Use of misoprostol prior to hysteroscopy in postmenopausal women: A randomized, placebo-controlled clinical trial

Study Objective: To compare results of diagnostic hysteroscopy in postmenopausal women using misoprostol for cervical ripening. Design: A randomized, placebo-controlled clinical trial (Canadian Task Force classification Ib). Setting: Hospital Barao de Lucena, Instituto Materno Infantil de Pernambuco. Patients: One hundred-twenty postmenopausal women. Intervention: Postmenopausal women received 200 mu g of vaginal misoprostol or placebo before hysteroscopy. Measurements and Main Results: Variables measured were procedure time, frequency of hysteroscopy carried out in each group (misoprostol and placebo), degree of pain during procedure, need for dilation, side effects, and complications of hysteroscopy. The chi(2), Fisher's exact, and Mann-Whitney tests were used and considered significant when alpha error was <5%. There were similarities between the groups in age (p = .09), body mass index (p = .55), time since menopause (p = .52), and genital bleeding (p = .52). Pain during the procedure, as measured by visual analog scale, was less severe in the misoprostol group than in the placebo group (median of 05 vs 07, p = .02), but there were similarities in duration (2.4 min vs 2.0 min, p = .3), pain during procedure and biopsy (p = .74 vs p = .19), need for dilation (p = .66), side effects, and complications. There were no differences in severity of post-procedure pain. Conclusions: Previous use of misoprostol reduced pain severity during hysteroscopy.151677

Use Of Misoprostol Prior To Hysteroscopy In Postmenopausal Women: A Randomized, Placebo-controlled Clinical Trial

Study Objective: To compare results of diagnostic hysteroscopy in postmenopausal women using misoprostol for cervical ripening. Design: A randomized, placebo-controlled clinical trial (Canadian Task Force classification Ib). Setting: Hospital Barão de Lucena, Instituto Materno Infantil de Pernambuco. Patients: One hundred-twenty postmenopausal women. Intervention: Postmenopausal women received 200 μg of vaginal misoprostol or placebo before hysteroscopy. Measurements and Main Results: Variables measured were procedure time, frequency of hysteroscopy carried out in each group (misoprostol and placebo), degree of pain during procedure, need for dilation, side effects, and complications of hysteroscopy. The χ2, Fisher's exact, and Mann-Whitney tests were used and considered significant when alpha error was &lt;5%. There were similarities between the groups in age (p = .09), body mass index (p = .55), time since menopause (p = .52), and genital bleeding (p = .52). Pain during the procedure, as measured by visual analog scale, was less severe in the misoprostol group than in the placebo group (median of 05 vs 07, p = .02), but there were similarities in duration (2.4 min vs 2.0 min, p = .3), pain during procedure and biopsy (p = .74 vs p = .19), need for dilation (p = .66), side effects, and complications. There were no differences in severity of post-procedure pain. Conclusions: Previous use of misoprostol reduced pain severity during hysteroscopy. © 2008 AAGL.1516773Song, J., Use of misoprostol in obstetrics and gynecology (2000) Obstet Gynecol Surv, 55, pp. 503-510Hofmeyr, G.J., Gulmezoglu, A.M., Vaginal misoprostol for cervical ripening and induction of labor (Cochrane Review) (2002) The Cochrane Library, p. 2. , Update Software, OxfordMuzonzini, G., Hofmeyr, G.J., Buccal or sublingual misoprostol for cervical ripening and induction of labour (Cochrane Review) (2006) The Cochrane Library, p. 1. , Update Software, OxfordBlanchard, K., Clark, S., Winikoff, B., Gaines, G., Kabani, G., Shannon, C., Misoprostol for women's health: a review (2002) Obstet Gynecol, 99, pp. 316-332Arias, F., Pharmacology of oxytocin and prostaglandins (2000) Clin Obstet Gynecol, 43, pp. 455-468Bisharah, M., A randomized trial of sublingual misoprostol for cervical priming before hysteroscopy (2003) J Am Gynecol Laparosc, 10, pp. 390-391Schoenhard, G., Oppermann, J., Kohn, F.E., Metabolism and pharmacokinetic studies of misoprostol (1985) Dig Dis Sci, 30, pp. 126-128Zieman, M., Fong, S.K., Benowitz, N.L., Banskter, D., Darney, P.D., Absorption kinetics of misoprostol with oral or vaginal administration (1997) Obstet Gynecol, 90, pp. 88-92Moraes Filho, O.B., Albuquerque, R.M., Pacheco, A.J., Misoprostol sublingual versus vaginal para indução do parto a termo (2005) Revista Brasileira de Ginecologia e Obstetricia, 27, pp. 24-31Preutthipan, S., Herabutya, Y., A randomized controlled trial of vaginal misoprostol for cervical priming before hysteroscopy (1999) Obstet Gynecol, 94, pp. 427-430Machado, M.K.N., Pina, H., Matos, E., Acurácia da histeroscopia na avaliação da cavidade uterina em pacientes com sangramento uterino pós-menopausa (2003) Revista Brasileira de Ginecologia e Obstetricia, 25, pp. 237-241Scavuzzi, A., Amorim, M., Pinho Neto, J.S., Santos, L.S., Comparação entre os achados ultra-sonográficos, histeroscópicos e histopatológicos no sangramento uterino da pós-menopausa (2003) Revista Brasileira de Ginecologia e Obstetricia, 25, pp. 229-235Pinto-Neto, A.M., Costa Paiva, L.H.S., Fonsech-Carvasan, G.H., (2003) Menopausa: Diagnóstico e Tratamento. 1st ed., pp. 23-29. , São PauloPropst, A.M., Libermam, R.F., Harlow, B.L., Ginsburg, E.S., Complications of hysteroscopy surgery: predicting patients at risk (2000) Obstet Gynecol, 96, pp. 517-520Jansen, F.W., Vredevoogd, C.B., Von Ulzen, K., Hermans, J., Trimbos, J.B., Trimbos-Kemper, T.C., Complications of hysteroscopy: a prospective, multicenter study (2000) Obstet Gynecol, 96, pp. 266-270Spirlet, M.B., Use of misoprostol in gynecology and obstetrics (2002) Gynecol Obstet Fertil, 30, pp. 317-324Barcaite, A., Bartusevicius, D.R., Railaite, R., Nadisauskiene, R., Vaginal misoprostol for cervical priming before hysteroscopy in perimenopausal and postmenopausal women (2005) Int J Gynaecol Obstet, 91, pp. 141-145George, A.V., Basim, A.R., New developments in ambulatory hysteroscopic surgery (2005) Baillieres Best Pract Res Clin Obstet Gynaecol, 19, pp. 727-742Fleiss, W., (1981) Statistical Methods for Rates and Proportions, pp. 38-45. , Wiley, AtlantaTantini, C., Técnica do exame de histeroscopia (2002) Histeroscopia Diagnóstica, pp. 119-128. , Mencaglia L., and Albuquerque Neto L.C. (Eds), Medsi, São PauloCollins, S.L., Moore, R.A., McQuay, H.J., The visual analogue pain intensity scale: what is moderate pain in millimeters? (1997) Rev Pain, 95, pp. 95-97Magram, A.J., Horan, T.C., Pearson, M.L., Silver, L.C., Jarvis, W.R., Guideline for prevention of surgical site infection, 1999: Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee (1999) Am J Infect Control, 27, pp. 97-132Ngai, S.W., Chan, Y.M., Ho, P.C., The use of misoprostol prior to hysteroscopy in postmenopausal woman (2001) European Society of Human Reproduction and Embryology, 16, pp. 1486-1488Perez-Medina, T., Bajo, M.J., Martinez-Cortes, L., Castellanos, P., Perez de Avila, I., Six thousand office diagnostic-operative hysteroscopies (2000) Obstet Gynecol, 71, pp. 33-38Karim, A., Antiulcer prostaglandin misoprostol: single and multiple dose pharmacokinetic profile (1987) Prostaglandins, 33, pp. 40-50Schoenhard, G., Oppermann, J., Kohn, F.E., Metabolism and pharmacokinetic studies of misoprostol (1985) Dig Dis Sci, 30, pp. 126-128Thomas, A.J., Leyland, N., Durand, N., Windrin, R.C., The use of misoprostol as a cervical ripening agent in operative hysteroscopy: a double-blind, placebo-controlled trial (2002) Am J Obstet Gynecol, 186, pp. 876-879Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenberg, W., Haynes, R.B., (2000) Evidence-Based Medicine. How to Practice and Teach EBM. 2nd ed., , Churchill Livingstone, TorontoMoher, D., Schultz, K.F., Altman, D.G., The consort statement: revised recommendations for improvising the quality of reports of parallel-group randomised trials (2001) Lancet, 357, pp. 1191-119

Cytokines in systemic lupus erythematosus: Far beyond Th1/Th2 dualism lupus: Cytokine profiles

The aims of this study were to delineate cytokine profiles of systemic lupus erythematosus (SLE), construct prediction models for diagnosis and disease activity using those profiles, and to examine the associations between TNFB Ncol polymorphism, body mass index (BMI) and Vitamin D levels with cytokine levels. Two hundred SLE patients and 196 healthy controls participated in this case-control study. Plasma cytokines levels of tumor necrosis factor (TNF)-α, interferon (IFN)-γ 3, interleukin (IL)-1β, IL- 4, IL-6, IL-10, IL-12 and IL-17 were measured and cytokines profiles were computed. IL-6, IL-12, IL-17, IFN-γ 3 and IL-10 levels were significantly higher in SLE, while IL-4 was lower in SLE. The Th1/Th2 and Th1+Th17/Th2 profiles were significantly higher in SLE than in healthy controls, whereas there were no significant differences in the proinflammatory cytokine profile (TNFα+IL-6+IL-1β). In total, 90.4% of all subjects were correctly classified using Th1+Th17 profile and IL-10 (positively associated) and IL-4 (negatively associated) as predictor variables (sensitivity=66.7% and specificity=96.9%). In all, 20.9% of the variance in the SLE Disease Activity Index was predicted by the Th1+Th17/Th2 ratio, IL-10 and BMI (all positively) and proinflammatory profile (inversely associated). B1/B1 genotype is accompanied by increased IL-17 and Th17/Th2 ratio, while B1/B2 genotype is accompanied by higher IL-4 and IFNγ 3 values. 25-OH Vitamin D was inversely associated with IFN-γ 3 levels. SLE is accompanied by Th1, Th17 and Treg profile and lowered IL-4 production. Lowered Vitamin D levels and B1/B1 genotype, but not BMI, contribute to changes in cytokines profiles. Future treatments should target Th1, Th2 and Th17 profiles rather than inflammatory cytokines

Increased lipid and protein oxidation and lowered anti-oxidant defenses in systemic lupus erythematosus are associated with severity of illness, autoimmunity, increased adhesion molecules, and Th1 and Th17 immune shift

This study investigated nitro-oxidative stress in patients with systemic lupus erythematosus (SLE) in association with disease activity, immune-inflammatory biomarkers, and adhesion molecules. Two-hundred-four patients with SLE and 256 healthy volunteers were enrolled in this case-control study, which measured nitro-oxidative stress biomarkers, including lipid peroxides (LOOH), advanced oxidation protein products (AOPPs), nitric oxide metabolites (NOx), sulfhydryl (−SH) groups, products of deoxyribonucleic acid (DNA)/ribonucleic acid (RNA) oxidative degradation, and total radical-trapping anti-oxidant parameter (TRAP). Also measured were anti-nuclear antibodies (ANAs), antibodies against double-stranded DNA (dsDNA), plasma levels of diverse cytokines, C-reactive protein, and adhesion molecules. LOOH (p < 0.001) and AOPP (p < 0.001) were significantly higher, while TRAP was significantly lower (p < 0.001) in SLE patients than in controls. AOPP and LOOH were significantly and positively associated with SLE disease activity index (SLEDAI) scores, anti-nuclear antibodies, and antibodies against double-stranded DNA (anti-dsDNA) levels, while TRAP was significantly and inversely correlated with SLEDAI, ANA, and dsDNA antibody levels. There were significant positive associations between AOPP and LOOH and immune-inflammatory markers, indicating T helper (Th)-17 and Th1 bias and Th1 + Th17/Th2 ratio (p = 0.002 and p = 0.001, respectively). AOPP and LOOH (positively) and TRAP (inversely) were associated with adhesion molecule expression. A model predicting SLE was computed showing that, using LOOH, AOPP, NOx, adhesion molecules, and body mass index, 94.2% of the patients were correctly classified with a specificity of 91.5%. Increased nitro-oxidative stress takes part in the (auto)immune pathophysiology of SLE and modulates severity of illness and adhesion molecule expression

Increased lipid and protein oxidation and lowered anti-oxidant defenses in systemic lupus erythematosus are associated with severity of illness, autoimmunity, increased adhesion molecules, and Th1 and Th17 immune shift

This study investigated nitro-oxidative stress in patients with systemic lupus erythematosus (SLE) in association with disease activity, immune-inflammatory biomarkers, and adhesion molecules. Two-hundred-four patients with SLE and 256 healthy volunteers were enrolled in this case-control study, which measured nitro-oxidative stress biomarkers, including lipid peroxides (LOOH), advanced oxidation protein products (AOPPs), nitric oxide metabolites (NOx), sulfhydryl (−SH) groups, products of deoxyribonucleic acid (DNA)/ribonucleic acid (RNA) oxidative degradation, and total radical-trapping anti-oxidant parameter (TRAP). Also measured were anti-nuclear antibodies (ANAs), antibodies against double-stranded DNA (dsDNA), plasma levels of diverse cytokines, C-reactive protein, and adhesion molecules. LOOH (p < 0.001) and AOPP (p < 0.001) were significantly higher, while TRAP was significantly lower (p < 0.001) in SLE patients than in controls. AOPP and LOOH were significantly and positively associated with SLE disease activity index (SLEDAI) scores, anti-nuclear antibodies, and antibodies against double-stranded DNA (anti-dsDNA) levels, while TRAP was significantly and inversely correlated with SLEDAI, ANA, and dsDNA antibody levels. There were significant positive associations between AOPP and LOOH and immune-inflammatory markers, indicating T helper (Th)-17 and Th1 bias and Th1 + Th17/Th2 ratio (p = 0.002 and p = 0.001, respectively). AOPP and LOOH (positively) and TRAP (inversely) were associated with adhesion molecule expression. A model predicting SLE was computed showing that, using LOOH, AOPP, NOx, adhesion molecules, and body mass index, 94.2% of the patients were correctly classified with a specificity of 91.5%. Increased nitro-oxidative stress takes part in the (auto)immune pathophysiology of SLE and modulates severity of illness and adhesion molecule expression