Misoprostol administration before hysteroscopy may reduce time needed for cervical dilatation in nulliparous women: Study

Hysteroscopy offers superior diagnostic and therapeutic capabilities compared to traditional methods like transvaginal ultrasound and blind dilatation and curettage (D&C). It provides direct visualization of the uterine cavity, enabling targeted biopsies and treatment of various uterine conditions. This procedure is recognized as the preferred method for evaluating uterine health in women of all ages. Recent study conducted by Salah et al. aimed to evaluate the efficacy of administering misoprostol before hysteroscopy in nulliparous women through a systematic review and meta-analysis of randomized controlled trials. Thirteen studies involving 1528 participants were included in the analysis, comparing misoprostol to placebo, dinoglandin, diclofenac, and different doses/routes of misoprostol. The results showed that misoprostol administration improved the time needed for cervical dilatation without increasing complications or side effects compared to placebo. However, misoprostol had similar outcomes to dinoglandin with higher side effects.

Role of Misoprostol in Cervical Preparation

Misoprostol, a synthetic prostaglandin E1 analog, is commonly used in obstetrics and gynecology for various purposes, including cervical preparation before hysteroscopy. The study highlighted that nulliparous and postmenopausal women are more susceptible to pain and complications during hysteroscopy due to their cervical characteristics. The systematic review assessed various outcomes such as ease of dilatation, time needed for dilatation, preoperative cervical width, pain scores, and side effects.

Comparative Analysis of Misoprostol

The analysis revealed that misoprostol significantly reduced the time needed for cervical dilatation but did not show significant differences in preoperative cervical width, failure of dilatation, or preoperative pain compared to placebo. When compared to dinoglandin, misoprostol had similar outcomes in terms of dilatation time and cervical width but led to more preoperative pain and bleeding. The review emphasized the need for further well-organized randomized controlled trials to determine the optimal dose and timing of misoprostol administration before hysteroscopy in high-risk women.

Conclusion and Recommendations

Overall, the study concluded that misoprostol administration before hysteroscopy in nulliparous women can be beneficial in reducing the time needed for cervical dilatation, ultimately improving procedural efficiency and potentially reducing costs. The findings suggest that misoprostol is a valuable option for cervical preparation, but future research with larger sample sizes and standardized protocols is recommended to confirm its efficacy and safety in this specific population.

Key Points

– Evaluating the efficacy of misoprostol before hysteroscopy in nulliparous women through a systematic review and meta-analysis of 13 studies involving 1528 participants.

– Misoprostol administration improved the time needed for cervical dilatation without increasing complications or side effects compared to a placebo, but had similar outcomes to dinoglandin with higher side effects.

– Misoprostol, a synthetic prostaglandin E1 analog, is commonly used in obstetrics and gynecology for cervical preparation before hysteroscopy, especially for nulliparous and postmenopausal women who are more susceptible to pain and complications.

– The systematic review assessed outcomes such as ease of dilatation, time needed for dilatation, preoperative cervical width, pain scores, and side effects when comparing misoprostol to placebo, dinoglandin, diclofenac, and different doses/routes of misoprostol.

– Misoprostol significantly reduced the time needed for cervical dilatation compared to placebo, but did not show significant differences in preoperative cervical width, failure of dilatation, or preoperative pain. However, it led to more preoperative pain and bleeding compared to dinoglandin.

– The study concluded that misoprostol administration before hysteroscopy in nulliparous women can be beneficial in reducing the time needed for cervical dilatation, improving procedural efficiency, and potentially reducing costs. Further well-organized randomized controlled trials are recommended to determine the optimal dose and timing of misoprostol administration in high-risk women.

Reference –

Noha M. Salah et al. (2024). The Use Of Misoprostol Before Hysteroscopy In Nulliparous Women: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials. *BMC Pregnancy And Childbirth*, 24. https://doi.org/10.1186/s12884-024-06993-z.

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Dietary fibre safe, affordable and effective adjunct therapy for diabetes in pregnancy: Study

Dietary fibre is a safe, affordable, and effective adjunct therapy for diabetes in pregnancy, as suggested by a study published in Diabetic Medicine.

Dietary fibre improves glycaemic control in type 2 diabetes, but its therapeutic role in women with diabetes in pregnancy is unclear. We assessed the effect of dietary fibre on markers of glycaemic control in women with diabetes in pregnancy. They searched four databases (Cochrane Library, MEDLINE, Embase and Web of Science) to identify RCTs exploring the effect of dietary fibre, high-fibre diets or fibre supplementation on fasting blood glucose (FBG), 2-h postprandial blood glucose (PBG) and requirement for insulin therapy, among other glycaemic makers in pregnant women with diabetes. Data were pooled for each outcome to calculate change from baseline mean (SD) and overall mean difference (MD) between control and intervention groups. Results: Of 1462 identified studies, data from 20 eligible trials containing 1061 participants were pooled. On meta-analysis, a higher fibre intake was associated with reduced FBG (MD: −0.35 mmol/L, 95% CI: −0.53, −0.18, p < 0.01), PBG (MD: −0.90 mmol/L, 95% CI: −1.39, −0.40, p < 0.01) and requirement for insulin (OR: 0.24, 95% CI: 0.13, 0.46, p < 0.01). There was significant heterogeneity for FBG and PBG (>90%), attributable to differences in Intervention type for PBG (Dietary Approach to Stop Hypertension [DASH] diet, low glycaemic index, supplement; p < 0.01) and study duration (for FBG: p = 0.002; not for PBG). Studies were mostly scored as high risk of bias due to lack of blinding (Cochrane Risk of Bias Tool v.2.0). High-quality dietary intervention studies in pregnancy are lacking. Our results suggest that high-fibre diets improve fasting and postprandial glycaemia and reduce the likelihood of requiring insulin in women with diabetes in pregnancy.

Reference:

Jones D, Kyriakidou A, Cooper L, et al. The effect of high-fibre diets on glycaemic control in women with diabetes in pregnancy: A systematic review and meta-analysis. Diabet Med. 2024; 00:e15435. doi:10.1111/dme.15435

Keywords:

Dietary, fibre, safe, affordable, effective, adjunct, therapy, diabetes, pregnancy, study, Diabetic Medicine, Jones D, Kyriakidou A, Cooper L

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Psilocybin therapy effectively improves post-pandemic depression symptoms among clinicians: JAMA

A new study published in the Journal of American Medical Association found that psilocybin therapy is a novel treatment paradigm for post-pandemic depression symptoms linked with frontline clinical practice in physicians facing mild to severe symptoms. Burnout, depression, and posttraumatic stress disorder (PTSD) are among the psychological morbidities suffered by physicians, advanced practice practitioners (APPs), and nurses as a result of working during the COVID-19 epidemic. Thereby, Anthony Back and colleagues undertook this study to see if psilocybin treatment helped relieve symptoms of depression, burnout, and PTSD among US doctors who developed these symptoms while working on the front lines of clinical care during the epidemic.

The participants in this double-blind randomized clinical experiment were recruited between February and December of 2022. Physicians, APPs, and nurses who worked on the front lines for more than a month during the pandemic and who did not have any pre-pandemic mental health diagnoses but who at enrollment showed moderate to severe depressive symptoms were among the participants. The niacin or psilocybin arm was allocated to participants at random. Based on the intention-to-treat principle, data analysis was carried out from December 2023 to May 2024. 3 integration visits, 1 medication session, and 2 preparation visits made up one intervention episode. The participants were given either 100 mg of niacin or 25 mg of psilocybin orally during the medication session.

Of the 30 doctors who took part, 15 were randomized to receive psilocybin and 15 to receive niacin. From the first preparation session to day 28, the mean change in depressive symptoms (MADRS scores) of the psilocybin arm was −21.33 (7.84) whereas the niacin arm’s was −9.33 (7.32). The mean difference between the two arms was −12.00 which showed improvement. Although it was not statistically significant, the mean change in SPFI ratings from the first preparation session to day 28 indicated a numerically greater improvement in burnout symptoms in the psilocybin arm as compared to the niacin arm.

The PCL-5 score change was assessed descriptively since the SPFI score change was not statistically significant. The mean reduction in PCL-5 scores revealed that the psilocybin arm had a numerically bigger decrease in PTSD symptoms from the first preparation session to day 28, although this difference was not statistically verified. Overall, this randomized clinical experiment discovered that psilocybin treatment significantly reduced the depressive symptoms of physicians and consistently following frontline work throughout the COVID-19 epidemic.

Source:

Back, A. L., Freeman-Young, T. K., Morgan, L., Sethi, T., Baker, K. K., Myers, S., McGregor, B. A., Harvey, K., Tai, M., Kollefrath, A., Thomas, B. J., Sorta, D., Kaelen, M., Kelmendi, B., & Gooley, T. A. (2024). Psilocybin Therapy for Clinicians With Symptoms of Depression From Frontline Care During the COVID-19 Pandemic. In JAMA Network Open (Vol. 7, Issue 12, p. e2449026). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.49026

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Higher fasting serum irisin tied to PCOS among lean and obese adolescents, reports study

Pakistan: A recent study published in the journal Women’s Health has explored the potential of irisin, a muscle-derived hormone, as a biomarker in adolescents and young adults with polycystic ovarian syndrome (PCOS).

The research suggests that both lean and obese adolescents and young adults with PCOS exhibited significantly higher fasting serum irisin levels compared to their respective control groups. Additionally, the participants’ metabolic and reproductive traits were closely associated with irisin levels.

PCOS is characterized by irregular menstrual cycles, elevated androgen levels, and polycystic ovaries and is often associated with metabolic abnormalities such as insulin resistance, obesity, and infertility. Given the complex nature of PCOS, researchers have been searching for reliable biomarkers that could aid in its diagnosis and help track its progression, particularly in younger populations. Irisin, a myokine that may be associated with insulin sensitivity, has been studied about PCOS, a common hormonal disorder characterized by insulin resistance. Previous research has indicated elevated circulating irisin levels in adult women with PCOS.

Against the above background, Hira Moin, Department of Physiology, NUST School of Health Sciences, National University of Sciences and Technology, Islamabad, Pakistan, and colleagues aimed to investigate the variations in serum irisin levels between lean and obese adolescents and young adults with PCOS, as well as their corresponding lean and obese control groups. Additionally, it seeks to explore the correlation between irisin levels and the metabolic and reproductive traits of the participants.

For this purpose, the researchers employed a cross-sectional study design, including 60 cases of PCOS and 60 controls. The participants were categorized into lean and obese groups based on their body mass index (BMI). The study involved measuring fasting serum irisin levels along with assessing various physical, metabolic, hormonal, and reproductive characteristics of the participants.

The study revealed the following findings:

  • Lean cases of PCOS had significantly higher fasting serum irisin levels than lean controls (PCOS = 17.07 ± 5.61 ng/ml versus lean controls = 11.04 ± 7.51 ng/ml).
  • Lean cases also had elevated levels of glucose, insulin, HOMA-IR, LH, estradiol, and testosterone, along with significantly lower levels of QUICKI compared to lean controls.
  • Obese cases of PCOS had significantly higher fasting serum irisin levels compared to obese controls (PCOS = 22.06 ± 3.83 ng/ml vs obese controls = 16.86 ± 6.74 ng/ml).
  • Obese cases exhibited elevated levels of glucose, insulin, HOMA-IR, LH, estradiol, and testosterone, and significantly lower levels of FSH and QUICKI compared to obese controls.
  • Serum irisin levels showed significant positive correlations with BMI, glucose, insulin, HOMA-IR, LH, estradiol, and testosterone.
  • Positive correlations were also found with triglycerides, total cholesterol, and low-density lipoprotein cholesterol.
  • Significant negative correlations were observed with high-density lipoprotein cholesterol and QUICKI in the entire cohort.
  • Fasting serum glucose (β = 0.337), triglycerides (β = 0.249), and LH (β = 0.382) were identified as positive predictors of serum irisin concentrations in the overall sample.

“Lean and obese adolescent and young adult cases of PCOS exhibited significantly higher fasting serum irisin levels compared to their respective controls. Additionally, metabolic and reproductive traits of the participants were found to correlate with irisin levels,” the researchers concluded.

Reference:

Majeed, S., Moin, H., Shafi, R., Fatima, S., Zahra, T., & Zafar, S. (2024). Exploring the role of irisin as a potential biomarker in adolescents and young adults with polycystic ovarian syndrome. Women’s Health. https://doi.org/10.1177/17455057241302559

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JAMA Study Finds Deucravacitinib Effective and Safe for Psoriasis Patients

This recent 3-year study revealed that deucravacitinib which is an oral treatment for moderate to severe plaque psoriasis to offer a sustainable and safe long-term option for patients. The analysis combined data from the POETYK PSO-1 and PSO-2 randomized trials and a subsequent long-term extension (LTE) trial. This research published in the JAMA Dermatology evaluated the safety and efficacy of the drug through 148 weeks, despite challenges like the COVID-19 pandemic coinciding with the LTE trial period.

The PSO-1 and PSO-2 studies were global, double-blinded, phase 3 trials involving patients randomized to receive placebo, deucravacitinib, or apremilast. After 52 weeks, eligible patients could enroll in the nonrandomized LTE trial for open-label deucravacitinib therapy. From August 12, 2019, to June 15, 2022, 513 patients who began deucravacitinib treatment at day 1 transitioned to the LTE trial.

The cumulative analysis demonstrated that the safety profile of this treatment improved or remained consistent over time. Adverse event (AE) rates decreased from the first year (229.2 per 100 person-years) to the 3-year period (144.8 per 100 person-years). Serious AEs and discontinuations due to AEs also remained low, with slight reductions observed over time.

Common AEs, such as nasopharyngitis and upper respiratory tract infections, were less frequent during the three-year period. COVID-19 incidence increased during the pandemic but was well-managed. Other conditions of interest, including herpes zoster, cardiovascular events, and malignancies, occurred at low rates throughout the study.

Efficacy analysis revealed that patients maintained significant improvements in their psoriasis symptoms through 3 years. These measures included achieving a 75% or 90% reduction in Psoriasis Area and Severity Index (PASI 75/90) and reaching clear or almost clear skin ratings on the static Physician Global Assessment scale (sPGA 0/1). These results highlight the durable clinical benefits of continuous deucravacitinib therapy.

Overall, this study establishes deucravacitinib as a safe and effective long-term treatment for moderate to severe plaque psoriasis. By maintaining its efficacy and demonstrating a manageable safety profile over 3 years, deucravacitinib offers hope for sustained relief for patients with this chronic condition.

Source:

Armstrong, A. W., Lebwohl, M., Warren, R. B., Sofen, H., Imafuku, S., Ohtsuki, M., Spelman, L., Passeron, T., Papp, K. A., Kisa, R. M., Vaile, J., Berger, V., Vritzali, E., Hoyt, K., Colombo, M. J., Scotto, J., Banerjee, S., Strober, B., Thaçi, D., & Blauvelt, A. (2024). Safety and Efficacy of Deucravacitinib in Moderate to Severe Plaque Psoriasis For Up to 3 Years. In JAMA Dermatology. American Medical Association (AMA). https://doi.org/10.1001/jamadermatol.2024.4688

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Multiple GA exposure reduces neurodevelopmental score in children, finds study

A recent analysis of the General Anesthesia compared to Spinal anesthesia (GAS) trial database has raised concerns about the potential neurodevelopmental impact of multiple anesthetic exposures in early childhood. The study published in the Anesthesiology journal found that children who underwent two or more general anesthetic (GA) exposures before the age of 5 had lower intelligence scores and greater emotional and behavioural difficulties when compared to the children with one or no GA exposures.

The multicentre study initially demonstrated that a single GA exposure for elective inguinal hernia repair in infancy had no significant impact on neurodevelopmental outcomes at ages 2 and 5. However, this secondary analysis looked to investigate whether repeated GA exposures influenced outcomes.

This research utilized data from 231 children (90 with multiple GA exposures and 141 with one or no exposures). The primary measure was the full-scale intelligence quotient (FSIQ) from the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) at age 5. Secondary outcomes included assessments of verbal and performance IQ, as well as emotional and behavioural domains, through caregiver-reported questionnaires.

The results revealed that children with multiple GA exposures scored, on average, 5.8 points lower in FSIQ than the children with one or no exposure. Also, verbal and performance IQ scores were also lower in the multiply exposed group. Emotional, behavioural, and executive function difficulties were more pronounced among these children, as reported by caregivers.

While the findings suggest a potential link between multiple GA exposures and diminished neurodevelopmental outcomes, this study acknowledged limitations. Residual confounding factors like pre-existing health conditions or the complexity of surgeries requiring multiple anesthetics, may have influenced results. Also, the small sample size limits the generalizability of the findings.

This research emphasized that while the study underlined the potential risks of multiple anesthetic exposures, the clinical significance should be interpreted cautiously. The observed reduction in intelligence scores and increased behavioural challenges highlight the importance of judicious decision-making regarding repeated surgeries requiring GA in young children. As ongoing research seeks to further explore the neurodevelopmental impact of anesthesia in early life, this study reinforces the importance of careful consideration in pediatric surgical planning and the need for strategies to reduce potential risks.

Reference:

Xin, A., Grobler, A., Bell, G., de Graaff, J. C., Dorris, L., Disma, N., McCann, M. E., Withington, D. E., & Davidson, A. J. (2024). Neurodevelopmental Outcomes After Multiple General Anaesthetic Exposure Before Five Years Of Age – A Cohort Study. In Anesthesiology. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/aln.0000000000005293

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Immediate versus Non-Immediate Loading: Study Finds Comparable Success in Overdenture Implant Treatments

China: A recent systematic review and meta-analysis comparing immediate versus non-immediate loading (NIL) protocols for reduced-diameter implants supporting overdentures has revealed promising findings for both treatment approaches.

The study, published in The International Journal of Oral & Maxillofacial Implants, concluded that immediate loading (IL) protocols can achieve comparable survival rates and marginal bone loss (MBL) outcomes compared to non-immediate loading protocols. The researchers noted that these results could have significant implications for planning and managing dental implants, particularly in cases requiring reduced-diameter implants for overdenture support.

Implantology has seen significant advancements in recent years, and loading protocols are an essential factor in the success of implant-supported overdentures. The primary difference between immediate loading and non-immediate loading lies in the timing of the prosthesis placement. In immediate loading, the overdenture is placed on the implants right after insertion, while in non-immediate loading, the prosthesis is applied after a healing period of several months. Both approaches have been used in clinical practice, with each having its advantages and challenges. However, the optimal protocol for reduced-diameter implants, which are often used in patients with limited bone availability, has been a topic of ongoing research.

Against the above background, researchers from China, led by Ying Liu, aimed to evaluate the impact of immediate loading versus non-immediate loading protocols on overdentures supported by reduced-diameter implants (≤ 3.5 mm).

For this purpose, the researchers conducted a comprehensive search of electronic databases, including MEDLINE (via PubMed), Embase, and the Cochrane Central Register of Controlled Trials, to identify randomized controlled trials (RCTs) comparing the clinical outcomes of immediately loaded and non-immediately loaded reduced-diameter implants supporting overdentures. The risk of bias within and across the studies was assessed using RoB 2.0, while the certainty of evidence was evaluated using the GRADE system.

A sensitivity analysis was performed by excluding studies at high risk of bias and repeating the data synthesis using the random effects model. Additionally, subgroup analyses were carried out based on implant diameter and follow-up duration.

The following were the key findings of the study:

  • Six RCTs with 255 patients were included in the systematic review.
  • Meta-analyses found similar implant survival rates between immediately loaded (IL) and non-immediately loaded (NIL) implants in the mini-implant subgroup (RR = 0.98) and narrow-diameter implant subgroup (RR = 0.99).
  • No significant difference in implant survival rates was observed in short-term (RR = 0.98) and long-term (RR = 0.97) follow-up subgroups.
  • Marginal bone loss showed no statistically significant difference between loading protocols in long-term follow-up (MD = 0.03).
  • Three RCTs investigating peri-implant parameters revealed relatively higher modified plaque index (PI) and probing depth (PD) in reduced-diameter implants under IL.

“The IL protocol, when compared to NIL, yields comparable survival rates and marginal bone loss (MBL) in reduced-diameter implants supporting overdentures,” the researchers concluded.

Reference:

Liu Y, He F, Zhao Y, Sun Q, Xia H, Xia D, Bai Y. Immediate Versus Non-immediate Loading Protocols for Reduced-Diameter Implants Supporting Overdentures: A Systematic Review and Meta-analysis. Int J Oral Maxillofac Implants. 2024 Oct 16;39(5):657-664. doi: 10.11607/jomi.10625. PMID: 38498788.

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Rotavirus vaccine is safe for use in NICU babies, researchers find

Researchers from Children’s Hospital of Philadelphia (CHOP) found that transmission of rotavirus vaccine strains in a neonatal intensive care unit (NICU) is rare and without clinical consequences, strongly suggesting that giving the rotavirus vaccine to eligible infants during their hospitalization provides immune benefits that outweigh any risks.

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Sugary drinks significantly raise cardiovascular disease risk, but occasional sweet treats don’t, scientists find

A little of what you fancy does you good… unless it’s a fizzy drink. Scientists studying the impact of sugar on the risk of cardiovascular disease have found that eating too much added sugar increases your risk of stroke or aneurysm, but eating a few treats is associated with a lower risk of cardiovascular diseases. Meanwhile, drinking sweetened beverages raises your risk of stroke, heart failure, and atrial fibrillation.

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New international guidelines announced for premature ovarian insufficiency

New guidelines on the diagnosis and management of premature ovarian insufficiency (POI)—developed by the Center for Research Excellence in Women’s Health in Reproductive Life (CRE-WHiRL) at Monash University, and key international women’s health organizations with an international team of experts including women with lived experience—have been published simultaneously in three journals, including Climacteric.

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