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Sikora M, Gamper M, Zivanovic I, Münst J, Bischofberger H, Kociszewski J, Viereck V. Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy-An Update. J Clin Med 2024; 13:1377. [PMID: 38592248 PMCID: PMC10932143 DOI: 10.3390/jcm13051377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/15/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using the keywords "incontinence" and "bulking" or "laser". Although the two approaches are less effective than sling insertions, there are specific conditions in which one or the other technique is more advantageous. Injecting bulking agents into the urethra only takes some minutes and works without general anesthesia. The method is particularly suited for elderly, frail, or obese patients with multiple comorbidities, but is also applicable for all patients and in combination with other therapies. Generally, the safety profile is good but differs between bulking materials. Two laser types-the Erbium:YAG laser with SMOOTH-mode and the fractional ablative CO2 laser-deliver heat into the tissue to induce tissue tightening and regeneration. Intravaginal laser therapy improves mild to moderate SUI, while studies describe how intraurethral laser therapy is also beneficial for severe SUI. Young women between childbirths, as well as postmenopausal women, may benefit from laser therapy. The method is safe, can be performed on an outpatient basis, and does not require any artificial material.
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Affiliation(s)
- Michal Sikora
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Marianne Gamper
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Irena Zivanovic
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Julia Münst
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Helena Bischofberger
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Jacek Kociszewski
- Department of Gynecology and Obstetrics, Evangelisches Krankenhaus Hagen-Haspe, 58135 Hagen, Germany;
| | - Volker Viereck
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
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Nakib N, Sutherland S, Hallman K, Mianulli M, R Boulware D. Randomized trial of mechanotherapy for the treatment of stress urinary incontinence in women. Ther Adv Urol 2024; 16:17562872241228023. [PMID: 38328552 PMCID: PMC10848796 DOI: 10.1177/17562872241228023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/05/2023] [Indexed: 02/09/2024] Open
Abstract
Background Stress urinary incontinence (SUI) presents as unintentional urine leakage associated with activities. It significantly affects quality of life (QoL) and is the most common type of incontinence in women. Current treatment options, particularly non-surgical therapies, are lacking. Objective To assess the efficacy of mechanotherapy provided by the Flyte® intra-vaginal device during pelvic floor muscle training (PFMT). Design This was a randomized, controlled, double-blinded trial. Materials and methods Flyte is a repeat use device for conditioning and strengthening the pelvic floor muscles (PFMs). It provides two-part mechanotherapy. Part 1 is the stretching and preloading of the PFM from the internal wand. Part 2 integrates mechanical pulses which elicit muscle cellular and tissue level responses that trigger cellular regeneration, improve neuromuscular facilitation and motor learning. Subjects used the device for 5 min/day for 12 weeks. Subjects (144) were randomized and evaluated at 6 and 12 weeks. Arm A (72) received both Part 1 and Part 2 mechanotherapy for 12 weeks, whereas Arm B (72) received Part 1 therapy for 6 weeks, then crossed over to full therapy. Mean age was 50, 49, respectively, prior pelvic/abdominal surgery 26%, 46%, and previous incontinence treatments 13%, 22%. The primary endpoint was 24-h pad weight (24-HR PW) at 6 weeks. Secondary endpoints were 24-HR PW at 12 weeks and QoL [International Consultation on Incontinence Questionnaire (ICIQ), Urinary Incontinence Quality of Life (IQOL)]. Results Part 1 therapy had a greater than anticipated therapeutic effect. Thus, the study was underpowered to identify differences between study arms. Therefore, data were pooled to assess the effects of mechanotherapy. Twenty four-HR PW was significantly reduced at 6 weeks (p = <0.0001), with further reduction from 6 to 12 weeks (p = <0.0001). Data were stratified based on 24-HR PW severity. Significant reductions were noted in all severity groups (mild p = <0.0001, moderate p = <0.0001, severe p = <0.01). QoL was similarly improved at 6 weeks (ICIQ p = <0.0001, IQOL p = <0.0001), and 12 weeks (ICIQ p = <0.0001, IQOL p = <0.0001). Compliance was >80% at 6 weeks and 70% at 12 weeks. Conclusion Two-part mechanotherapy significantly improved 24-HR PW and QoL across all severities of SUI. Improvements were noted in as little as 2 weeks and appeared to be sustained through 2-year follow up. Trial registration Registered on ClinTrials.gov (NCT02954042).
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Affiliation(s)
- Nissrine Nakib
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Marcus Mianulli
- Gnarus Medical Consulting Inc., 18615 27th Avenue North, Plymouth, MN 55447, USA
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
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Avlani D, Kumar A, H N S. Development of Dispersible Vaginal Tablets of Tenofovir Loaded Mucoadhesive Chitosan Microparticles for Anti-HIV Pre-Exposure Prophylaxis. Mol Pharm 2023; 20:5006-5018. [PMID: 37656937 DOI: 10.1021/acs.molpharmaceut.3c00288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Tenofovir disoproxil fumarate (TDF)-loaded bioadhesive chitosan microparticles (CM) were developed by an emulsification internal gelation technique. Among different batches produced, ECH-4 was found to display a high % entrapment efficiency (68.93 ± 1.76%) and sustained drug release of 88.05 ± 0.38% at 24 h. Solid state characterization of ECH-4 employing DSC and PXRD indicated that the TDF existed in an amorphous state as a solid-solid solution in chitosan. Scanning electron microscopy revealed CM of ECH-4 was spherical in shape with a rough surface topography. Laser scattering analysis using Malvern Master sizer indicated that particle size of ECH-4 was in the range of 0.52 ± 0.10 μm to 284.79 ± 21.42 μm with a surface-mean diameter of 12.41 ± 0.06 μm. Ex vivo mucoadhesion studies using rabbit mucosa as a substrate indicated that 10.34 ± 2.08% of CM of ECH-4 was retained at the end of 24 h. The microparticles of ECH-4 were incorporated into dispersible tablets (DT-TCM) intended for intravaginal administration, in view to arrest the pre-exposure transmission of HIV during sexual intercourse. In vitro release from the dispersible tablet (F3) into simulated vaginal fluid (pH 4.5) displayed a sustained release profile of TDF as 89.98 ± 1.61% of TDF was released at 24 h. The in vitro dissolution profile of the DT-TCM was found to be similar to that of TDF loaded CM with the values of f1 (difference factor) and f2 (similarity factor) being 1.52 and 78.02, respectively. Therefore, DT-TCM would be a promising novel drug delivery platform for pre-exposure prophylaxis against HIV.
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Affiliation(s)
- Dhruti Avlani
- Department of Pharmaceutics, Dr. Prabhakar B Kore Basic Science Research Center, Off-campus, KLE College of Pharmacy (A constituent unit of KAHER-Belagavi), Rajajinagar, Bengaluru 560010 Karnataka, India
| | - Avichal Kumar
- Department of Pharmaceutics, Dr. Prabhakar B Kore Basic Science Research Center, Off-campus, KLE College of Pharmacy (A constituent unit of KAHER-Belagavi), Rajajinagar, Bengaluru 560010 Karnataka, India
| | - Shivakumar H N
- Department of Pharmaceutics, Dr. Prabhakar B Kore Basic Science Research Center, Off-campus, KLE College of Pharmacy (A constituent unit of KAHER-Belagavi), Rajajinagar, Bengaluru 560010 Karnataka, India
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Goldstein SW, Goldstein I, Kim NN. Vestibular tissue changes following administration of intravaginal prasterone: a vulvoscopic open-label pilot study in menopausal women with dyspareunia. Sex Med 2023; 11:qfad028. [PMID: 37351544 PMCID: PMC10281961 DOI: 10.1093/sexmed/qfad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/07/2023] [Accepted: 05/20/2023] [Indexed: 06/24/2023] Open
Abstract
Background Prasterone, an intravaginal dyspareunia treatment in menopausal women, improves vaginal health through intracellular conversion of dehydroepiandrosterone into androgens and estrogens. Phase 3 trials for prasterone showed significant improvement in vaginal tissue health and reduction of pain. Aim To assess vestibular changes with daily use of intravaginal prasterone in menopausal women with moderate to severe dyspareunia. Methods This open-label prospective pilot study was conducted over 20 weeks. It included 11 menopausal women (median age, 56 years) who were treated daily with intravaginal inserts of 6.5-mg prasterone and assessed monthly. During vulvoscopy, vestibular pain was assessed by cotton-tipped swab testing, and vestibular and vaginal health was independently assessed with the Visual Scale (VS). In addition, vulvoscopic photographs were obtained and assessed via the Vulvoscopic Genital Tissue Appearance (VGTA) scale to evaluate overall genital tissue health. Mean changes from baseline for genital tissue health and pain assessments were analyzed by repeated measures 1-way analysis of variance, followed by a Dunnett post hoc test. Sexual event diaries were completed and adverse events recorded. Outcomes Outcomes included indices of genital tissue health: pain assessment by cotton-tipped swab testing, VS of the vestibule and vagina, VGTA, and sexual event diary. Results Aggregate scores from the cotton-tipped swab test progressively improved, reaching statistical significance at week 16, which was maintained through week 20 (-7.27, P = .019). VS scores significantly improved from baseline by week 4 and were maintained through week 20 for the vestibule (-3.00, P = .004) and vagina (-4.00, P = .002). An overall 1607 vulvoscopic photographs were examined; all showed reduction in vestibular erythema and pallor at the end of the study. The mean change from baseline at week 20 for the VGTA score was -7.9 (P = .0016). Intercourse associated with pain was reduced from 81.3% of initiated events during the first month of the study to 8.3% during the last month. Sexual activities that were discontinued due to discomfort were reduced from 45.8% to 6.3%. No prasterone-related serious adverse events were reported. Clinical Implications Prasterone, a safe and effective intravaginal hormone treatment, significantly improves vestibular health parameters. Strengths and Limitations Strengths are the prospective study design and the use of multiple outcome measures to assess vestibular tissue health and pain associated with sexual activity. Limitations are the small study cohort and use of nonvalidated outcome measures. Conclusion Our findings suggest that intravaginal prasterone exerts biologic activity on the androgenic endodermal vestibule, as the medication passes from vagina to vestibule, resulting in amelioration of pain associated with sexual activity.
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Affiliation(s)
- Sue W Goldstein
- Corresponding author: San Diego Sexual Medicine, 5555 Reservoir Dr, Suite 300, San Diego, CA 92120, United States.
| | - Irwin Goldstein
- San Diego Sexual Medicine, San Diego, CA 92120, United States
- Sexual Medicine, Alvarado Hospital, San Diego, CA 92120, United States
| | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA 92121, United States
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Omar RF, Leboeuf M, Lemyre M, Chabot I, Trottier S, Ulmann A, Bergeron MG. A Pre-Phase III Efficacy Trial of the Spermicide/Contraceptive Effect of the Invisible Condom, a Non-Hormonal Vaginal Gel, in Women From Canada. J Obstet Gynaecol Can 2021; 44:175-181. [PMID: 34656768 DOI: 10.1016/j.jogc.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the spermicidal efficacy of non-hormonal vaginal gel in vitro and in a post-coital test, and to evaluate its contraceptive efficacy in Canadian women of childbearing age. METHODS We conducted single-centre trial to assess spermicidal and contraceptive efficacy of vaginal gel. Participants were healthy, sexually active women aged 18-49 years and their regular male sexual partners (30 couples). Measured outcomes included effect of vaginal gel on sperm motility in vitro, its effect on sperm in a post-coital test, and its effect on pregnancy prevention over 3 months. RESULTS For in vitro spermicidal effect, 98% and 67% of sperm were immotile in the presence of the gel with sodium lauryl sulfate (gel-SLS) and gel alone, respectively. For the post-coital test, 99% and 93% of sperm were immotile in the presence of gel-SLS and gel alone, respectively. In the second part of trial, a total of 410 instances of vaginal intercourse in 95 menstrual cycles were protected (during 3-month period of gel-SLS use before each sexual intercourse with probability of 24 conceptions prevented according to Wilcox's table). Four women became pregnant during the study period; 2 during unprotected vaginal intercourse around the time of ovulation, and 2 attributed to user failure. CONCLUSION Based on our results, the vaginal gel demonstrated important spermicidal and contraceptive effect. A larger phase III contraceptive efficacy trial is warranted. The vaginal gel may represent a non-hormonal spermicide/contraceptive option for women.
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Affiliation(s)
- Rabeea F Omar
- Centre de Recherche en Infectiologie de l'Universite Laval, CHU de Québec-Université Laval, CHUL Hospital, Québec City, QC.
| | - Mathieu Leboeuf
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Université Laval, Québec City, QC; Department of Obstetrics and Gynaecology, CHU de Québec-Université Laval, CHUL Hospital, Québec City, QC
| | - Madeleine Lemyre
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Université Laval, Québec City, QC; Department of Obstetrics and Gynaecology, CHU de Québec-Université Laval, CHUL Hospital, Québec City, QC
| | - Isabelle Chabot
- Centre de Recherche en Infectiologie de l'Universite Laval, CHU de Québec-Université Laval, CHUL Hospital, Québec City, QC
| | - Sylvie Trottier
- Centre de Recherche en Infectiologie de l'Universite Laval, CHU de Québec-Université Laval, CHUL Hospital, Québec City, QC
| | | | - Michel G Bergeron
- Centre de Recherche en Infectiologie de l'Universite Laval, CHU de Québec-Université Laval, CHUL Hospital, Québec City, QC
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Vincent KL, Frost PA, Motamedi M, Dick EJ, Wei J, Yang J, White R, Gauduin MC. High-Resolution Quantitative Mapping of Macaque Cervicovaginal Epithelial Thickness: Implications for Mucosal Vaccine Delivery. Front Immunol 2021; 12:660524. [PMID: 34262561 PMCID: PMC8273733 DOI: 10.3389/fimmu.2021.660524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
Vaginal mucosal surfaces naturally offer some protection against sexually transmitted infections (STIs) including Human Immunodeficiency Virus-1, however topical preventative medications or vaccine designed to boost local immune responses can further enhance this protection. We previously developed a novel mucosal vaccine strategy using viral vectors integrated into mouse dermal epithelium to induce virus-specific humoral and cellular immune responses at the site of exposure. Since vaccine integration occurs at the site of cell replication (basal layer 100-400 micrometers below the surface), temporal epithelial thinning during vaccine application, confirmed with high resolution imaging, is desirable. In this study, strategies for vaginal mucosal thinning were evaluated noninvasively using optical coherence tomography (OCT) to map reproductive tract epithelial thickness (ET) in macaques to optimize basal layer access in preparation for future effective intravaginal mucosal vaccination studies. Twelve adolescent female rhesus macaques (5-7kg) were randomly assigned to interventions to induce vaginal mucosal thinning, including cytobrush mechanical abrasion, the chemical surfactant spermicide nonoxynol-9 (N9), the hormonal contraceptive depomedroxyprogesterone acetate (DMPA), or no intervention. Macaques were evaluated at baseline and after interventions using colposcopy, vaginal biopsies, and OCT imaging, which allowed for real-time in vivo visualization and measurement of ET of the mid-vagina, fornices, and cervix. P value ≤0.05 was considered significant. Colposcopy findings included pink, rugated tissue with variable degrees of white-tipped, thickened epithelium. Baseline ET of the fornices was thinner than the cervix and vagina (p<0.05), and mensing macaques had thinner ET at all sites (p<0.001). ET was decreased 1 month after DMPA (p<0.05) in all sites, immediately after mechanical abrasion (p<0.05) in the fornix and cervix, and after two doses of 4% N9 (1.25ml) applied over 14 hrs in the fornix only (p<0.001). Histological assessment of biopsied samples confirmed OCT findings. In summary, OCT imaging allowed for real time assessment of macaque vaginal ET. While varying degrees of thinning were observed after the interventions, limitations with each were noted. ET decreased naturally during menses, which may provide an ideal opportunity for accessing the targeted vaginal mucosal basal layers to achieve the optimum epithelial thickness for intravaginal mucosal vaccination.
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Affiliation(s)
- Kathleen L. Vincent
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Patrice A. Frost
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, United States
- Southwest National Primate Research Center, San Antonio, TX, United States
| | - Massoud Motamedi
- Department of Ophthalmology and Visual Sciences, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Edward J. Dick
- Southwest National Primate Research Center, San Antonio, TX, United States
- Disease Intervention and Prevention Program, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Jingna Wei
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Jinping Yang
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Robert White
- Disease Intervention and Prevention Program, Texas Biomedical Research Institute, San Antonio, TX, United States
| | - Marie-Claire Gauduin
- Southwest National Primate Research Center, San Antonio, TX, United States
- Disease Intervention and Prevention Program, Texas Biomedical Research Institute, San Antonio, TX, United States
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Stephen CP, Norman ST. Design and development of a biological implant for long term intravaginal retention in cattle. Aust Vet J 2021; 99:326-333. [PMID: 33954984 DOI: 10.1111/avj.13076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/22/2021] [Revised: 03/27/2021] [Accepted: 04/21/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Design, develop and trial an intravaginal device able to remain within the bovine vagina for up to 6 months, accommodating various technologies, while not adversely affecting the cow, or pregnancy. METHODS Device scoping required minimal interference with vaginal drainage, no constant pressure on any single point of the vaginal mucosa and minimal footprint on the vaginal floor. A polycarbonate prototype was developed consisting of a central cargo space to house sensors and battery, with a separate retention module. Mathematical modelling informed the required length and flexibility of the arms on the retention module to reduce pressure necrosis and inflammation within the vagina. The prototype was initially trialled, with a loaded cargo pod, for 4 weeks in five non-pregnant cows. Cows were monitored for signs of systemic infection and inflammation by collecting blood samples for haematology and acute phase inflammatory proteins. Cows were also assessed for general demeanour, signs of discomfort and positioning of the device. Later, the device was inserted into 20 early pregnant cows, with 20 contemporary, untreated controls. Cows were monitored, as in the initial trial, every 4 weeks for the next 5 to 6 months until calving. RESULTS In Trial 1, there was 100% retention with no adverse effects. In Trial 2, device retention was 75% until calving with no adverse effects on cow health or pregnancy. CONCLUSIONS We describe the longest successful deployment of an intravaginal device in pregnant and non-pregnant cattle, with long-term retention, no adverse effects and 28 cm3 of cargo space.
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Affiliation(s)
- C P Stephen
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2678, Australia.,Graham Centre for Agricultural Innovation, Charles Sturt University, Wagga Wagga, New South Wales, 2678, Australia
| | - S T Norman
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2678, Australia.,Graham Centre for Agricultural Innovation, Charles Sturt University, Wagga Wagga, New South Wales, 2678, Australia.,Kallangur Veterinary Surgery, Kallangur, Queensland, Australia
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Patel A, Dhande R, Thakkar H. Development of intravaginal rod insert bearing liposomal raloxifene hydrochloride and Leuprolide acetate as a potential carrier for uterine targeting. J Pharm Pharmacol 2021; 73:653-663. [PMID: 33772288 DOI: 10.1093/jpp/rgab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/29/2020] [Accepted: 01/26/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This project aimed at the formulation of dual drug entrapped liposomes held as freeze-dried intravaginal rod insert (IVR), to be administered by vaginal route for uterine targeting. METHODS Liposomes were formulated by dehydration-rehydration method using 3 : 1 molar ratio of1,2-distearoyl-sn-glycero-3-phosphocholine : Cholesterol. Characterization was done for vesicle size, zeta potential, entrapment efficiency, surface morphology and % loading. KEY FINDINGS Spherical and discrete vesicles of size 354 nm were observed in transmission electron microscopy (TEM) image. The entrapment efficiency of 90.91% and 74.3% w/w was obtained for Raloxifene Hydrochloride (RLX) and Leuprolide acetate (LA) respectively. Drug release was sustained for 6 days. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay results showed that dual drug entrapped liposomal formulation show significant cytotoxicity, as also confirmed by higher apoptosis in cell cycle analysis and apoptosis studies (FACS) analysis. Pharmacodynamic studies in New Zealand white female rabbits revealed that intravaginal administration of RLX-LA entrapped liposomal formulation shows considerable fibroid regression. CONCLUSIONS Uterine targeting of liposomal RLX-LA suggests its potential to solve the limitations of the presently available therapeutic options.
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Affiliation(s)
- Arpita Patel
- Shri G.H. Patel Pharmacy Building, Centre for Postgraduate Studies in Pharmacy, TIFAC Core in NDDS, Donor's Plaza, Fatehgunj, Vadodara, India
| | - Rahul Dhande
- Shri G.H. Patel Pharmacy Building, Centre for Postgraduate Studies in Pharmacy, TIFAC Core in NDDS, Donor's Plaza, Fatehgunj, Vadodara, India
| | - Hetal Thakkar
- Shri G.H. Patel Pharmacy Building, Centre for Postgraduate Studies in Pharmacy, TIFAC Core in NDDS, Donor's Plaza, Fatehgunj, Vadodara, India
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Chow NS, Seddighi R, Knych HK, Sun X, Doherty TJ. Sedative effects and pharmacokinetics of detomidine when administered intravenously and intravaginally as a gel in alpacas. Vet Anaesth Analg 2020; 47:773-780. [PMID: 32863105 DOI: 10.1016/j.vaa.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the sedative effects and pharmacokinetics of detomidine gel administered intravaginally to alpacas in comparison with intravenously (IV) administered detomidine. STUDY DESIGN Randomized, crossover, blinded experiment. ANIMALS A group of six healthy adult female Huacaya alpacas (70.3 ± 7.9 kg). METHODS Alpacas were studied on two occasions separated by ≥5 days. Treatments were IV detomidine hydrochloride (70 μg kg-1; treatment DET-IV) or detomidine gel (200 μg kg-1; treatment DET-VAG) administered intravaginally. Sedation and heart rate (HR) were evaluated at intervals for 240 minutes. Venous blood was collected at intervals for 360 minutes after treatment for analysis of detomidine, carboxydetomidine and hydroxydetomidine using liquid chromatography-tandem mass spectrometry. Measured variables were compared between treatments and over time using mixed model analysis. Data are presented as the mean ± standard error of the mean, and a p value of <0.05 was considered significant. RESULTS Onset of sedation was faster in treatment DET-IV (1.6 ± 0.2 minutes) than in treatment DET-VAG (13.0 ± 2.5 minutes). Time to maximum sedation was shorter in treatment DET-IV (8.3 ± 1.3 minutes) than in treatment DET-VAG (25 ± 4 minutes). Duration of sedation was not different between treatments. There was a significant linear relationship between sedation score and plasma detomidine concentration. HR was less than baseline for 60 and 125 minutes for treatments DET-IV and DET-VAG, respectively. The maximal decrease in HR occurred at 15 minutes for both treatments. The mean maximum plasma concentration of detomidine, time to maximum concentration and bioavailability for treatment DET-VAG were 39.6 ng mL-1, 19.9 minutes and 20%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Detomidine administration at the doses studied resulted in moderate sedation when administered IV or intravaginally to alpacas.
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Affiliation(s)
- Natalie S Chow
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Reza Seddighi
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA.
| | - Heather K Knych
- K.L. Maddy Equine Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Xiacun Sun
- Office of Information Technology, University of Tennessee, Knoxville, TN, USA
| | - Thomas J Doherty
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
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Kent DE, Bernardy J. Safety and mechanism of action of noninvasive radiofrequency treatment for vaginal laxity: Histological study in the swine vaginal model. J Cosmet Dermatol 2020; 19:1361-1366. [PMID: 31591822 DOI: 10.1111/jocd.13159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/19/2019] [Accepted: 09/04/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Structural changes in collagen and elastin fiber density have been previously evaluated by qualitative histological studies; however, quantitative evaluations are lacking. AIM To evaluate quantitative changes in collagen and elastin fibers in the vaginal wall in a porcine model after volumetric radiofrequency heating with an intravaginal applicator. METHODS An animal model was used (domestic pig, multipara: 5.67 ± 0.94 deliveries, 3 years of age). Three pigs under general anesthesia were treated (8-minute, vaginal canal area) once per week for the course of three weeks. There were 2 follow-up evaluations at one and four weeks. Histology specimens were obtained via punch biopsy under ultrasound control. Ultrasound video measurements of the vaginal wall thickness were also obtained. Tissue samples were stained by H&E as well as stains for collagen and elastin fibers. RESULTS Elastin (P < .001) and collagen (P < .01) fiber density increased after every treatment. The measured increase in fibers was highest at the one-week follow-up. Elastin accounted on average for 51.46 ± 16.86% of the tissue examined (increase of 36.8% points), while collagen accounted on average for 44.83 ± 18.92% (increase of 17.1% points). The number of synthetically active cells was increased by 16%. While vaginal wall thickness did show an increase of 1.66 mm (32%), this tendency was not statistically significant (P > .05). CONCLUSION Results suggest that volumetric heating of vaginal tissue produced quantitative improvement in the connective tissue organization in a porcine study. Neocollagenesis and neoelastogenesis were observed with an increased number of synthetically active cells.
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Affiliation(s)
| | - Jan Bernardy
- Veterinary Research Institute, Brno, Czech Republic
- Department of Veterinary Sciences, Czech University of Life Sciences Prague, Prague, Czech Republic
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11
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Masello M, Scarbolo M, Schneck MV, Perez MM, Schillkowsky EM, Sitko EM, Hernandez FS, Cabrera EM, Rossi RM, Giordano JO. Intravaginal instillation of prostaglandin F 2α was as effective as intramuscular injection for induction of luteal regression in lactating dairy cows. J Dairy Sci 2019; 103:2743-2755. [PMID: 31882220 DOI: 10.3168/jds.2019-17589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 09/15/2019] [Accepted: 11/07/2019] [Indexed: 02/04/2023]
Abstract
Our objectives were to test the efficacy of intravaginal (IVG) administration of PGF2α to induce corpus luteum (CL) regression, compare circulating progesterone (P4) profiles in cows receiving IVG versus intramuscular (IM) treatment with PGF2α, and evaluate reproductive outcomes. Lactating Holstein cows were synchronized using a Double-Ovsynch protocol [GnRH, 7 d later PGF2α, 3 d later GnRH, 7 d later GnRH, 7 d later PGF2α, 1 d later PGF2α, 32 h later GnRH, 16 to 20 h timed artificial insemination (TAI)] to receive TAI at 67 ± 3 d in milk. Seven days after the first GnRH treatment (time 0), cows with at least 1 visible CL ≥15 mm were blocked by parity and randomly assigned to a treatment that consisted of IM injection (IM-PGF; n = 201) or IVG instillation (IVG-PGF; n = 201) of PGF2α. Cows in IM-PGF received a single 25-mg dose of PGF2α (dinoprost tromethamine) intramuscularly. Cows in IVG-PGF received two 25-mg doses of PGF2α 12 h apart delivered through a catheter in the cranial portion of the vagina. Blood samples were collected at 0, 12, 48, and 72 h after treatment. Ovulation to the first GnRH of Double-Ovsynch was determined through transrectal ultrasonography. Only cows with P4 ≥1 ng/mL (functional CL) at time 0 (IM-PGF = 169; IVG-PGF = 179) were included in the analyses. Binary and quantitative data were analyzed by logistic regression and ANOVA with repeated measures, respectively. Results are presented as least squares means. Concentrations of P4 and the proportion of cows with a new CL at time 0 did not differ. Overall, the proportion of cows with CL regression using 1 ng of P4/mL (IM-PGF = 89.0%; IVG-PGF = 86.7%) or 0.5 ng of P4/mL (IM-PGF = 82.2%; IVG-PGF = 82.1%) as the cutoff did not differ. Concentrations of P4 were affected by treatment, time, and treatment × time interaction. Cows in IVG-PGF had greater mean P4 at 12 h than cows in IM-PGF. Mean P4 did not differ at 48 or 72 h after treatment. The proportion of cows with estrus recorded within 3 d of treatment (IM-PGF = 45.4%; IVG-PGF = 48.9%), ovulation risk after treatment (IM-PGF = 88.5%; IVG-PGF = 85.1%), and pregnancies per artificial insemination after TAI (IM-PGF = 51.5%; IVG-PGF = 57.8%) did not differ. We concluded that 2 IVG doses of 25 mg of PGF2α 12 h apart were as effective as a single 25-mg IM dose of PGF2α for inducing luteal regression in lactating dairy cattle.
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Affiliation(s)
- M Masello
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - M Scarbolo
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - M V Schneck
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - M M Perez
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - E M Schillkowsky
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - E M Sitko
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - F Sosa Hernandez
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - E M Cabrera
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - R M Rossi
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - J O Giordano
- Department of Animal Science, Cornell University, Ithaca, NY 14853.
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Borst C, Grimm C, Tanew A, Radakovic S. Imiquimod-induced effluvium after intravaginal application for treatment of cervical intraepithelial neoplasia. JAAD Case Rep 2019; 5:602-604. [PMID: 31312711 PMCID: PMC6610626 DOI: 10.1016/j.jdcr.2019.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Carina Borst
- Division of Rheumatology, University Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christoph Grimm
- Division of General Gynecology and Gynecologic Oncology, University Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Adrian Tanew
- University Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Sonja Radakovic
- University Department of Dermatology, Medical University of Vienna, Vienna, Austria
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13
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Seddighi R, Knych HK, Cox SK, Sun X, Moorhead KA, Doherty TJ. Evaluation of the sedative effects and pharmacokinetics of detomidine gel administered intravaginally to horses. Vet Anaesth Analg 2019; 46:772-779. [PMID: 31474339 DOI: 10.1016/j.vaa.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 06/01/2019] [Accepted: 06/02/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine the sedative effects and pharmacokinetic profile of detomidine when administered intravaginally as a gel formulation to horses. STUDY DESIGN Randomized, crossover, masked experimental design. ANIMALS A group of six healthy adult mares (494 ± 56 kg). METHODS Mares were studied on two occasions and were administered either detomidine hydrochloride (10 μg kg-1) intravenously (treatment IV) or detomidine gel (40 μg kg-1) intravaginally (treatment IVG), separated by 1 week. Sedation, ataxia, muzzle-floor distance and heart rate (HR) were evaluated every 15 minutes for 240 minutes. Venous blood samples were collected at 15, 30, 45, 60, 90, 120, 150, 180, 240, 300 and 360 minutes postadministration and were analyzed for detomidine and metabolites using liquid chromatography-tandem mass spectrometry. Measured variables were compared over time and between treatments using mixed model analysis. Correlation between drug plasma concentrations and muzzle-floor distance, and sedation and ataxia scores was determined using the Spearman correlation coefficient. Data are presented as mean ± standard error of the mean and p value was set at <0.05. RESULTS Sedation was shorter with IV (119 ± 16 minutes) than with IVG (188 ± 22 minutes). Ataxia scores remained greater than baseline for 90 and 135 minutes for treatments IV and IVG, respectively. HR was lower than baseline for 45 and 30 minutes for IV and IVG, respectively, but did not differ between treatments. The mean maximum plasma concentration of detomidine, time to maximum concentration and bioavailability for treatment IVG was 8.57 ng mL-1, 0.37 hour and 25%, respectively. There was a significant correlation (r = 0.68) between plasma detomidine concentrations and sedation score. CONCLUSIONS AND CLINICAL RELEVANCE Detomidine gel administered intravaginally resulted in clinically important sedation and is a viable method for detomidine gel delivery in mares.
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Affiliation(s)
- Reza Seddighi
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA.
| | - Heather K Knych
- K. L. Maddy Equine Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Sherry K Cox
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Xiaocun Sun
- Office of Information Technology, University of Tennessee, Knoxville, TN, USA
| | - Kaitlin A Moorhead
- College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Thomas J Doherty
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
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Woollard SM, Olwenyi OA, Dutta D, Dave RS, Mathews S, Gorantla S, Johnson N, Giavedoni L, Norgren RB Jr, Byrareddy SN. Preliminary Studies on Immune Response and Viral Pathogenesis of Zika Virus in Rhesus Macaques. Pathogens 2018; 7:E70. [PMID: 30127237 DOI: 10.3390/pathogens7030070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/18/2018] [Accepted: 08/10/2018] [Indexed: 01/08/2023] Open
Abstract
Zika Virus (ZIKV) is primarily transmitted through mosquito bites. It can also be transmitted during sexual intercourse and in utero from mother to fetus. To gain preliminary insight into ZIKV pathology and immune responses on route of transmission, rhesus macaques (RMs) were inoculated with ZIKV (PRVABC59) via intravaginal (IVAG) (n = 3) or subcutaneous (sub Q) (n = 2) routes. Systemic ZIKV infection was observed in all RMs, regardless of the route of inoculation. After 9 days postinfection (dpi), ZIKV was not detected in the plasma of IVAG- and sub-Q-inoculated RMs. Importantly, RMs harbored ZIKV up to 60 dpi in various anatomical locations. Of note, ZIKV was also present in several regions of the brain, including the caudate nucleus, parietal lobe, cortex, and amygdala. These observations appear to indicate that ZIKV infection may be systemic and persistent regardless of route of inoculation. In addition, we observed changes in key immune cell populations in response to ZIKV infection. Importantly, IVAG ZIKV infection of RMs is associated with increased depletion of CD11C hi myeloid cells, reduced PD-1 expression in NK cells, and elevated frequencies of Ki67+ CD8+ central memory cells as compared to sub Q ZIKV-infected RMs. These results need to interpreted with caution due to the small number of animals utilized in this study. Future studies involving large groups of animals that have been inoculated through both routes of transmission are needed to confirm our findings.
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Kharouta M, Malin M, Son C, Al-Hallaq H, Hasan Y. Initial experience using superflab as intravaginal packing during interstitial brachytherapy for advanced gynecologic cancer. J Contemp Brachytherapy 2018; 10:218-24. [PMID: 30038641 DOI: 10.5114/jcb.2018.76522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/04/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose Interstitial brachytherapy implemented for locally advanced gynecologic cancer can result in toxicity due to the proximity of organs at risk (OAR). We report our experience using superflab bolus as vaginal packing to displace OAR during interstitial brachytherapy. Material and methods Twelve patients with stage IB-IVA gynecologic cancer were treated with definitive chemoradiation including interstitial brachytherapy. A Syed template was used for a computed tomography (CT)-based pre-plan with magnetic resonance imaging (MRI) fusion. A 1-2 cm superflab bolus was cut and sterilized. The tandem and obturator were placed, and superflab was then inserted into the vagina. Interstitial needles were then placed through the template and superflab as per the pre-plan under transabdominal ultrasound guidance. Prescription doses ranged from 85-90 Gy EQD2 including external beam radiation therapy (EBRT). 5-6 Gy per fraction was delivered biologically effective dose (BID) over 2-3 days in 1-2 implants. Toxicities were evaluated post-treatment, 1 month, and 3 months. Results The rectum, bladder, and sigmoid had significant average displacement from the prescription isodose line. The average reduction in D2cc between pre- and post-implant was 5.19 Gy per fraction (p < 0.0001), 7.19 Gy (p < 0.0004), and 1.78 Gy (p < 0.003) for the rectum, bladder, and sigmoid, respectively. The high-risk target volume (HR-TV) received a median D90 of 104% (range, 58-122%) of the prescription dose, and 92% (range, 71-131%) in the pre-/post-implant plans, respectively (p = 0.4). Conclusions Our initial experience with superflab as vaginal packing demonstrates technical feasibility and dosimetric improvement for OAR.
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Nawroth F, von Wolff M. Seminal Plasma Activity to Improve Implantation in In Vitro Fertilization-How Can It Be Used in Daily Practice? Front Endocrinol (Lausanne) 2018; 9:208. [PMID: 29755413 PMCID: PMC5934414 DOI: 10.3389/fendo.2018.00208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/13/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Frank Nawroth
- Centre for Infertility, Prenatal Medicine, Endocrinology and Osteology, Amedes, Hamburg, Germany
- *Correspondence: Frank Nawroth,
| | - Michael von Wolff
- Division of Gynecological Endocrinology and Reproductive Medicine, University Women’s Hospital, Bern, Switzerland
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17
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Pathak M, Coombes AGA, Ryu B, Cabot PJ, Turner MS, Palmer C, Wang D, Steadman KJ. Sustained Simultaneous Delivery of Metronidazole and Doxycycline From Polycaprolactone Matrices Designed for Intravaginal Treatment of Pelvic Inflammatory Disease. J Pharm Sci 2017; 107:863-869. [PMID: 29100864 DOI: 10.1016/j.xphs.2017.09.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/04/2017] [Accepted: 09/19/2017] [Indexed: 11/18/2022]
Abstract
Poly(ɛ-caprolactone) (PCL) intravaginal matrices were produced for local delivery of a combination of antibacterials, by rapidly cooling a mixture of drug powders dispersed in PCL solution. Matrices loaded with different combinations of metronidazole (10%, 15%, and 20% w/w) and doxycycline (10% w/w) were evaluated in vitro for release behavior and antibacterial activity. Rapid "burst release" of 8%-15% of the doxycycline content and 31%-37% of the metronidazole content occurred within 24 h when matrices were immersed in simulated vaginal fluid at 37°C. The remaining drug was extracted gradually over 14 days to a maximum of 65%-73% for doxycycline and 62%-71% for metronidazole. High levels of antibacterial activity up to 89%-91% against Gardnerella vaginalis and 84%-92% against Neisseria gonorrhoeae were recorded in vitro for release media collected on day 14, compared to "nonformulated" metronidazole and doxycycline solutions. Based on the in vitro data, the minimum levels of doxycycline and metronidazole released from PCL matrices in the form of intravaginal rings into vaginal fluid in vivo were predicted to exceed the minimum inhibitory concentrations for N. gonorrhea (reported range 0.5-4.0 μg/mL) and G. vaginalis (reported range 2-12.8 μg/mL) respectively, which are 2 of the major causative agents for pelvic inflammatory disease.
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Affiliation(s)
- Meenakshi Pathak
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia.
| | - Allan G A Coombes
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
| | - BoMi Ryu
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
| | - Peter J Cabot
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
| | - Mark S Turner
- The University of Queensland, School of Agriculture and Food Sciences, St. Lucia, Brisbane, Queensland 4072, Australia
| | - Cheryn Palmer
- Princess Alexandra Hospital, Department of Sexual Health, Ipswich Road, Woolloongabba, Queensland 4102, Australia
| | - Dongjie Wang
- The University of Queensland, School of Agriculture and Food Sciences, St. Lucia, Brisbane, Queensland 4072, Australia
| | - Kathryn J Steadman
- The University of Queensland, School of Pharmacy, 20 Cornwall Street, Woolloongabba, Brisbane, Queensland 4102, Australia
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Wijma R, Stangaferro ML, Masello M, Elmetwally MA, Granados GE, Amovilli F, Giordano JO. Intravaginal instillation of gonadotropin-releasing hormone analogues with an absorption enhancer induced a surge of luteinizing hormone in lactating dairy cows. J Dairy Sci 2017; 100:7626-7637. [PMID: 28711266 DOI: 10.3168/jds.2016-12513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/24/2016] [Accepted: 05/20/2017] [Indexed: 11/19/2022]
Abstract
Our objectives were to evaluate circulating LH concentrations after intravaginal (IVG) instillation of GnRH analogs in lactating dairy cows. In 2 experiments, lactating Holstein cows (experiment 1: n = 32; experiment 2: n = 47) received the experimental treatments 48 h after the first of 2 PGF2α treatments given 12 h apart and 7 d after a modified Ovsynch protocol (GnRH at -7 d, PGF2α at -24 h, PGF2α at -56 h, GnRH at 0 h). In experiment 1, cows were stratified by parity and randomly allocated to receive the following treatments: 2 mL of saline IVG (SAL, n = 6), 100 µg of gonadorelin (Gon) i.m. (G100-IM, n = 5), and 100 (G100, n = 7), 500 (G500, n = 8), or 1,000 µg of Gon IVG (G1000, n = 7). In experiment 2, treatments were SAL (n = 8), G100-IM (n = 8), G1000 (n = 7), 1,000 µg of Gon plus 10% citric acid (CA) IVG (G1000CA, n = 8), 80 µg of buserelin IVG (B80, n = 8), and 80 µg of buserelin plus 10% CA IVG (B80CA, n = 8). In both experiments, blood was collected every 15 min from -15 min to 4 h, and every 30 min from 4 to 6 h after treatment. Data for area under the curve (AUC), mean LH concentrations, and time to maximum LH concentration were analyzed by ANOVA with (mean LH only) or without repeated measures using PROC MIXED of SAS (version 9.4, SAS Institute Inc., Cary, NC). The proportion of cows with a surge of LH was evaluated with Fisher's exact test using PROC FREQ of SAS. In both experiments, LH concentrations were affected by treatment, time, and the treatment by time interaction. In experiment 1, the AUC for LH and maximum LH concentration were greatest for the G100-IM treatment and were greater for the G1000 than for the SAL and G500 treatments. The proportion of cows with an observed surge of LH was 100 and 0% for cows that received Gon i.m. and IVG, respectively. In experiment 2, the AUC and maximum LH concentrations were greater for the G100-IM, G1000CA, and B80CA treatments than for the other IVG treatments. The proportion of cows with a surge of LH differed by treatment (SAL = 0%, G100-IM = 100%, G1000 = 14%, G1000CA = 88%, B80 = 13%, and B80CA = 100%). For the treatments with a surge of LH, time to maximum concentration of LH was the shortest for the G100-IM treatment, intermediate for the G1000CA treatment, and the longest for cows in the B80CA treatment. In conclusion, Gon (up to 1,000 µg) absorption through intact vaginal epithelium after a single IVG instillation was insufficient to elicit a surge of LH of normal magnitude. Conversely, IVG instillation of 1,000 µg of Gon and 80 µg of buserelin with the addition of citric acid as absorption enhancer resulted in a surge of LH of similar characteristics than that induced after i.m. injection of 100 µg of Gon.
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Affiliation(s)
- R Wijma
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - M L Stangaferro
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - M Masello
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - M A Elmetwally
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - G E Granados
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - F Amovilli
- Department of Animal Science, Cornell University, Ithaca, NY 14853
| | - J O Giordano
- Department of Animal Science, Cornell University, Ithaca, NY 14853.
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Lalji S, Lozanova P. Evaluation of the safety and efficacy of a monopolar nonablative radiofrequency device for the improvement of vulvo-vaginal laxity and urinary incontinence. J Cosmet Dermatol 2017; 16:230-234. [PMID: 28556393 DOI: 10.1111/jocd.12348] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Vaginal childbirth, natural process of aging, congenital factors, and surgical interventions are considered the main causes of vulvo-vaginal laxity driven by changes in collagen and elastin fibers. This causes a loss of strength and flexibility within the vaginal wall. As a result, women may experience lack of sensation and stress urinary incontinence (SUI)-the condition of involuntary loss of urine associated with activities that cause an increase in intra-abdominal pressure (eg, sneezing, coughing, and lifting). Both vaginal laxity and urinary incontinence significantly affect patients' quality of life (QoL). The aim of this study was to evaluate efficacy and safety of a noninvasive radiofrequency device when used to treat SUI and vulvo-vaginal laxity through its heating effect which stimulates collagen and elastin fibers. METHODS Twenty-seven women (average age 44.78±10.04 years) with indications of mild/moderate SUI as well as vulvo-vaginal laxity were treated with a monopolar radiofrequency device. The treatment course consisted of three once-a-week sessions. Each session included intravaginal treatment followed by treatment of labia majora and the perineum. Improvement in the SUI condition was evaluated by applying the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF). Data were collected at the baseline, after the last treatment and at 1-month follow-up visit. Vaginal laxity was assessed by subjective vulvo-vaginal laxity questionnaire (VVLQ). Data were collected before the 1st treatment and during the 1-month follow-up visit. Patient's satisfaction was recorded using a satisfaction questionnaire. Data were collected after the last treatment and at the 1-month follow-up visit. Any adverse events related to the treatments were monitored. RESULTS On a scale of 0 to 5, the average frequency of urine leak improved from "2-3 times a week" (2.15±1.03 points prior to treatment) to "once a week" (1.00±0.78 points post-treatment), and on to "never" (0.44±0.51 points at the 1-month follow-up visit). Sixteen subjects (59.3%) reported decrease in the amount of leakage, with 15 women (55.6%) becoming completely leak-free at the 1-month follow-up. At the 1-month follow-up visit, 24 subjects (88.9%) expressed their condition's interference with everyday life decreased and 17 patients (62.9%) said the condition did not interfere with their everyday life at all as a result of the treatment. All results are statistically significant (P<.05). No adverse events were recorded. All subjects reported improvement in vaginal laxity, from average perception of "very loose" (2.19±1.08 points prior to treatment) to "moderately tight" (5.74±0.76 points at the 1-month follow-up visit). During the follow-up visit, 89% of the patients "agreed" or "strongly agreed" that their SUI condition improved, and 93% of the patients "agreed" or "strongly agreed" that their gratification during intercourse improved. None of the subjects reported dissatisfaction. CONCLUSION The study confirmed the monopolar radiofrequency method as an effective and safe treatment of SUI and vulvo-vaginal laxity. The treatments were well tolerated by all subjects with no adverse effects.
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Affiliation(s)
| | - Paula Lozanova
- Department of Dermatology and venerology, Medical University, Sofia, Bulgaria
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20
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Sealy RE, Hurwitz JL. Short Communication: Parallel Analyses of Systemic and Local Vaccinations with Envelope Formulated in Adjuvant for Induction of HIV-Specific Antibodies in the Vaginal Mucosa. AIDS Res Hum Retroviruses 2017; 33:424-427. [PMID: 27825246 DOI: 10.1089/aid.2016.0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To prevent HIV-1 infections in females, vaccines that elicit antibodies in vaginal secretions are much desired. To induce these antibodies, intravaginal vaccinations are sometimes recommended. However, the benefit of intravaginal vaccination remains a topic of debate, and parallel studies of intravaginal and intramuscular vaccination routes are rarely performed. Here we describe tests of mucosal and systemic antibodies after mouse vaccinations by several routes with HIV-1 envelope protein formulated in adjuvant. Response magnitudes were as follows: intraperitoneal > intramuscular = intravaginal tissue ≥ subcutaneous. We found that the well-accepted and logistically feasible intramuscular immunization was similar to intravaginal tissue immunization for the induction of antibodies in blood and vaginal secretions. Results suggest that a routine comparison of intravaginal and intramuscular immunizations may serve as a beneficial gatekeeper for the development of new intravaginal HIV-1 vaccines.
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Affiliation(s)
- Robert E. Sealy
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Julia L. Hurwitz
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee
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Koh DSC, Ang EPJ, Coyuco JC, Teo HZ, Huang X, Wei X, Ng MJ, Lim SL, Tan KH. Comparing two regimens of intravaginal misoprostol with intravaginal gemeprost for second-trimester pregnancy termination: a randomised controlled trial. ACTA ACUST UNITED AC 2017; 43:252-259. [PMID: 28432086 DOI: 10.1136/jfprhc-2016-101652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/17/2016] [Revised: 02/21/2017] [Accepted: 03/20/2017] [Indexed: 11/03/2022]
Abstract
AIM To compare the efficacy and safety of intravaginal misoprostol 200 µg, 400 µg and gemeprost regimens for second-trimester termination of pregnancy (TOP). METHODS A three- armed randomi sed controlled trial (Clinical Trial Certificate 1100015) where 116 women undergoing second-trimester TOP were given intravaginal misoprostol 200 µ g (n=37), misoprostol 400 µg (n=40) or gemeprost 1 mg (n=39) at 4- hour intervals until abortion occurred with a maximum of five doses. RESULTS The misoprostol 400 µg group had the highest incidence of successful abortions (92.5%) compared to the misoprostol 200 µg (70.3%; p=0.017) and gemeprost 1 mg (74.4%; p=0.037) within 48 hours. There was no significant difference in abortion rate between misoprostol 200 µg and gemeprost. The misoprostol 400 µg group had the highest incidence of fever (70.0%) compared to misoprostol 200 µg (24.3%; p<0.001) and gemeprost 1 mg (46.2%; p=0.041). The gemeprost group had the highest incidence of diarrhoea (38.5%) compared to misoprostol 400 µg (10.0%; p=0.004) and misoprostol 200 µg (8.1%; p=0.003) groups. CONCLUSIONS Intravaginal misoprostol 400 µ g at 4- hour intervals was the most effective regimen but was associated with a high incidence of fever. Misoprostol 200 µg demonstrated similar effectiveness as gemeprost and had lower incidence of diarrhoea. Gemeprost should not be first line for medical therapy given the cost, storage requirements and lower efficacy.
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Affiliation(s)
- Daniel Seow Choon Koh
- Associate Consultant, Division of Obstetrics & Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Esther Pei Jing Ang
- Pharmacist, Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jurja Chua Coyuco
- Pharmacist, Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Hua Zhen Teo
- Clinical Pharmacist, Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Xiaoling Huang
- Clinical Pharmacist, Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Xing Wei
- Executive, Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mor Jack Ng
- Manager, Division of Obstetrics & Gynecology, OBGYN Academic Clinical Program, KK Women's and Children's Hospital, Singapore, Singapore
| | - Serene Liqing Lim
- Associate Consultant, Division of Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Senior Consultant, Division of Obstetrics & Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
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Gattoc L, Frew PM, Thomas SN, Easley KA, Ward L, Chow HHS, Ura CA, Flowers L. Phase I dose-escalation trial of intravaginal curcumin in women for cervical dysplasia. Open Access J Clin Trials 2016; 9:1-10. [PMID: 28592920 PMCID: PMC5459318 DOI: 10.2147/oajct.s105010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background This is a Phase I trial demonstrating safety and tolerability of
intravaginal curcumin for future use in women with cervical neoplasia. Objective The objective of this study was to assess the safety, tolerability,
and pharmacokinetics of intravaginal curcumin in healthy women. Study design We conducted a 3+3 dose-escalation Phase I trial in a group
of women aged 18–45 years. Thirteen subjects were given one of four
doses of curcumin powder (500 mg, 1,000 mg, 1,500 mg, and 2,000 mg) packed
in gelatin capsules, which was administered intravaginally daily for 14
days. The primary end point for this study was safety based on severe
adverse events regarding laboratory toxicity, clinical findings, and
colposcopic abnormalities. We administered an acceptability questionnaire to
assess product experience and attributes. Results No dose-limiting toxicities (0/13) were experienced (95%
confidence interval: 0.0%–22.8%) in this study. The
pharmacokinetics data demonstrated that curcumin and curcumin conjugates
were not measurable in the serum and negligible in the urine of the study
participants. Although 23 adverse events occurred during the course of the
trial, all events were grade I based on the National Cancer Institute Common
Terminology Criteria for Adverse Events Version 4.0 and were resolved by the
end of the study in an average of 9 days. Fifty-six percent of the adverse
events were related to the study drug, which included genital pruritus
(23% of subjects), vaginal discharge (100%), vaginal dryness
(15%), abnormal prothrombin (23%), and hypokalemia
(8%). Conclusion Intravaginal curcumin was well tolerated by all subjects and safe. In
this Phase I trial, there were no severe adverse events observed at any of
the administered dose levels. All adverse events were grade I and did not
result in early termination of the study. There was no evidence of systemic
absorption or significant local absorption of intravaginally administered
curcumin.
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Affiliation(s)
- Leda Gattoc
- Division of Gynecologic Oncology, Wayne State University, Detroit, MI, USA
| | - Paula M Frew
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, LA, USA.,Department of Behavioral Sciences and Health Education, LA, USA.,Hubert Department of Global Health, LA, USA
| | | | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Laura Ward
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - H-H Sherry Chow
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Chiemi A Ura
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta GA, USA
| | - Lisa Flowers
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta GA, USA
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Kuo HC, Mehta KJ, Yaparpalvi R, Hong L, Mynampati D, Tomé WA, Kalnicki S. Feasibility study and optimum loading pattern of a multi-ring inflatable intravaginal applicator. J Contemp Brachytherapy 2013; 5:93-100. [PMID: 23878554 DOI: 10.5114/jcb.2013.35580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 04/28/2013] [Accepted: 06/25/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE A cylinder applicator is the standard treatment device for intravaginal brachytherapy. However, they are limited in their ability to simultaneously spare the organs at risk (OAR), and reduce the hot spot in the vaginal mucosa, while achieving adequate dose conformality. This study aims to compare the dosimetric characteristics of single and multi-channel cylinders, and utilizes volume point dose optimizations to investigate the feasibility and optimum loading method for a multi-ring inflatable intravaginal applicator. MATERIAL AND METHODS STUDIES WERE DESIGNED TO: (1) test the feasibility of multi-ring applicators, (2) compare dose distributions between different multi-channel applicators and loading patterns, (3) test non-uniform prescription depths around the multi-ring cylinder. RESULTS Compared to a cylinder with a single central channel, a cylinder with 6 lumina arranged around the periphery, providing the lumina had adequate distance to the cylinder surface, could reduce dose beyond the prescription depth. However, when the number of outer lumina increased from 6 to 12, no further dose reduction could be achieved and the high dose volume close to the surface of the cylinder increased. Moreover, an additional ring, with lumina further away from the surface, provided increased dose shaping capabilities, allowing for individualized dose distributions. CONCLUSIONS Dose could be reduced to normal tissue and the inner mucosa, and better conformity was seen to unique anatomical shapes. A modified peripheral loading pattern provided the optimum dose distribution, yielding good conformity, dose sparing at adjacent organs, and dose reduction in the high dose region of the vaginal mucosa.
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Mahendru R, Yadav S. Shortening the induction delivery interval with prostaglandins: a randomized controlled trial of solo or in combination. J Turk Ger Gynecol Assoc 2011; 12:80-5. [PMID: 24591967 PMCID: PMC3939111 DOI: 10.5152/jtgga.2011.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 12/08/2010] [Accepted: 03/27/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety of misoprostol alone with dinoprostone followed by misoprostol, all inserted intravaginally in induction of labor at term and the obstetrical outcome. MATERIAL AND METHODS A pilot study comprising 111 primigravidae, >37 gestational weeks with singleton pregnancy in cephalic presentation having an unfavorable Bishop score admitted for labor induction, were considered and randomly allocated into two groups. In group I (n=55) with intravaginal 25mcg misoprostol 4 hourly (six doses at the most) and and group II (n=56), with dinoprostone 0.5mg followed eight hours later by 25mcg misoprostol induction to vaginal delivery time was found to be significantly different, being 14.8 h in group-I and shorter in group-II with a mean of 11.6 h. Vaginal delivery rates within 12 h (groups-I and -II: 47.2%, as compared to 60.7%, respectively) were found to be higher with dinoprostone-misoprostol induction, as well as vaginal delivery rates in 24 h, 80.0% and 91.1%. The need for oxytocin augmentation was more frequent in the misoprostol than in the dinoprostone-misoprostol group, (61.8%, and 39.3%), and all these observations were statistically significant. Abnormal foetal heart rate pattern occurred more frequently (18.2%) in group-I in contrast to 5.3% in group-II, as was the incidence rate of (18.2%) who had passage of meconium in group-I, this rate being significantly different from group-II having meconium passage in 3 cases, a rate of 5.3%. CONCLUSION Using dinoprostone followed by vaginal misoprostol is safe and effective for induction of labor with less need for oxytocin augmentation and shorter induction delivery interval.
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Affiliation(s)
- Rajiv Mahendru
- Department of Obstetrics and Gynecology, Mmimsr, Mullana, Ambala, India
| | - Shweta Yadav
- Department of Obstetrics and Gynecology, Mmimsr, Mullana, Ambala, India
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