Ehkäisy raskaudenkeskeytyksen jälkeen

VertaisasrvioituKapseleita ja kierukoita tulisi suositella raskaudenkeskeytystä hakevalle naiselle keskeytyksen jälkeiseksi ehkäisyksi, koska ne ovat menetelmistä tehokkaimpia. Kaikkien ehkäisymenetelmien käyttö voidaan aloittaa välittömästi kirurgisen keskeytyksen yhteydessä. Kun keskeytys on lääkkeellinen, pilleri-, rengas-, laastari- ja kapseliehkäisy voidaan aloittaa keskeytyksen alkaessa. Raskauden keskeytyminen tulee varmistaa ennen kierukkaehkäisyn aloitusta

Seksuaaliväkivallan uhrin hoitopolku - ensimmäisen vuoden kokemukset Helsingin Seri-tukikeskuksesta

Vertaisarvioitu. English summary. Finnish summaryPeer reviewe

Risk factors and the choice of long-acting reversible contraception following medical abortion : effect on subsequent induced abortion and unwanted pregnancy

Objective: To analyse the post-abortion effect of long-acting reversible contraception (LARC) plans and initiation on the risk of subsequent unwanted pregnancy and abortion. Materials and methods: retrospective cohort study of 666 women who underwent medical abortion between January-May 2013 at Helsinki University Hospital, Finland. Altogether 159 (23.8%) women planning post-abortion use of levonorgestrel-releasing intrauterine system (LNG-IUS) participated in a randomized study and had an opportunity to receive the LNG-IUS free-of-charge from the hospital. The other 507 (76.2%) women planned and obtained their contraception according to clinical routine. Demographics, planned contraception, and LARC initiation at the time of the index abortion were collected. Data on subsequent abortions were retrieved from the Finnish Abortion Register and electronic patient files until the end of 2014. Results: During the 21 months ([median], IQR 20-22) follow-up, 54(8.1%) women requested subsequent abortions. When adjusted for age, previous pregnancies, deliveries, induced abortions and gestational-age, planning LARC for post-abortion contraception failed to prevent subsequent abortion (33 abortions/360 women, 9.2%) compared to other contraceptive plans (21/306, 6.9%) (HR 1.22, 95% CI 0.68-2.17). However, verified LARC initiation decreased the abortion rate (4 abortions/177 women, 2.3%) compared to women with uncertain LARC initiation status (50/489, 10.2%) (HR 0.17, 95% CI 0.06-0.48). When adjusted for LARC initiation status, age= 25 years (27/383, 7.0%, HR1.95, 95% CI 1.04-3.67). Conclusions: Initiation of LARC as part of abortion service at the time of medical abortion is an important means to prevent subsequent abortion, especially among young women.Peer reviewe

Kierukkaehkäisyn aloitus eri elämäntilanteissa

Vertaisarvioitu. English summary.Suositukset raskauden ehkäisystä ovat mullistuneet viime vuosina, kun pitkäaikaisen ehkäisyn eli kierukoiden ja ehkäisykapseleiden tehokkuus ja käyttäjätyytyväisyys myös väestötasolla on selvinnyt. Erityisesti kierukkaehkäisyn käyttöaiheet ja käyttäjäryhmät ovat laajentuneet. Kierukka on noussut synnyttämättömien ja nuorten naisten ensisijaisten ehkäisyvaihtoehtojen joukkoon. Uusimman tutkimus­näytön mukaan kierukkaehkäisy voidaan aloittaa myös keisarileikkauksen yhteydessä ja välittömästi alatiesynnytyksen tai lääkkeellisen raskaudenkeskeytyksen jälkeen, mikä luo mahdollisuuden tehostaa menetelmän käyttöä ja sujuvoittaa raskaudenehkäisypalveluiden tarjontaa entisestään. Kierukan asetusta tulisi tarjota matalalla kynnyksellä yhden käynnin periaatteella. Haasteena on optimoida palvelu­järjestelmä mahdollistamaan tämä.Suositukset raskauden ehkäisystä ovat mullistuneet viime vuosina, kun pitkäaikaisen ehkäisyn eli kierukoiden ja ehkäisykapseleiden tehokkuus ja käyttäjätyytyväisyys myös väestötasolla on selvinnyt. Erityisesti kierukkaehkäisyn käyttöaiheet ja käyttäjäryhmät ovat laajentuneet. Kierukka on noussut synnyttämättömien ja nuorten naisten ensisijaisten ehkäisyvaihtoehtojen joukkoon. Uusimman tutkimusnäytön mukaan kierukkaehkäisy voidaan aloittaa myös keisarileikkauksen yhteydessä ja välittömästi alatiesynnytyksen tai lääkkeellisen raskaudenkeskeytyksen jälkeen, mikä luo mahdollisuuden tehostaa menetelmän käyttöä ja sujuvoittaa raskaudenehkäisypalveluiden tarjontaa entisestään. Kierukan asetusta tulisi tarjota matalalla kynnyksellä yhden käynnin periaatteella. Haasteena on optimoida palvelujärjestelmä mahdollistamaan tämä

Drug absorption through a cell monolayer: a theoretical work on a non-linear three-compartment model

The subject of analysis is a non-linear three-compartment model, widely used in pharmacological absorption studies. It has been transformed into a general form, thus leading automatically to an appropriate approximation. This made the absorption profile accessible and expressions for absorption times, apparent permeabilities and equilibrium values were given. These findings allowed a profound analysis of results from non-linear curve fits and delivered the dependencies on the systems' parameters over a wide range of values. The results were applied to an absorption experiment with multidrug transporter-affected antibiotic CNV97100 on Caco-2 cell monolayers.Comment: 21 pages, 8 figures (v4: detailed definition of the treated model - additional information about limitations

Predicting the effect of prandial stage and particle size on absorption of ODM-204.

The prediction of absorption properties plays a key role in formulation development when the compound under development shows poor solubility and its absorption is therefore presumed to be solubility limited. In our work, we combined and compared data obtained from in vitro dissolution tests, transit intestinal model studies (TIM -1) and physiologically based pharmacokinetic modelling. Our aim was to determine the ability of these methods to predict performance of poorly soluble lipophilic weak base in vivo. The validity of the predictive methods was evaluated against the in vivo clinical pharmacokinetic (PK) data obtained after administration of the first test formulation, Tl. The aim of our study was to utilize the models in evaluating absorption properties of the second test formulation, T2, which has not yet been clinically administered. The compound in the studies was ODM-204, which is a novel, orally administered, investigational, nonsteroidal dual inhibitor of CYP17A1 and androgen receptor. Owing to its physicochemical properties ODM-204 is prone to low or variable bioavailability. The models examined provided congruent data on dose dependent absorption, food effect at a dose of 200 mg and on the effect of API (active pharmaceutical ingredient) particle size on absorption. Our study shows that the predictive tools of in vitro dissolution, TIM-1 system and the PBPK (physiologically based pharmacokinetic) simulation, showed predictive power of different mechanisms of bioavailability and together provided valuable information for decision making.Peer reviewe

First-in-human Phase 1 open label study of the BET inhibitor ODM-207 in patients with selected solid tumours

Background Bromodomain and extra-terminal domain (BET) proteins are reported to be epigenetic anti-cancer drug targets. This first-in-human study evaluated the safety, pharmacokinetics and preliminary anti-tumour activity of the BET inhibitor ODM-207 in patients with selected solid tumours. Methods This was an open-label Phase 1 study comprised of a dose escalation part, and evaluation of the effect of food on pharmacokinetics. ODM-207 was administered orally once daily. The dose escalation part was initiated with a dose titration in the initial cohort, followed by a 3 + 3 design. Results Thirty-five patients were treated with ODM-207, of whom 12 (34%) had castrate-resistant prostate cancer. One dose-limiting toxicity of intolerable fatigue was observed. The highest studied dose achieved was 2 mg/kg due to cumulative toxicity observed beyond the dose-limiting toxicity (DLT) treatment window. Common AEs included thrombocytopenia, asthenia, nausea, anorexia, diarrhoea, fatigue, and vomiting. Platelet count decreased proportionally to exposure with rapid recovery upon treatment discontinuation. No partial or complete responses were observed. Conclusions ODM-207 shows increasing exposure in dose escalation and was safe at doses up to 2 mg/kg but had a narrow therapeutic window.Peer reviewe

How to stop disproportionation of a hydrochloride salt of a very weakly basic compound in a non-clinical suspension formulation

Our objectives were to stabilize a non-clinical suspension for use in toxicological studies and to develop methods to investigate the stability of the formulation in terms of salt disproportionation. The compound under research was a hydrochloride salt of a practically insoluble discovery compound ODM-203. The first of the three formulation approaches was a suspension prepared and stored at room temperature. The second formulation was stabilized by pH adjustment. In the third approach cooling was used to prevent salt disproportionation. 5 mg/mL aqueous suspension consisting of 20 mg/mL PVP/VA and 5 mg/mL Tween 80 was prepared for each of the approaches. The polymer was used as precipitation inhibitor to provide prolonged supersaturation while Tween 80 was used to enhance dissolution and homogeneity of the suspension. The consequences of salt disproportionation were studied by a small-scale in vitro dissolution method and by an in vivo pharmacokinetic study in rats. Our results show that disproportionation was successfully suppressed by applying cooling of the suspension in an ice bath at 2-8 degrees C. This procedure enabled us to proceed to the toxicological studies in rats. The in vivo study results obtained for the practically insoluble compound showed adequate exposures with acceptable variation at each dose level.Peer reviewe