Comparing the treatment of endometriosis‐related pain by excision of endometriosis or hysterectomy: A multicentre prospective cohort study

Objective: To compare the effectiveness of endometriosis excision alone to excision plus hysterectomy, with and without bilateral oophorectomy, for endometriosis‐related symptoms. Design: Multicentre prospective cohort. Setting: Eighty‐six specialist endometriosis centres. Population: Women undergoing rectovaginal endometriosis surgery between 2009 and 2021. Methods: We performed multivariable regression with random effects for patient and centre, controlling for age, BMI, smoking, laparoscopic versus open approach and type of bowel surgery performed, with sensitivity analysis for loss to follow‐up. Main Outcome Measures: Pain scores, bowel symptoms and quality‐of‐life measures. Results: Compared to endometriosis excision alone, women undergoing hysterectomy with conservation of ovaries had greater improvement in non‐cyclical pain (MD: 1.41/10, 95% CI: 1.03–1.78, p < 0.001), dyspareunia (MD: 1.12/10, 95% CI: 0.71–1.53, p < 0.001), back pain (MD: 1.29/10, 95% CI: 0.92–1.67, p < 0.001) and quality‐of‐life scores (MD: 8.77/100, 95% CI: 5.79–11.75, p < 0.001) at 24 months post‐operatively. Women undergoing hysterectomy with bilateral oophorectomy also had greater improvement in non‐cyclical pelvic pain (MD: 2.22/10, 95% CI: 1.80–2.63, p < 0.001), dyspareunia (MD: 1.05/10, 95% CI: 0.59–1.52, p < 0.001), back pain (MD: 1.18/10, 95% CI: 0.77–1.59, p < 0.001) and quality of life (MD: 12.41/100, 95% CI: 9.07–15.74, p < 0.001) at 24 months compared to endometriosis excision alone. Compared to hysterectomy with ovarian conservation, hysterectomy with bilateral oophorectomy was associated with greater improvement in non‐cyclical pelvic pain (MD: 0.81/10, 95% CI: 0.32–1.30, p = 0.001) at 24 months and quality of life (MD: 3.74/100, 95% CI: 0.56–6.92, p = 0.021) at 12 months, although this result was sensitive to loss to follow‐up. Conclusions: Patients who undergo endometriosis excision plus hysterectomy experience greater improvement in pain and quality of life compared to those who have endometriosis excision alone. There are additional benefits of bilateral oophorectomy with hysterectomy, although its value is less clear due to loss of follow‐up

Research Journal of Pharmaceutical, Biological and Chemical Sciences Recent Advances in NDDS (Novel drug delivery systems) for delivery of Anti- HIV drugs

ABSTRACT Novel drug delivery systems present an opportunity for formulation scientists to overcome the many challenges associated with antiretroviral (ARV) drug therapy, thereby improving the management of patients with HIV/AIDS. Currently available Anti-HIV drugs can be classified into three categories: nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors. Most of these drugs bear some significant drawbacks such as relatively short half-life, low bioavailability, poor permeability and undesirable side effects. Efforts have been made to design drug delivery systems for antiHIV agents to: a) reduce the dosing frequency, b) increase the bioavailability and decrease the degradation/metabolism in the gastrointestinal tract, c) improve the CNS penetration and inhibit the CNS efflux, and d) deliver them to the target cells selectively with minimal side effects. This paper provides a comprehensive review of the various ARV delivery systems that have been developed for achieving sustained drug release kinetics, specifically targeting drugs to the macrophages, brain and gastric mucosa, and for addressing formulation difficulties such as poor solubility, stability and drug entrapment. Studies on the potential of systems for alternative routes of ARV drug administration, i.e, transdermal and buccal are also highlighted. The physico-chemical properties and the in vitro/in vivo performances of various systems such as sustained release tablets, ceramic implants, nanoparticles, nanocontainers, liposomes, emulsomes, aspasomes, microemulsions, nanopowders and Pheroid TM are summarised. Further studies that remain to be undertaken for formulation optimisation are also identified. This review highlights the significant potential that novel drug delivery systems have for the future effective treatment of HIV/AIDS patients on ARV drug therapy

Exploring the absorption and clinical effects of natural progesterone cream when used in isolation and in combination with oestradiol to form a continuous hormone replacement therapy

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Women's views on autologous cell-based therapy for post-obstetric incontinence

Aim: Fecal and urinary incontinence are devastating consequences of obstetric-related perineal injury. The aim of the present study is to determine acceptability to parous women of autologous cell-based therapy for fecal and urinary incontinence that arises due to pelvic diaphragm tearing during vaginal childbirth. Materials & methods: A multiple choice questionnaire survey was offered to 76 parous women at the Maternity Unit, University College Hospital, London, UK. Seventy completed questionnaires – response rate: 92%. Results: In total, 84% of women indicated a willingness to accept autologous cell-based therapy for obstetric injury-induced incontinence rather than surgery. Conclusion: These observational data provide an indication of likely acceptance of autologous cell-based therapies for birth injury incontinence and will help with designing new therapeutic approaches.The project was supported by grants from the UK Medical Research Council (MR/L002752/1), The Sir Halley Stewart Trust, The Henry Smith Charity, and the UCL Grand Challenge Studentship Scheme. The research was undertaken at UCL/UCLH which receives funding from the Department of Health's NIHR as a Comprehensive Biomedical Research Centre.Published versio