Ormeloxifene is an effective and safe treatment for dysfunctional uterine bleeding. A study of 60 women found that ormeloxifene significantly reduced menstrual blood loss and increased hemoglobin levels after both 3 and 6 months of treatment. It also significantly decreased endometrial thickness. The majority of women reported marked improvement in symptoms and found ormeloxifene acceptable with minimal side effects. Ormeloxifene is thus a good alternative for managing dysfunctional uterine bleeding.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
—Gestational Diabetes Mellitus (GDM) is a problem which may occur during pregnancy. For treatment of GDM either the Metformin or Insulin is used. So this prospective randomized multicenter trial in women with GDM was conducted to compare the treatment outcomes of metformin and insulin. This study was conducted at Rajkiya Mahila Chikitsalaya, in Obstetrics & Gynaecology Department of Jawaharlal Nehru Medical College, Ajmer. This study was done on 110 women who were diagnosed GDM by DIPSI criteria with a singleton pregnancy and meet entry criteria are randomized to insulin or metformin treatment (55 cases in each group).It was observed that metformin is equally efficacious and safe as insulin with a lot of advantages like less costly, better compliance, less weight gain, less change of hypoglycaemic attack and more feasible as insulin require several daily injection with not much difference in perinatal outcome except statistically significant difference in baby weight, mean cord blood sugar level at birth, large for gestation age. So it can be concluded that Metformin treatment is suitable for non-obese as well as obese type 2 diabetes patients in pregnancy without complications. Metformin is a safer alternate to insulin in GDM management with no adverse maternal and fetal outcome.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Methods: The current case-control study was conducted at Ain Shams University Maternity Hospital. The study included two groups of women: group A, including pregnant women with a history of unexplained recurrent miscarriage; and group B, including control pregnant women with no prior miscarriage. Women included in either group were at their first trimester of pregnancy (6-13 weeks of gestation). For all included women, 3-hour oral glucose test was performed. Serum insulin levels were measured at the same times. Markers of insulin resistance, including HOMA-IR, HOMA-B, AUCG and AUCI were calculated.
A Comprehensive Review of Studies Related to Chinese Herbal Medicine suzi smith
A Comprehensive Review of Studies Related to Chinese Herbal Medicine and Traditional Chinese Medicine (TCM) in Conjunction with Assisted Reproductive Technology (ART), IVF, and IUI for Male and Female Infertility
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
—Gestational Diabetes Mellitus (GDM) is a problem which may occur during pregnancy. For treatment of GDM either the Metformin or Insulin is used. So this prospective randomized multicenter trial in women with GDM was conducted to compare the treatment outcomes of metformin and insulin. This study was conducted at Rajkiya Mahila Chikitsalaya, in Obstetrics & Gynaecology Department of Jawaharlal Nehru Medical College, Ajmer. This study was done on 110 women who were diagnosed GDM by DIPSI criteria with a singleton pregnancy and meet entry criteria are randomized to insulin or metformin treatment (55 cases in each group).It was observed that metformin is equally efficacious and safe as insulin with a lot of advantages like less costly, better compliance, less weight gain, less change of hypoglycaemic attack and more feasible as insulin require several daily injection with not much difference in perinatal outcome except statistically significant difference in baby weight, mean cord blood sugar level at birth, large for gestation age. So it can be concluded that Metformin treatment is suitable for non-obese as well as obese type 2 diabetes patients in pregnancy without complications. Metformin is a safer alternate to insulin in GDM management with no adverse maternal and fetal outcome.
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Methods: The current case-control study was conducted at Ain Shams University Maternity Hospital. The study included two groups of women: group A, including pregnant women with a history of unexplained recurrent miscarriage; and group B, including control pregnant women with no prior miscarriage. Women included in either group were at their first trimester of pregnancy (6-13 weeks of gestation). For all included women, 3-hour oral glucose test was performed. Serum insulin levels were measured at the same times. Markers of insulin resistance, including HOMA-IR, HOMA-B, AUCG and AUCI were calculated.
A Comprehensive Review of Studies Related to Chinese Herbal Medicine suzi smith
A Comprehensive Review of Studies Related to Chinese Herbal Medicine and Traditional Chinese Medicine (TCM) in Conjunction with Assisted Reproductive Technology (ART), IVF, and IUI for Male and Female Infertility
ENDOMETRIOSIS UPDATEFocus on Dienogest Dr Sharda jain dr Jyoti Agarwal Lifecare Centre
ENDOMETRIOSIS UPDATEFocus on Dienogest
AGENDA
Background
What’s New in Endometriosis
Clinical Discussions in Managing Endometriosis
Newer Evidences on Dienogest
PANEL DISCUSSION ON PRACTICAL APPROACH TO ENDOMETRIOSISWith FOCUS ON DINOGESTLifecare Centre
PANEL DISCUSSION ON PRACTICAL APPROACH TO ENDOMETRIOSISWith FOCUS ON DINOGEST
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Dysfunctional uterine bleeding (DUB) is the major cause of heavy menstrual bleeding and impacts on women’s health both medically and socially. First-line therapy has traditionally been medical therapy but this is frequently ineffective. On the other hand, hysterectomy is obviously 100% effective in stopping bleeding but is more costly and can cause severe complications and affect the quality of life. Endometrial ablation is less invasive and preserves the uterus and has shown to improve the quality of life indices.
PANEL DISCUSSION ON ENDOMETRIOSIS IN ADOLESCENTS (2018 )Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS IN ADOLESCENTS (2018 ) MODERATOR
DR SHARDA JAIN
DR ILA GUPTA
DR DIPTI NABH
panelist
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
Histomorphological Profile and Immunohistochemical Analysis of Endometrium in...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy
J Man, JC Hutchinson, M Ashworth, AE Heazell, S Levine and NJ Sebire
Volume 47, Issue 11; Date: November, pages 574–578
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16018/full
Organ weights and ratios for postmortem identification of fetal growth restriction: utility and confounding factors
J Man, JC Hutchinson, M Ashworth, I Jeffrey, AE Heazell, and NJ Sebire
Volume 48, Issue 5; Date: November, pages 585–590
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16017/full
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
ENDOMETRIOSIS UPDATEFocus on Dienogest Dr Sharda jain dr Jyoti Agarwal Lifecare Centre
ENDOMETRIOSIS UPDATEFocus on Dienogest
AGENDA
Background
What’s New in Endometriosis
Clinical Discussions in Managing Endometriosis
Newer Evidences on Dienogest
PANEL DISCUSSION ON PRACTICAL APPROACH TO ENDOMETRIOSISWith FOCUS ON DINOGESTLifecare Centre
PANEL DISCUSSION ON PRACTICAL APPROACH TO ENDOMETRIOSISWith FOCUS ON DINOGEST
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Dysfunctional uterine bleeding (DUB) is the major cause of heavy menstrual bleeding and impacts on women’s health both medically and socially. First-line therapy has traditionally been medical therapy but this is frequently ineffective. On the other hand, hysterectomy is obviously 100% effective in stopping bleeding but is more costly and can cause severe complications and affect the quality of life. Endometrial ablation is less invasive and preserves the uterus and has shown to improve the quality of life indices.
PANEL DISCUSSION ON ENDOMETRIOSIS IN ADOLESCENTS (2018 )Lifecare Centre
PANEL DISCUSSION ON ENDOMETRIOSIS IN ADOLESCENTS (2018 ) MODERATOR
DR SHARDA JAIN
DR ILA GUPTA
DR DIPTI NABH
panelist
UMA RAI
RAJ BOKARIA
JYOTI AGARWAL
JYOTI BHASKER
RENU CHAWLA
DIPTI NABH
VANDANA GUPTA
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
Histomorphological Profile and Immunohistochemical Analysis of Endometrium in...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy
J Man, JC Hutchinson, M Ashworth, AE Heazell, S Levine and NJ Sebire
Volume 47, Issue 11; Date: November, pages 574–578
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16018/full
Organ weights and ratios for postmortem identification of fetal growth restriction: utility and confounding factors
J Man, JC Hutchinson, M Ashworth, I Jeffrey, AE Heazell, and NJ Sebire
Volume 48, Issue 5; Date: November, pages 585–590
Read the free-access article here: http://onlinelibrary.wiley.com/doi/10.1002/uog.16017/full
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
IOSR Journal of Business and Management (IOSR-JBM) is an open access international journal that provides rapid publication (within a month) of articles in all areas of business and managemant and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications inbusiness and management. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
IOSR Journal of Electronics and Communication Engineering(IOSR-JECE) is an open access international journal that provides rapid publication (within a month) of articles in all areas of electronics and communication engineering and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications in electronics and communication engineering. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
IOSR Journal of Electronics and Communication Engineering(IOSR-JECE) is an open access international journal that provides rapid publication (within a month) of articles in all areas of electronics and communication engineering and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications in electronics and communication engineering. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Abstract—3D ultrasound (3-dimensional sonography) when combined with sonosalpingography, it provides detailed information regarding internal and external contours of the uterus, without the need for radiation contrast material or surgical intervention. This study was done because of the need of such diagnostic modality that is highly accurate as well as least invasive. A descriptive study was conducted on 50 infertile females to assess the diagnostic value of 3-dimensional SHG in reference of diagnostic hystero-laproscopy (DHL) assuming as gold standard. It was found that sensitivity of 3-dimensional SHG reasons of tubal patency, ovarian pathology and uterine cavity was found 97.6%, 90.91% and 71.43% respectively. And diagnostic accuracy of 3-dimensional SHG in reference of DHL for tubal patency, ovarian pathology and for uterine cavity was found 96%, 92% and 96% respectively. So it can be concluded from present study that 3-Dimensional sonohysterography is an efficient tool to assess women with infertility. Its sensitivity, specificity, and diagnostic accuracy is comparable to hysterolaproscopy.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
Dynamics of Combined Oral Contraceptive: A Study of Some Haematological Param...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Introduction: Ovarian reserve is defi ned as the existent quantitative and qualitative follicular supply found in the ovaries which may turn into mature follicles and assigns a woman’s reproductive potential. The commonly appointed tests of ovarian reserve can be divided into static markers (FSH, estradiol, inhibin-B and [AMH] Anti-Mullerian Hormone), dynamic markers (clomiphene citrate, gonadotrophins and Gonadotrophin Releasing Hormone [GnRh] analogue stimulation tests) and ultrasonographic markers (Antral Follicle Count [AFC],
ovarian volume and ovarian blood fl ow). Leiomyomas are the most common genital tract tumors of benign nature and the most frequent benign uterine disorder in women of reproductive period.
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
— Female genital tuberculosis is one of the major etiological factors of female infertility. Diagnosis of genital tuberculosis is very important in such cases. So this comparative observational type of study was carried out on infertile women to compare the diagnostic effectively of ultrasonograpgy (USG), genital tuberculosis, Tuberculin test, Nucleic acid amplification test (PCR), histopathology and hysteroscopy & laparoscopy (DHL) assuming culture as gold standard. It was observed that the 28% of infertile cases were found positive for genital tuberculosis on culture. Sensitivity of PCR 64.28%, DHL 92.85%, USG 42.85%, Histopathology 60.71% and Tuberculin Test 64.28%. So sensitivity was found with significant variation ranging from 42.85% with ultrasonography (USG) to 92.85% with DHL. Specificity of PCR 52.77%, DHL 55.55%, USG 98.61%, Histopathology 91.66% and Tuberculin Test 36.11%. So specificity was also found with significant variation being found maximum with USG (98.61%) and minimum with tuberculin test (36.11%). Positive predictive value (PPV) was found maximum (92.3%) with USG and minimum (28.12%) with tuberculin test and negative predictive value (NPV) was found maximum (95.23%) with DHL and minimum (72.22%) with tuberculin test. Diagnostic effectively of diagnosing GTB with various studied modalities vary with significant variation.
A COMPARATIVE ANALYSIS OF HEMATOLOGICAL INDICES IN PREGNANT WOMEN AND NON PR...FidelityP
Red blood cell (RBC) indices are individual components of a routine blood test called the complete blood count (CBC). The CBC is used to measure the quantity and physical characteristics of different types of cells found in your blood. Blood consists of RBCs, white blood cells (WBCs), and platelets that are suspended in your plasma. Platelets are cells that enable clot formation. RBCs contain hemoglobin, which carries oxygen throughout your body to all of your tissues and organs. An RBC is pale red and gets its color from hemoglobin. It’s shaped like a doughnut, but it has a thinner area in the middle instead of a hole. Your RBCs are normally all the same color, size, and shape. However, certain conditions can cause variations that impair their ability to function properly. The RBC indices measure the size, shape, and physical characteristics of the RBCs. Your doctor can use RBC indices to help diagnose the cause of anemia. Anemia is a common blood disorder in which you have too few, misshapen, or poorly functional RBCs123
Abstract— Anemia in pregnancy is commonly considered as risk factor for poor pregnancy outcome and can threaten the maternal and fetal life also. So this present cases control study was carried at R. K. Joshi District Hospital Dausa (Rajasthan) India, with the aim to find out the effect of anemia in Antenatal period on pregnancy outcomes. For this study, 50 Antenatal Cases (ANCs) with anemia were selected as study group among ANCs attending for delivery in district hospital Dausa. For control group age and BMI matched 50 normal healthy ANCs without anemia were selected from the same area. ANCs with any other diseases were excluded from the study. It was found in this study that although proportion of ANCs with LSCS, PPH and Sepsis were higher in anemic ANCs but it was not found significant. Likewise IUGR, LBW babies, premature births and still births were more in anemic ANCs but it was found significant only in case of LBW babies. So it can be concluded that anemia in ANCs effect weight of newborn babies born by ANC with anemia.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
1. IOSR Journal of Pharmacy and Biological Sciences (IOSR-JPBS)
e-ISSN: 2278-3008.Volume 5, Issue 5 (Mar. – Apr. 2013), PP 18-21
www.iosrjournals.org
www.iosrjournals.org 18 | Page
The Efficacy and Safety of Ormeloxifene in Dysfunctional Uterine
Bleeding
Dr. Neha Agarwal1
, Dr. Saroj Singh2
1
(Lecturer, Department of Obstetrics and Gynaecology, Sarojini Naidu Medical College, Agra, India)
2
(Professor, Department of Obstetrics and Gynaecology, Sarojini Naidu Medical College, Agra, India)
Abstract: The study was undertaken to assess the efficacy, safety and acceptability of ormeloxifene in the
medical management of Dysfunctional Uterine Bleeding (DUB). Sixty women with DUB were given
ormeloxifene 60mg twice a week for 12 weeks and once a week for next 12 weeks. Follow up was done at 3 and
6 months. The primary outcome measures were menstrual blood loss, hemoglobin concentration and
endometrial thickness. The secondary outcome measures were the acceptability and side effects of ormeloxifene.
There was a significant reduction in the menstrual blood loss as measured by median PBAC scores pre and post
treatment. The median PBAC score was significantly reduced from 334 to 111 after 3 months and to 32 after 6
months (p < 0.0001) The mean pretreatment Hb concentration was significantly increased from 9.04gm% to
10.01 gm% at 3 months and to 10.86 gm% at 6 months (p<0.0001).The mean pretreatment endometrial
thickness was reduced from 11.35mm to 9.4 mm after 3 months of therapy and to 8.13 mm after 6 months
(p<0.0001). 88.3% women showed marked subjective improvement in symptoms. There were no major side
effects. Ormeloxifene, with its convenient dose schedule, is an effective and safe alternative in the management
of dysfunctional uterine bleeding.
Keywords – Dysfunctional Uterine Bleeding (DUB), Menorrhagia, Ormeloxifene, Selective Estrogen Receptor
Modulator (SERM)
I. Introduction
Dysfunctional Uterine Bleeding (DUB) is a state of abnormal uterine bleeding without any clinically
detectable organic, systemic and iatrogenic cause. It is the most common menstrual disorder of women in
reproductive age and is a diagnosis of exclusion. It can affect any woman from menarche to menopause,
occurring more commonly at extremes of age.
Menorrhagia (menstrual blood loss >80 ml per cycle) affects 10-33% of women at some stage in their
lives [1]. Medical management of menorrhagia is a challenging task and wide variations in the available drugs
prescribed for this condition show a lack of consensus for medical treatment [2]. The medical options for initial
management of DUB include antifibrinolytics, nonsteroidal anti-inflammatory drugs (NSAIDs), combined
estrogen and progesterones or progesterones alone, high dose estrogens, gonadotropin-releasing hormone
agonists, danazol and levonorgesterol releasing intrauterine systems. Cyclical combined oral contraceptive pills
were widely used previously but side effects have limited their use in DUB. Danazol, progesterone and
gonadotropin-releasing hormone analogs are all effective in terms of reducing menstrual blood loss but adverse
effects and costs limit their long term use [3].
Selective Estrogen Receptor Modulators (SERMs) selectively bind with high affinity to estrogen
receptors and act as estrogen agonists in some tissues and estrogen antagonists in others. Ormeloxifene, a third
generation SERM, antagonizes the effect of estrogen on uterine and breast tissue and stimulates its effect on
vagina, bone, cardiovascular and central nervous system [4].Thus, it is especially beneficial in perimenopausal
women as it has no uterine stimulation, prevents bone loss, does not increase the risk of breast cancer, lowers
cholesterol level and maintains cognitive function of the brain. It has the additional advantage of reducing
premenstrual symptoms, mastalgia and dysmenorrhea. When ormeloxifene (centchroman) was used as a
contraceptive, its beneficial effect on menorrhagia and endometriosis was observed, which led to controlled
trials for the management of menorrhagia after its approval for this indication.
The aim of the present study was to assess the efficacy, safety and acceptability of ormeloxifene in the
medical management of dysfunctional uterine bleeding.
II. Methodology
This prospective study was conducted in the Department of Obstetrics and Gynaecology, S.N Medical
College, Agra over a period of one year. Sixty women with Dysfunctional Uterine Bleeding (DUB) were
recruited from the Gynaecological OPD. The diagnosis of DUB was made after excluding other possible causes
of abnormal uterine bleeding. The exclusion criteria were pelvic pathologies like uterine fibroids, suspected
adenomyosis, malignancies of uterus/cervix/ovary/vagina/endometrial hyperplasia with atypia; medical diseases
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like – liver dysfunction, heart disease, migraine, stroke, renal disease, hypo/hyperthyroidism, platelet disorders
or coagulopathy, previous history of thrombosis; pregnancy, abortion, use of IUCDs or oral contraceptives;
lactating women in first 6 months of post-natal period and hypersensitivity to the drug.
Informed consent was taken. All cases were given ormeloxifene 60mg twice a week for 12 weeks and
then once a week for next 12 weeks. Follow up was done at 3 months and 6 months or earlier if needed. The
primary outcome measures were menstrual blood loss, hemoglobin concentration and endometrial thickness in
proliferative phase by trans-vaginal sonography (TVS). The secondary outcome measures were the acceptability
and side effects of ormeloxifene.
Menstrual blood loss was objectively assessed by Pictorial Blood loss Assessment Chart (PBAC) [5],
which correlates well with the alkaline hematin test [6]. Subjective assessment of the improvement of symptoms
was also done. The women were given instructions on how to do PBAC scoring according to the degree of
soiling of sanitary napkins and number and size of clots passed (Table 1). A PBAC score ≥ 100 is equivalent to
menstrual blood loss ≥ 80ml and is considered diagnostic of menorrhagia [5].
Table 1: PBAC Scoring
Pads Lightly soiled 1
Moderately soiled 5
Saturated 20
Clots Small (smaller than a rupee coin) 1
Large (larger than a rupee coin) 5
PBAC score, hemoglobin concentration and endometrial thickness were measured before the start of
therapy, at 3 months and at 6 months. A detailed menstrual history (number of days of menstruation, number of
sanitary napkins used, passage of clots, dysmenorrhea) and physical examination was done at each visit. Any
side effects observed were noted. The subjective improvement of symptoms and acceptability of ormeloxifene
were also inquired.
All continuous efficacy parameters were presented as Mean ± Standard Deviation and Median (Range)
and were analyzed using the paired t test. The Chi square and Fisher’s exact test were used as appropriate for
independent nominal data. Statistical significance was taken at p ≤ 0.05.
III. Observations and Results
Sixty women with the diagnosis of DUB were recruited for the study; with a PBAC score more than
100 in the pretreatment cycles. Table 2 shows the clinical profile of the study group. The mean age of the
women was 32.8 years, mean parity 3.5 and the mean duration of symptoms was 11.5 months.
Table 2: Clinical profile of women
S.No. Clinical parameter Mean (Range)
1. Age (years) 32.8 (20-50)
2. Parity 3.5 (2-7)
3. Duration of symptoms (months) 11.5 (6-20)
Menstrual blood loss (assessed by PBAC score), hemoglobin level and endometrial thickness were observed
before starting treatment and then after 3 and 6 months of treatment. The outcome measures at 3 months are
shown in Table 3 and at 6 months are shown in Table 4.
Table 3: Outcome measures of the study (after 3 months)
S.No. Outcome parameter Pre-treatment Post-treatment
(3months)
p value
1. Median PBAC score 334 111 p<0.0001
(t=15.25)
2. Mean hemoglobin level
(gm%)
9.04 10.01 p<0.0001
(t=20.38)
3. Mean endometrial thickness
(mm)
11.35 9.4 p<0.0001
(t=24.27)
4. Presence of clots 46/60 (76.7%) 20/60 (33.3%) p<0.0001
5. Dysmenorrhea 17/60 (28.3%) 11/60 (18.3%) p=0.280
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Table 4: Outcome measures of the study (after 6 months)
S.No. Outcome parameter Pre-treatment Post-treatment
(6months)
p value
1. Median PBAC score 334 32 p<0.0001
(t=16.63)
2. Mean hemoglobin level
(gm%)
9.04 10.86 p<0.0001
(t=34.42)
3. Mean endometrial thickness
(mm)
11.35 8.13 p<0.0001
(t=23.53)
4. Presence of clots 46/60 (76.7%) 9/60 (15%) p<0.0001
5. Dysmenorrhea 17/60 (28.3%) 4/60 (6.7%) p=0.0032
The median pre-treatment PBAC score was 334 with a range of 123-643. After 3 months of treatment
with ormeloxifene it was reduced to 111 (range 42-201) and after 6 months to 32 (range 0-75). The reduction
was extremely statistically significant (p < 0.0001) at both intervals. Thus there was a 90.42% reduction in the
menstrual blood loss after 6 months of therapy.
Presence of clots is an obvious evidence of abnormally excessive flow as reported by Higham et al [5].
In the present study 80.43% (37/46) cases showed improvement by absence of clots at the end of the therapy.
Ormeloxifene also had a beneficial effect in reducing the occurrence of dysmenorrhea.
Most of the women were anemic, with 49 (81.67%) women having a hemoglobin level less than 10
gm%. The mean pretreatment Hemoglobin concentration was 9.04 gm% (range 7.3-11gm%). It was
significantly increased to 10.01 gm% at 3 months (range 8.4-11.7gm%; p<0.0001) and further increased to
10.86 gm% at 6 months (range 9.3-12.4gm%; p<0.0001). Thus there was significant increase in mean
hemoglobin concentration of 1.82 gm% after 6 months.
The mean pretreatment endometrial thickness as measured by TVS in the proliferative phase was 11.35
mm with a range of 8-17mm. It was reduced to 9.4 mm after 3 months of therapy (range 6-13mm; p< 0.0001)
and to 8.13 mm after 6 months (range 4-11mm; p<0.0001). The reduction was statistically significant.
The women were asked about the subjective improvement of symptoms as shown in Table 5. Majority
(88.3%) showed marked improvement in symptoms. Two women had no improvement of symptoms; however
there was no aggravation of symptoms in any woman. Ormeloxifene was acceptable to 96.67% women.
Table 5: Subjective assessment of symptoms
S.No. Subjective improvement Number Percentage (%)
1. No improvement 2 3.33
2. Mild improvement 5 8.33
3. Marked improvement 53 88.33
4. Aggravation of symptoms 0 0
Total 60 100
There were no major side effects. Amenorrhea was the most common symptom, seen in 17 women
(28.3%). Out of these, 15 women were ≥ 40 years and only 2 were < 40 years. Nausea vomiting (6.67%) and
headache (5%) were other side effects but neither was significant enough to stop the therapy.
IV. Discussion
Menorrhagia accounts for most of the referrals to the Gynaecological OPD and in majority of the cases
no organic pathology is identified. DUB reflects a disruption in the normal cyclic pattern of ovulatory hormonal
stimulation to the endometrial lining. It is considered a diagnosis of exclusion. Although a number of drugs are
available, there is a general lack of evidence-based approach, marked variation in practice and continuing
uncertainty regarding the most appropriate therapy [3].
In the present study, our results suggested that there was a significant reduction in menstrual blood
loss with ormeloxifene, as assessed by fall in PBAC score and patient’s subjective assessment. There was also a
significant rise in hemoglobin concentration and a significant decrease in endometrial thickness after 6 months
of therapy. The results were significant even after 3 months of therapy. Ormeloxifene was acceptable to most of
the women. The safety profile of ormeloxifene is very good with no major side effects. A few side effects which
occurred were mild gastrointestinal symptoms (6.67%) and headache (5%). Amenorrhea was seen in 17 women
(28.3%), most of them perimenopausal.
The present study showed a 90.42% reduction in menstrual blood loss. Kriplani et al conducted a pilot
study in which the median PBAC was significantly reduced from 388 to 80 at 2 months and to 5 at 4 months
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with a 99.7% reduction (p<0.001). Side effects like ovarian cyst, cervical erosion and discharge, gastric
dyspepsia, vague abdominal pain and headache occurred in a few women [7].
Similar to the present study, Dhananjay et al found a statistically significant increase in hemoglobin
concentration (8.26 to 10.59g/dl; p<0.001) and a statistically significant decrease in the endometrial thickness
(8.36 to 4.89mm; p<0.001) after 3 months of treatment with ormeloxifene [8].
Shravage et al found an 85.7% reduction in menstrual blood loss (a fall in mean PBAC score from 262
to 73) after 3 months of therapy. They found that ormeloxifene was more effective than medroxy progesterone
acetate in the treatment of DUB [9]. Dadhich et al also found a significant reduction in median PBAC score
(379 to 15), number of days of menstruation and number of sanitary napkins used after 6 months of
ormeloxifene therapy [3].
Biswas et al found that the difference between pretreatment and post-treatment median PBAC score of
97.2 and the rise in mean hemoglobin concentration of 1.31 g/dl was statistically significant (p<0.001). In the
present study the rise in mean hemoglobin concentration was 1.82 gm% (from 9.04 to 10.86 gm%) [4].
Amenorrhea was a common symptom seen in different studies with a wide range of 8% to 42.9% [3-
5,8,9]. It is more common in perimenopausal women However, with proper counseling the women do not find it
bothersome, in fact it is welcomed by them. Majority of women (88-92%) have complete relief with
ormeloxifene [3]. Some women do not respond to ormeloxifene and require an alternative treatment. The
percentage varies from 4 – 16.7% [3-5] in various studies as compared to 3.33% in the present study.
V. Conclusion
Ormeloxifene is effective and quick acting (usually bleeding is controlled in 2-3 days) and appears to
be a promising option for the medical management of DUB. It leads to a significant reduction in menstrual
blood loss, a significant rise in hemoglobin concentration and a significant decrease in endometrial thickness
without any major side effect. It has a convenient dose schedule of once or twice a week and is cost effective. It
can be used in any age group and is oncologically protective to the breast and endometrium. It is well tolerated
and a safe alternative for medical management of DUB.
References
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