraxial anesthesia. Conclusion Patients on buprenorphine and methadone had similar high opioid consumption and pain scores after CD. The anesthetic details and analgesic outcomes reported in this investigation may serve as a useful reference for future prospective investigations and aid in the clinical care of these patients.
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Affiliation(s)
- Joseph L Reno
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Michael Kushelev
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Julie H Coffman
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH, USA
| | | | - Avery M Meyer
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kristen M Carpenter
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - John C Coffman
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, OH, USA
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Stanislaus MA, Reno JL, Small RH, Coffman JH, Prasad M, Meyer AM, Carpenter KM, Coffman JC. Continuous Epidural Hydromorphone Infusion for Post-Cesarean Delivery Analgesia in a Patient on Methadone Maintenance Therapy: A Case Report. J Pain Res 2020; 13:837-842. [PMID: 32425588 PMCID: PMC7196209 DOI: 10.2147/jpr.s242271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/17/2020] [Indexed: 12/03/2022] Open
Abstract
The prevalence of opioid use disorder (OUD) in the United States has more than quadrupled over the past two decades. This patient population presents a number of challenges to clinicians, including difficult pain management after surgical procedures due to the development of opioid tolerance. Significantly greater opioid consumption and pain scores after cesarean delivery have been reported in patients with OUD compared to other obstetric patients. A multi-modal analgesic regimen is generally recommended, but there are few well-established pain management strategies after cesarean delivery specific to patients with OUD. We present the case of a patient with OUD maintained on daily methadone that received a continuous epidural hydromorphone infusion for post-cesarean analgesia, a technique not previously reported in obstetric patients and only rarely described for patients undergoing other surgical procedures. The patient received epidural anesthesia for cesarean delivery, and after surgery, the epidural catheter was left in place for the epidural hydromorphone infusion, initiated at 140 mcg/hr and continued for approximately 40 hrs. This strategy reduced her average daily oral opioid consumption by 97%, reduced self-reported pain scores, shortened the length of hospitalization and improved ability to ambulate compared to her previous cesarean delivery. The use of continuous epidural hydromorphone infusion was effective in this case, and this analgesic technique may also be applicable to other types of surgical procedures with the potential for significant post-operative pain, particularly in patients with OUD.
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Affiliation(s)
- Mellany A Stanislaus
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joseph L Reno
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Robert H Small
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie H Coffman
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH, USA
| | - Mona Prasad
- Department of OBGYN, Riverside Methodist Hospital, Columbus, OH, USA
| | - Avery M Meyer
- Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kristen M Carpenter
- Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John C Coffman
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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10
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Nilipour Y. The Art of Muscle Biopsy in the New Genetic Era: A Narrative Review. IRANIAN JOURNAL OF CHILD NEUROLOGY 2019; 13:7-17. [PMID: 31645863 PMCID: PMC6789082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 11/04/2022]
Abstract
Muscle biopsy has been practiced as a well-established part of paraclinical workup in patients with neuromuscular diseases since late 1960s. In this narrative review paper, the role of some pre and post muscle biopsy factors and their importance in achieving the best diagnostic results will be explained. Considering the new advances in diagnostic molecular techniques and the availability of local standard myopathology laboratory as well as the presence of a dedicated myopathologist, the indications of muscle biopsy in four major types of neuromuscular diseases will be shortly reviewed. Moreover, indications of muscle biopsy in four major types of neuromuscular diseases will be shortly discussed based on literature review of recent published diagnostic algorithms and our 11 years' experience of performing about 4000 muscle biopsies cases in the only standard referral diagnostic center for muscle biopsy in Iran. Although diagnostic algorithms of some muscle diseases have been changed based on recent advances in biochemical and molecular diagnostic techniques, still muscle biopsy continues to play a major role in the diagnosis and management of variety of neuromuscular disorders and has proved to be a preferable diagnostic procedure by some neuromuscular specialists for the cases who can benefit from rapid therapeutic management. The application of diagnostic algorithms should be practiced in accordance with geographic distribution of the diseases, the availability of diagnostic techniques and the presence of specialists in each center considering the local insurance coverage and the cost to be paid by the patient in every center.
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Affiliation(s)
- Yalda Nilipour
- Pediatric Pathology Research Center, Research Institute for Children's Health, Mofid Children Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Mofid Children Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
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