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[PMID]:27771050
[Au] Autor:Kirtane AR; Langer R; Traverso G
[Ad] Endereço:Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139; The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139.
[Ti] Título:Past, Present, and Future Drug Delivery Systems for Antiretrovirals.
[So] Source:J Pharm Sci;105(12):3471-3482, 2016 Dec.
[Is] ISSN:1520-6017
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The human immunodeficiency virus has infected millions of people and the epidemic continues to grow rapidly in some parts of the world. Antiretroviral (ARV) therapy has provided improved treatment and prolonged the life expectancy of patients. Moreover, there is growing interest in using ARVs to protect against new infections. Hence, ARVs have emerged as our primary strategy in combating the virus. Unfortunately, several challenges limit the optimal performance of these drugs. First, ARVs often require life-long use and complex dosing regimens. This results in low patient adherence and periods of lapsed treatment manifesting in drug resistance. This has prompted the development of alternate dosage forms such as vaginal rings and long-acting injectables that stand to improve patient adherence. Another problem central to therapeutic failure is the inadequate penetration of drugs into infected tissues. This can lead to incomplete treatment, development of resistance, and viral rebound. Several strategies have been developed to improve drug penetration into these drug-free sanctuaries. These include encapsulation of drugs in nanoparticles, use of pharmacokinetic enhancers, and cell-based drug delivery platforms. In this review, we discuss issues surrounding ARV therapy and their impact on drug efficacy. We also describe various drug delivery-based approaches developed to overcome these issues.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/administração & dosagem
Antirretrovirais/administração & dosagem
Terapia Antirretroviral de Alta Atividade/tendências
Sistemas de Liberação de Medicamentos/tendências
[Mh] Termos MeSH secundário: Animais
Terapia Antirretroviral de Alta Atividade/métodos
Dispositivos Anticoncepcionais Femininos/tendências
Formas de Dosagem
Sistemas de Liberação de Medicamentos/métodos
Previsões
Infecções por HIV/diagnóstico
Infecções por HIV/tratamento farmacológico
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anti-HIV Agents); 0 (Anti-Retroviral Agents); 0 (Dosage Forms)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171201
[Lr] Data última revisão:
171201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:28982161
[Au] Autor:Smith JM; Moss JA; Srinivasan P; Butkyavichene I; Gunawardana M; Fanter R; Miller CS; Sanchez D; Yang F; Ellis S; Zhang J; Marzinke MA; Hendrix CW; Kapoor A; Baum MM
[Ad] Endereço:Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
[Ti] Título:Novel multipurpose pod-intravaginal ring for the prevention of HIV, HSV, and unintended pregnancy: Pharmacokinetic evaluation in a macaque model.
[So] Source:PLoS One;12(10):e0185946, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Globally, women bear an uneven burden for sexual HIV acquisition. Results from two clinical trials evaluating intravaginal rings (IVRs) delivering the antiretroviral agent dapivirine have shown that protection from HIV infection can be achieved with this modality, but high adherence is essential. Multipurpose prevention technologies (MPTs) can potentially increase product adherence by offering protection against multiple vaginally transmitted infections and unintended pregnancy. Here we describe a coitally independent, long-acting pod-IVR MPT that could potentially prevent HIV and HSV infection as well as unintended pregnancy. The pharmacokinetics of MPT pod-IVRs delivering tenofovir alafenamide hemifumarate (TAF2) to prevent HIV, acyclovir (ACV) to prevent HSV, and etonogestrel (ENG) in combination with ethinyl estradiol (EE), FDA-approved hormonal contraceptives, were evaluated in pigtailed macaques (N = 6) over 35 days. Pod IVRs were exchanged at 14 days with the only modification being lower ENG release rates in the second IVR. Plasma progesterone was monitored weekly to determine the effect of ENG/EE on menstrual cycle. The mean in vivo release rates (mg d-1) for the two formulations over 30 days ranged as follows: TAF2 0.35-0.40; ACV 0.56-0.70; EE 0.03-0.08; ENG (high releasing) 0.63; and ENG (low releasing) 0.05. Mean peak progesterone levels were 4.4 ± 1.8 ng mL-1 prior to IVR insertion and 0.075 ± 0.064 ng mL-1 for 5 weeks after insertion, suggesting that systemic EE/ENG levels were sufficient to suppress menstruation. The TAF2 and ACV release rates and resulting vaginal tissue drug concentrations (medians: TFV, 2.4 ng mg-1; ACV, 0.2 ng mg-1) may be sufficient to protect against HIV and HSV infection, respectively. This proof of principle study demonstrates that MPT-pod IVRs could serve as a potent biomedical prevention tool to protect women's sexual and reproductive health and may increase adherence to HIV PrEP even among younger high-risk populations.
[Mh] Termos MeSH primário: Antivirais/administração & dosagem
Dispositivos Anticoncepcionais Femininos
Infecções por HIV/prevenção & controle
Herpes Genital/prevenção & controle
Gravidez não Planejada
[Mh] Termos MeSH secundário: Administração Intravaginal
Animais
Antivirais/farmacocinética
Feminino
Seres Humanos
Macaca nemestrina
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antiviral Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171006
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185946


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[PMID]:28927899
[Au] Autor:Dantas PRS; Maestá I; Filho JR; Junior JA; Elias KM; Howoritz N; Braga A; Berkowitz RS
[Ad] Endereço:Department of Gynecology and Obstetrics, Botucatu Medical School, Postgraduate Program of Gynecology, Obstetrics and Mastology of São Paulo State University. Rubião Júnior District, Botucatu, São Paulo, Brazil; Rio de Janeiro Trophoblastic Disease Center, Brazilian Association of Gestational Trophob
[Ti] Título:Does hormonal contraception during molar pregnancy follow-up influence the risk and clinical aggressiveness of gestational trophoblastic neoplasia after controlling for risk factors?
[So] Source:Gynecol Oncol;147(2):364-370, 2017 Nov.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the influence of hormonal contraception (HC) on the development and clinical aggressiveness of gestational trophoblastic neoplasia (GTN) and the time for normalization of human chorionic gonadotropin (hCG) levels. METHODS: A retrospective cohort study was conducted with women diagnosed with molar pregnancy, followed at the Rio de Janeiro Trophoblastic Disease Center, between January 2005 and January 2015. The occurrence of postmolar GTN and the time for hCG normalization between users of HC or barrier methods (BM) during the postmolar follow-up or GTN treatment were evaluated. RESULTS: Among 2828 patients included in this study, 2680 (95%) used HC and 148 (5%) used BM. The use of HC did not significantly influence the occurrence of GTN (ORa: 0.66, 95% CI: 0.24-1.12, p=0.060), despite different formulations: progesterone-only (ORa: 0.54, 95% CI: 0.29-1.01, p=0.060) or combined oral contraception (COC) (ORa: 0.50, 95% CI: 0.27-1.01, p=0.60) or with different dosages of ethinyl estradiol: 15mcg (ORa, 1.33, 95% CI 0.79-2.24, p=0.288), 20mcg (ORa: 1.02, 95% CI: 0.64-1.65, p=0.901), 30mcg (ORa: 1.17, 95% CI: 0.78-1.75, p=0.437) or 35mcg (ORa: 0.77, 95% CI: 0.42-1.39, p=0.386). Time to hCG normalization ≥10weeks (ORa: 0.58, 95% CI: 0.43-1.08, p=0.071) or time to remission with chemotherapy≥14weeks (ORa: 0.60, 95% CI: 0.43-1.09, p=0.067) did not significantly differ among HC users when compared to patients using BM, when controlling for other risk factors using multivariate logistic regression. CONCLUSIONS: The use of HC during postmolar follow-up or GTN treatment does not seem to increase the risk of GTN or its severity and does not postpone the normalization of hCG levels.
[Mh] Termos MeSH primário: Anticoncepcionais Orais Hormonais/administração & dosagem
Doença Trofoblástica Gestacional/epidemiologia
Mola Hidatiforme/terapia
[Mh] Termos MeSH secundário: Adulto
Gonadotropina Coriônica/sangue
Estudos de Coortes
Dispositivos Anticoncepcionais Femininos
Anticoncepcionais Orais Hormonais/efeitos adversos
Feminino
Seguimentos
Doença Trofoblástica Gestacional/sangue
Doença Trofoblástica Gestacional/etiologia
Doença Trofoblástica Gestacional/patologia
Seres Humanos
Mola Hidatiforme/sangue
Mola Hidatiforme/cirurgia
Gravidez
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Chorionic Gonadotropin); 0 (Contraceptives, Oral, Hormonal)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171108
[Lr] Data última revisão:
171108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170921
[St] Status:MEDLINE


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[PMID]:28708847
[Au] Autor:Stalter RM; Tharaldson J; Owen DH; Okumu E; Moench T; Mack N; Tolley EE; MacQueen KM
[Ad] Endereço:Contraceptive Technology Innovation Department, FHI 360, Durham, North Carolina, United States of America.
[Ti] Título:Attitudes and perceptions towards novel objective measures of ARV-based vaginal ring use: Results from a global stakeholder survey.
[So] Source:PLoS One;12(7):e0180963, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Results of recent microbicide and pre-exposure prophylaxis clinical trials have shown adherence to be a significant challenge with new HIV prevention technologies. As the vaginal ring containing dapivirine moves into two open label follow-on studies (HOPE/MTN-025 and DREAM) and other antiretroviral-based and multi-purpose prevention technology ring products advance through the development pipeline, there is a need for more accurate and reliable measures of adherence to microbicide ring products. We previously conducted a comprehensive landscape analysis to identify new technologies that could be applied to adherence measurement of vaginal rings containing antiretrovirals. To explore attitudes and perceptions towards the approaches that we identified, we conducted a survey of stakeholders with experience and expertise in microbicide and HIV prevention clinical trials. From May to July 2015 an electronic survey was distributed via email to 894 stakeholders; a total of 206 eligible individuals responded to at least one question and were included in the data analysis. Survey respondents were presented with various objective measures and asked about their perceived acceptability to trial participants, feasibility of implementation by study staff, usefulness for measuring adherence and ethical concerns. Methods that require no additional input from the participant and require no modifications to the existing ring product (i.e., measurement of residual drug or excipient, or a vaginal analyte that enters the ring) were viewed as being more acceptable to trial participants and more feasible to implement in the field. Respondents saw value in using objective measures to provide real-time feedback on adherence. However, approaches that involve unannounced home visits for sample collection or spot checks of ring use, which could provide significant value to adherence feedback efforts, were met with skepticism. Additional research on the acceptability of these methods to potential trial participants and trial staff is recommended.
[Mh] Termos MeSH primário: Antirretrovirais/análise
Atitude
Dispositivos Anticoncepcionais Femininos
Percepção
[Mh] Termos MeSH secundário: Adolescente
Adulto
Antirretrovirais/sangue
Antirretrovirais/uso terapêutico
Correio Eletrônico
Feminino
Infecções por HIV/prevenção & controle
Cabelo/química
Seres Humanos
Masculino
Pirimidinas/análise
Pirimidinas/sangue
Pirimidinas/uso terapêutico
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Retroviral Agents); 0 (Pyrimidines); TCN4MG2VXS (Dapivirine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0180963


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[PMID]:28594946
[Au] Autor:Hardy L; Jespers V; De Baetselier I; Buyze J; Mwambarangwe L; Musengamana V; van de Wijgert J; Crucitti T
[Ad] Endereço:HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
[Ti] Título:Association of vaginal dysbiosis and biofilm with contraceptive vaginal ring biomass in African women.
[So] Source:PLoS One;12(6):e0178324, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We investigated the presence, density and bacterial composition of contraceptive vaginal ring biomass and its association with the vaginal microbiome. Of 415 rings worn by 120 Rwandese women for three weeks, the biomass density was assessed with crystal violet and the bacterial composition of biomass eluates was assessed with quantitative polymerase chain reaction (qPCR). The biomass was visualised after fluorescence in situ hybridisation (FISH) and with scanning electron microscopy (SEM). The vaginal microbiome was assessed with Nugent scoring and vaginal biofilm was visualised after FISH. All vaginal rings were covered with biomass (mean optical density (OD) of 3.36; standard deviation (SD) 0.64). Lactobacilli were present on 93% of the rings, Gardnerella vaginalis on 57%, and Atopobium vaginae on 37%. The ring biomass density was associated with the concentration of A. vaginae (OD +0.03; 95% confidence interval (CI) 0.01-0.05 for one log increase; p = 0.002) and of G. vaginalis (OD +0.03; (95% CI 0.01-0.05; p = 0.013). The density also correlated with Nugent score: rings worn by women with a BV Nugent score (mean OD +0.26), and intermediate score (mean OD +0.09) had a denser biomass compared to rings worn by participants with a normal score (p = 0.002). Furthermore, presence of vaginal biofilm containing G. vaginalis (p = 0.001) and A. vaginae (p = 0.005) correlated with a denser ring biomass (mean OD +0.24 and +0.22 respectively). With SEM we observed either a loose network of elongated bacteria or a dense biofilm. We found a correlation between vaginal dysbiosis and the density and composition of the ring biomass, and further research is needed to determine if these relationships are causal. As multipurpose vaginal rings to prevent pregnancy, HIV, and other sexually transmitted diseases are being developed, the potential impact of ring biomass on the vaginal microbiota and the release of active pharmaceutical ingredients should be researched in depth.
[Mh] Termos MeSH primário: Biofilmes/crescimento & desenvolvimento
Dispositivos Anticoncepcionais Femininos
Disbiose/microbiologia
Vagina/microbiologia
[Mh] Termos MeSH secundário: Adulto
África
Biomassa
Feminino
Gardnerella vaginalis/patogenicidade
Seres Humanos
Microbiota/fisiologia
Microscopia Eletrônica de Varredura
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170609
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0178324


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[PMID]:28542081
[Au] Autor:Balkus JE; Palanee-Phillips T; Reddy K; Siva S; Harkoo I; Nakabiito C; Kintu K; Nair G; Chappell C; Kiweewa FM; Kabwigu S; Naidoo L; Jeenarain N; Marzinke M; Soto-Torres L; Brown ER; Baeten JM
[Ad] Endereço:*Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Departments of †Epidemiology; ‡Global Health, University of Washington, Seattle, WA; §Wits Reproductive Health and HIV Institute, Johannesburg, South Africa; ‖South African Medical Research Council, Durban, South Africa; ¶CAPRISA, Durban, South Africa; #Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda; **Emavundleni Research Centre, Cape Town, South Africa; ††Magee-Womens Hospital of UPMC, Pittsburgh, PA; ‡‡Departments of Pathology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; §§US National Institutes of Health, Bethesda, MD; and Departments of ‖‖Biostatistics; ¶¶Medicine, University of Washington, Seattle, WA.
[Ti] Título:Brief Report: Dapivirine Vaginal Ring Use Does Not Diminish the Effectiveness of Hormonal Contraception.
[So] Source:J Acquir Immune Defic Syndr;76(2):e47-e51, 2017 Oct 01.
[Is] ISSN:1944-7884
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the potential for a clinically relevant drug-drug interaction with concomitant use of a dapivirine vaginal ring, a novel antiretroviral-based HIV-1 prevention strategy, and hormonal contraception by examining contraceptive efficacies with and without dapivirine ring use. DESIGN: A secondary analysis of women participating in MTN-020/ASPIRE, a randomized, double-blind, placebo-controlled trial of the dapivirine vaginal ring for HIV-1 prevention. METHODS: Use of a highly effective method of contraception was an eligibility criterion for study participation. Urine pregnancy tests were performed monthly. Pregnancy incidence by arm was calculated separately for each hormonal contraceptive method and compared using an Andersen-Gill proportional hazards model stratified by site and censored at HIV-1 infection. RESULTS: Of 2629 women enrolled, 2310 women returned for follow-up and reported using a hormonal contraceptive method at any point during study participation (1139 in the dapivirine arm and 1171 in the placebo arm). Pregnancy incidence in the dapivirine arm versus placebo among women using injectable depot medroxyprogesterone acetate was 0.43% vs. 0.54%, among women using injectable norethisterone enanthate was 1.15% vs. 0%, among women using hormonal implants was 0.22% vs. 0.69%, and among women using oral contraceptive pills was 32.26% vs. 28.01%. Pregnancy incidence did not differ by study arm for any of the hormonal contraceptive methods. CONCLUSIONS: Use of the dapivirine ring does not reduce the effectiveness of hormonal contraceptives for pregnancy prevention. Oral contraceptive pill use was associated with high pregnancy incidence, potentially because of poor pill adherence. Injectable and implantable methods were highly effective in preventing pregnancy.
[Mh] Termos MeSH primário: Antirretrovirais/administração & dosagem
Anticoncepção
Anticoncepcionais Femininos/administração & dosagem
Dispositivos Anticoncepcionais Femininos
Pirimidinas/administração & dosagem
[Mh] Termos MeSH secundário: Adolescente
Adulto
Antirretrovirais/farmacologia
Anticoncepcionais Femininos/farmacologia
Anticoncepcionais Orais Hormonais/administração & dosagem
Anticoncepcionais Orais Hormonais/farmacologia
Método Duplo-Cego
Interações Medicamentosas
Feminino
Seguimentos
Infecções por HIV/tratamento farmacológico
Infecções por HIV/prevenção & controle
Seres Humanos
Incidência
Acetato de Medroxiprogesterona/administração & dosagem
Acetato de Medroxiprogesterona/farmacologia
Meia-Idade
Noretindrona/administração & dosagem
Noretindrona/análogos & derivados
Noretindrona/farmacologia
Gravidez
Pirimidinas/farmacologia
Adulto Jovem
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anti-Retroviral Agents); 0 (Contraceptive Agents, Female); 0 (Contraceptives, Oral, Hormonal); 0 (Pyrimidines); C2QI4IOI2G (Medroxyprogesterone Acetate); HY3S2K0J0F (norethindrone enanthate); T18F433X4S (Norethindrone); TCN4MG2VXS (Dapivirine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE
[do] DOI:10.1097/QAI.0000000000001455


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[PMID]:28432791
[Au] Autor:Sothornwit J; Werawatakul Y; Kaewrudee S; Lumbiganon P; Laopaiboon M
[Ad] Endereço:Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
[Ti] Título:Immediate versus delayed postpartum insertion of contraceptive implant for contraception.
[So] Source:Cochrane Database Syst Rev;4:CD011913, 2017 Apr 22.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The spacing of pregnancies has a positive impact on maternal and newborn health. The progestin contraceptive implant, which is a long-acting, reversible method of contraception, has a well-established low failure rate that is compatible with tubal sterilization. The standard provision of contraceptive methods on the first postpartum visit may put some women at risk of unintended pregnancy, either due to loss to follow-up or having sexual intercourse prior to receiving contraception. Therefore, the immediate administration of contraception prior to discharge from the hospital that has high efficacy may improve contraceptive prevalence and prevent unintended pregnancy. OBJECTIVES: To compare the initiation rate, effectiveness, and side effects of immediate versus delayed postpartum insertion of implant for contraception. SEARCH METHODS: We searched for eligible studies up to 28 October 2016 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and POPLINE. We examined review articles and contacted investigators. We also checked registers of ongoing clinical trials, citation lists of included studies, key textbooks, grey literature, and previous systematic reviews for potentially relevant studies. SELECTION CRITERIA: We sought randomised controlled trials (RCTs) that compared immediate postpartum versus delayed insertion of contraceptive implant for contraception. DATA COLLECTION AND ANALYSIS: Two review authors (JS, YW) independently screened titles and abstracts of the search results, and assessed the full-text articles of potentially relevant studies for inclusion. They extracted data from the included studies, assessed risk of bias, compared results, and resolved disagreements by consulting a third review author (PL or SK). We contacted investigators for additional data, where possible. We computed the Mantel-Haenszel risk ratio (RR) with 95% confidence interval (CI) for binary outcomes and the mean difference (MD) with 95% CI for continuous variables. MAIN RESULTS: Three studies that included 410 participants met the inclusion criteria of the review. We did not identify any ongoing trials. Two included studies were at low risk of selection, attrition, and reporting biases, but were at high risk of performance and detection biases due to the inability to blind participants to the intervention. One included study was at high risk of attrition bias. The overall quality of the evidence for each comparison ranged from very low to moderate; the main limitations were risk of bias and imprecision.Initiation rate of contraceptive implants at the first postpartum check-up visit was significantly higher in the immediate insertion group than in the delayed insertion group (RR 1.41, 95% CI 1.28 to 1.55; three studies, 410 participants; moderate quality evidence).There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant used at six months after insertion (RR 1.02, 95% CI 0.93 to 1.11; two studies, 125 participants; low quality evidence) or at 12 months after insertion (RR 1.04; 95% CI 0.81 to 1.34; one study, 64 participants;very low quality evidence)Women who received an immediate postpartum contraceptive implant insertion had a higher mean number of days of abnormal vaginal bleeding within six weeks postpartum (MD 5.80 days, 95% CI 3.79 to 7.81; one study, 215 participants; low quality evidence) and a higher rate of other side effects in the first six weeks after birth (RR 2.06, 95% CI 1.38 to 3.06; one study, 215 participants; low quality evidence) than those who received a delayed postpartum insertion. There appeared to be little or no difference between the groups in heavy, irregular vaginal bleeding or associated severe cramping within 12 months (RR 1.01, 95% CI 0.72 to 1.44, one study, 64 participants;very low quality evidence).It was unclear whether there was any difference between the groups in scores for participant satisfaction on a 0-10 scale (MD -0.40, 95% CI -1.26 to 0.46, low quality evidence), or in rates of unintended pregnancy (RR 1.82, 95% CI 0.38 to 8.71, 1 RCT, 64 women, very low quality evidence) at 12 months, or in rate of breastfeeding rate at six months (RR 2.01, 95% CI 0.72 ro 5.63, 1 RCT, 64 women, very low quality evidence) rate did not differ significantly between the groups. AUTHORS' CONCLUSIONS: Evidence from this review indicates that the rate of initiation of contraceptive implant at the first postpartum check-up visit was higher with immediate postpartum insertion than with delayed insertion. There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant use at 6 months. It was unclear whether there was any difference between the groups in continuation of contraceptive use at 12 months or in the unintended pregnancy rate at 12 months.
[Mh] Termos MeSH primário: Anticoncepção/métodos
Dispositivos Anticoncepcionais Femininos
Período Pós-Parto
[Mh] Termos MeSH secundário: Aleitamento Materno/estatística & dados numéricos
Anticoncepção/instrumentação
Dispositivos Anticoncepcionais Femininos/efeitos adversos
Dispositivos Anticoncepcionais Femininos/estatística & dados numéricos
Feminino
Seres Humanos
Satisfação do Paciente/estatística & dados numéricos
Gravidez
Gravidez não Planejada
Ensaios Clínicos Controlados Aleatórios como Assunto
Fatores de Tempo
Hemorragia Uterina/epidemiologia
Hemorragia Uterina/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170801
[Lr] Data última revisão:
170801
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170423
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD011913.pub2


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[PMID]:28421909
[Au] Autor:Uçar MG; Sanlikan F; Ilhan TT; Göçmen A; Çelik Ç
[Ad] Endereço:a Department of Obstetrics and Gynaecology , Selçuk University Medicine Faculty , Selçuklu Konya , Turkey.
[Ti] Título:Management of intra-abdominally translocated contraceptive devices, is surgery the only way to treat this problem?
[So] Source:J Obstet Gynaecol;37(4):480-486, 2017 May.
[Is] ISSN:1364-6893
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:This study was a multi-centre retrospective review of patients with uterine perforation caused by intrauterine contraceptive devices (IUDs). A total of 15 patients were registered, in a seven year period. Among them, five were asymptomatic and the rest were symptomatic. Asymptomatic patients were managed conservatively, except in one case in which the patient requested surgery because she also wanted a tubal ligation. Symptomatic patients all underwent surgery. All the surgeries were elective and all the surgical procedures were initiated laparoscopically. There were seven complications in the surgically managed group: conversion to laparotomy (n = 3), bowel injury (n = 2), bladder injury (n = 1), and wound infection (n = 1). Mild and severe adhesions (81.8%), and abscess (18.1%) formation related to translocated IUD (TIUD) were observed during surgery. All the patients were uneventful at 1 to 5 years of follow-up. A TIUD, by causing adhesions, complicates future laparoscopic surgery and increases the likelihood of conversion to laparotomy. While surgery is indicated to prevent TIUD-induced adhesive complications, it may also be the cause of both adhesions and complications, resulting in a vicious cycle. Some asymptomatic women, especially elderly patients with comorbidities, may not need or may be better managed without treatment. Impact statement In this study we try to find an answer for the question of "Should removal of a translocated intrauterine contraceptive device (TIUD) routinely be performed even if patients are asymptomatic?" From only the theoretical point of view there were some reports supporting conservative management in asymptomatic patients. The other studies addressing this issue were case reports including few patients with a short-term follow-up. The novelties of the present study include multi-centre design, detailed clinical and surgical information about the patients and the long period of follow-up. Most clinicians have limited experiences in managing TIUD because perforation is a rare event. So it can be difficult to know exactly what the surgeon will encounter intraoperatively. We undertook this study with the aim of providing a perspective about patients with TIUD for those faced with this situation. This is a descriptive study reporting 15 cases of TIUDs and management. Asymptomatic patients were managed conservatively, and symptomatic patients were operated. There are important implications resulting from this study that in asymptomatic patients leaving the IUD in place may be a reasonable option, mostly as the risk of surgical intervention is quite high with a high rate of complications with surgical management.
[Mh] Termos MeSH primário: Tratamento Conservador
Dispositivos Anticoncepcionais Femininos/efeitos adversos
Perfuração Uterina/terapia
[Mh] Termos MeSH secundário: Cavidade Abdominal/diagnóstico por imagem
Adulto
Feminino
Seguimentos
Seres Humanos
Laparoscopia/efeitos adversos
Laparotomia/efeitos adversos
Meia-Idade
Complicações Pós-Operatórias/prevenção & controle
Radiografia
Estudos Retrospectivos
Aderências Teciduais/prevenção & controle
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170420
[St] Status:MEDLINE
[do] DOI:10.1080/01443615.2016.1268577


  9 / 1498 MEDLINE  
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[PMID]:28338393
[Au] Autor:Houtchens MK; Zapata LB; Curtis KM; Whiteman MK
[Ad] Endereço:Department of Neurology, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
[Ti] Título:Contraception for women with multiple sclerosis: Guidance for healthcare providers.
[So] Source:Mult Scler;23(6):757-764, 2017 05.
[Is] ISSN:1477-0970
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Family planning is essential for any comprehensive treatment plan for women of reproductive age with multiple sclerosis (MS), including counseling on using effective contraception to optimally time desired and prevent unintended pregnancies. This topical review summarizes the first evidence-based recommendations on contraception safety for women with MS. In 2016, evidence-based recommendations for contraceptive use by women with MS were included in US Medical Eligibility Criteria for Contraceptive Use. They were developed after review of published scientific evidence on contraception safety and consultation with experts. We summarize and expand on the main conclusions of the Centers for Disease Control and Prevention guidance. Most contraceptive methods appear based on current evidence to be safe for women with MS. The only restriction is use of combined hormonal contraceptives among women with MS with prolonged immobility because of concerns about possible venous thromboembolism. Disease-modifying therapies (DMTs) do not appear to decrease the effectiveness of hormonal contraception although formal drug-drug interaction studies are limited. Neurologists can help women with MS make contraceptive choices that factor their level of disability, immobility, and medication use. For women with MS taking potentially teratogenic medications, highly effective methods that are long-acting (e.g. intrauterine devices, implants) might be the best option.
[Mh] Termos MeSH primário: Anticoncepção/normas
Anticoncepcionais Femininos/normas
Dispositivos Anticoncepcionais Femininos/normas
Esclerose Múltipla
Guias de Prática Clínica como Assunto/normas
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Contraceptive Agents, Female)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170325
[St] Status:MEDLINE
[do] DOI:10.1177/1352458517701314


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[PMID]:28322067
[Au] Autor:Özdener AE; Park TE; Kalabalik J; Gupta R
[Ad] Endereço:a School of Pharmacy and Health Sciences , Fairleigh Dickinson University , Florham Park , USA.
[Ti] Título:The future of pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) infection.
[So] Source:Expert Rev Anti Infect Ther;15(5):467-481, 2017 May.
[Is] ISSN:1744-8336
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: People at high risk for HIV acquisition should be offered pre-exposure prophylaxis (PrEP). Tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) is currently the only medication recommended for pre-exposure prophylaxis (PrEP) by the Centers for Disease Control and Prevention (CDC) in people at high risk for HIV acquisition. This article will review medications currently under investigation and the future landscape of PrEP therapy. Areas covered: This article will review clinical trials that have investigated nontraditional regimens of TDF/FTC, antiretroviral agents from different drug classes such as integrase strand transfer inhibitors (INSTI), nucleoside reverse transcriptase inhibitors (NRTI), and non-nucleoside reverse transcriptase inhibitors (NNRTI) as potential PrEP therapies. Expert commentary: Currently, there are several investigational drugs in the pipeline for PrEP against HIV infection. Increased utilization of PrEP therapy depends on provider identification of people at high risk for HIV transmission. Advances in PrEP development will expand options and access for people and reduce the risk of HIV acquisition.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/uso terapêutico
Drogas em Investigação/uso terapêutico
Infecções por HIV/prevenção & controle
Profilaxia Pré-Exposição/métodos
[Mh] Termos MeSH secundário: Administração Intravaginal
Ensaios Clínicos como Assunto
Dispositivos Anticoncepcionais Femininos
Esquema de Medicação
Combinação de Medicamentos
Emtricitabina/uso terapêutico
Feminino
Infecções por HIV/virologia
Inibidores de Integrase de HIV/uso terapêutico
HIV-1/efeitos dos fármacos
Seres Humanos
Masculino
Inibidores da Transcriptase Reversa/uso terapêutico
Tenofovir/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anti-HIV Agents); 0 (Drug Combinations); 0 (Drugs, Investigational); 0 (HIV Integrase Inhibitors); 0 (Reverse Transcriptase Inhibitors); 99YXE507IL (Tenofovir); G70B4ETF4S (Emtricitabine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170322
[St] Status:MEDLINE
[do] DOI:10.1080/14787210.2017.1309292



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