ABSTRACT
This study compared the effect of preservative-containing (PC) and preservative-free (PF) prostaglandin analogue (PGA) formulations on the ocular surface, especially on the meibomian gland (MG) in patients with open-angle glaucoma (OAG). This is a retrospective study of treatment-naïve patients with OAG (n=80) and healthy controls (n=40). OAG patients were randomized into groups using either PC-PGA or PF-PGA for 12 months. All participants underwent ocular surface and MG examinations including their meibum score, meiboscore, and lid margin abnormality score (LAS). Eighty OAG patients were randomized into two groups (n=42 in PC, n=38 in PF). All PGA and control groups showed similar ocular surface and MG parameters at the baseline. Both PC- and PF-PGA groups showed increased meibum scores, meiboscores, and LASs at 12 months compared to the baseline (all p<0.05). At the 12-months visit, PC-PGA group showed severe OSDI, shorter TBUT, greater OSS, and worse MG parameters than those of the other two groups (all p<0.05). In addition, PF-PGA group showed worse meiboscores, meibum scores, and severe OSS scores than those of the control group (all p<0.05). Both PC and PF formulations can cause damage to the MG in patients using PGA. However, PC formulations induced more ocular discomfort, poorer ocular surface, and more severe MG loss compared to PF formulations. Therefore, it would be advisable to use PF formulations in patients with a preexisting or concomitant ocular surface disease or MGD.
Subject(s)
Humans , Benzalkonium Compounds , Glaucoma , Glaucoma, Open-Angle , Meibomian Glands , Preservatives, Pharmaceutical , Prostaglandins, Synthetic , Retrospective StudiesABSTRACT
Objective To explore effects of atorvastatin on the expressions of cyclooxygenase-2(COX-2) and membrane-associated prostaglandin E2 synthase-1 (mPGES-1) in the carotid atherosclerotic plaques of rabbits.Methods Totally 33 male New Zealand white rabbits(≥ 36months of age ) were assigned into normal control group (n=8) and animal model group with carotid atherosclerotic stenosis (n =25).The rabbit models were randomly divided into non-intervention group,celecoxib treatment group (15 mg · kg-1 · d-1,twice daily) and atorvastatin treatment group (5 mg · kg-1 · d-1,once daily) (n=8 each).Four weeks after treatment,the mRNA and protein expressions of COX-2 and mPGES-1 in carotid plaques were determined by RT-PCR and Western blot,respectively.Results The mRNA expressions of COX-2 (0.97±0.09,0.44±0.05,0.60±0.04vs.0.23±0.04,F=66.77,P＜0.01) and mPGES-1 (0.92±0.07,0.41±0.04,0.61±0.03 vs.0.17±0.03,F=54.87,P＜0.01)in carotid atherosclerotic plaques were significantly higher in non intervention group,celecoxib treatment group and atorvastatin treatment group than in normal control group.The mRNA expressions of COX-2 and mPGES-1 were decreased in celecoxib treatment group and atorvastatin treatment group as compared with non-intervention group ( both P ＜ 0.01 ).The protein expressions of COX-2 (0.89±0.06,0.42±0.07,0.62±0.04 vs.0.18±0.05,F=61.75,P ＜0.01) and mPGES-1(0.91±0.05,0.44±0.05,0.63±0.05 vs.0.21±0.04,F=86.44,P＜0.01)in carotid atherosclerotic plaques in non-intervention group,celecoxib treatment group and atorvastatin treatment group were increased as compared with those in normal control group.The mRNA and protein expressions of COX-2 and mPGES-1 were decreased in celecoxib treatment group and atorvastatin treatment group as compared with non-intervention group(all P＜0.01 ).The expressions of COX-2 and mPGES-1 in carotid atherosclerotic plaques were reduced in celecoxib treatment group as compared with atorvastatin treatment group (P ＜ 0.01).Conclusions As COX-2 inhibitor celecoxib,atorvastatin may inhibit the expressions of COX-2 and mPGES-1,and interfere with the inflammatory response which plays key role in the pathological progress of carotid atherosclerotic plaques,and thus slow the progress of carotid atherosclerosis.
ABSTRACT
OBJETIVO: verificar a eficácia e a segurança de dinoprostone e misoprostol para indução do parto vaginal, com ou sem o uso de ocitocina em nulíparas. MÉTODOS: realizou-se estudo retrospectivo, observacional, envolvendo 238 pacientes que foram submetidas à indução do parto de janeiro de 2008 a fevereiro de 2010 com uso de misoprostol 25 mcg via vaginal ou pessário contendo 10 mg de dinoprostone. Desse grupo, foram selecionadas 184 pacientes, que apresentavam as seguintes características: nulíparas, gestação entre 37 e 42 semanas, feto único, apresentação cefálica, membranas íntegras e índice de Bishop < 3. Os resultados obstétricos e neonatais foram analisados e comparados entre ambos os grupos. A análise estatística foi realizada com o teste t, Chi quadrado e exato de Fisher, adotando-se como nível de significância valores p<0,05. RESULTADOS: a taxa de parto vaginal não foi estatisticamente diferente em pacientes que utilizaram misoprostol e dinoprostone (43,2 versus 50 por cento, p=0,35), respectivamente. O amadurecimento do colo foi superior no grupo com misoprostol (87,3 versus 75,6 por cento, p=0,04). Foi necessária a utilização da ocitocina em 58,8 por cento no grupo com misoprostol e 57,3 por cento no grupo com dinoprostone após o amadurecimento do colo. Falha de indução foi a principal indicação do parto cesárea em ambos os grupos, sem diferença estatística significante. Eventos adversos maternos e fetais, como taquissistolia e índices de Apgar foram similares. CONCLUSÃO: dinoprostone e misoprostol são eficazes para indução do parto vaginal, embora seja necessária a associação com ocitocina, apresentando perfil de segurança semelhante, sendo misoprostol mais eficiente no amadurecimento do colo uterino.
PURPOSE: to determine the efficacy and safety of dinoprostone and misoprostol for the induction of vaginal childbirth, with or without the use of oxytocin in nulliparous women. METHODS: in this retrospective observational study, 238 patients were subjected to the induction of delivery from January 2008 to February 2010 with the use of misoprostol 25 mcg by the vaginal route or a pessary containing 10 mg of dinoprostone. A total of 184 patients were selected, with the following characteristics: nulliparous, gestational age of 37-42 weeks, singleton pregnancies, cephalic presentation, intact membranes, and Bishop score < 3. Obstetric and neonatal data were analyzed and compared between groups. The Student t-test, chi-square test and Fisher's exact test were used for statistical analysis, with the level of significance set at p<0.05. RESULTS: the rate of vaginal childbirth did not differ significantly in patients who used misoprostol and dinoprostone (43.2 percent versus 50 percent; p = 0.35, respectively). The ripening of cervix was higher in the group treated with misoprostol (87.3 percent versus 75.6 percent, p=0.04). The use of oxytocin was necessary in 58.8 percent of the misoprostol group and 57.3 percent in the dinoprostone group after the ripening of cervix. Failed induction was the primary indication of caesarean section delivery in both groups, with no significant difference between them. Fetal and maternal adverse events, such as tachysystole and Apgar scores were similar. CONCLUSION: dinoprostone and misoprostol are both effective for vaginal childbirth induction, although they need to be combined with oxytocin. They showed a similar safety profile, with misoprostol being more efficient regarding cervical ripening.
Subject(s)
Humans , Female , Pregnancy , Adult , Cervical Ripening , Misoprostol/pharmacokinetics , Pregnancy Outcome , Prostaglandins A, Synthetic/pharmacokinetics , Labor, Induced/methodsABSTRACT
OBJETIVO: Avaliar a relação custo-efetividade dos análogos das prostaglandinas para o tratamento do glaucoma e da hipertensão ocular no estado de Minas Gerais, Brasil. MÉTODOS: Este estudo transversal avaliou o custo (preço máximo ao consumidor) das diferentes apresentações dos análogos de prostaglandinas (bimatoprosta, latanoprosta, travoprosta) em relação à sua efetividade na redução da pressão intra-ocular. Para cada uma das medicações, calculou-se o custo mensal, anual e em 5 anos para se obter uma redução percentual de 1 por cento e 20 por cento na pressão intra-ocular (PIO), assim como o custo mensal, anual e em 5 anos para se obter uma redução de 1 mmHg e 8 mmHg a partir da PIO inicial. RESULTADOS: O custo mensal para se obter uma redução de 1 por cento e 20 por cento da PIO foi, respectivamente, de R$ 1,35 e R$ 27,00 para a bimatoprosta 5 ml, R$ 1,50 e R$ 30,00 para a bimatoprosta 3 ml, R$ 1,53 e R$ 30,60 para a travoprosta e R$ 2,22 e R$ 44,40 para a latanoprosta. O custo mensal máximo para uma redução de 1 e 8 mmHg da PIO foi, respectivamente, de R$ 6,01 e R$ 48,08 para a bimatoprosta 5 ml, de R$ 6,67 e R$ 53,36 para a travoprosta, de R$ 6,70 e R$ 53,60 para a bimatoprosta 3 ml e de R$ 9,83 e R$ 78,64 para a latanoprosta. CONCLUSÃO: A medicação mais custo-efetividade foi a bimatoprosta, na apresentação de 5 ml. Aquela que se mostrou com a mais baixa relação custo-efetividade foi a latanoprosta. A travoprosta e a bimatoprosta na apresentação de 3 ml apresentaram resultados semelhantes, ficando em posição intermediária entre as demais.
PURPOSE: Assess cost-effectiveness of glaucoma and/or ocular hypertension medical therapy using prostaglandin analogues in the state of Minas Gerais, Brazil. METHODS: This cross-sectional study evaluated the cost (average wholesale price) of different prostaglandin analogues (bimatoprost, latanoprost, travoprost) in relation to its effectiveness in reducing intra-ocular pressure. Monthly, annually and 5-year cost to achieve 1 percent and 20 percent of IOP reduction was calculated. Monthly, annually and 5-year cost to reduce 1 mmHg and 8 mmHg from baseline IOP was also calculated. RESULTS: Monthly cost to achieve 1 percent and 20 percent of IOP reduction was, respectively, R$ 1.35 and R$ 27.00 for bimatoprost 5 ml, R$ 1.50 and R$ 30.00 for bimatoprost 3 ml, R$ 1.53 and R$ 30.60 for travoprost and R$ 2.22 and R$ 44.40 for latanoprost. Monthly maximum cost to reduce baseline IOP 1 mmHg and 8 mmHg was, respectively, R$ 6.01 and R$ 48.08 for bimatoprost 5 ml, R$ 6.67 and R$ 53.36 for travoprost, R$ 6.70 and R$ 53.60 for bimatoprost 3 ml and R$ 9.83 and R$ 78.64 for latanoprost. CONCLUSION: Cost-effectiveness was better for bimatoprost 5 ml. The medication, which had the worst cost-effectiveness relationship, was latanoprost. Travoprost and bimatoprost 3 ml showed similar and intermediate results.