Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Role of Dydrogesterone in Threatened Abortion Dr Sharda Jain Lifecare Centre
*EXPERINCE SHARING By EXPERTS*
Dr Uma Rai(DGF *E*)
Dr Sangeetaa Gupta(DGF *E*)
Dr Neerja Varshney(DGF *E*)
Dr Surjeet Kapoor(DGF *E*)
Dr Rupam arora(DGF *E*)
Dr Meenakshi Ahuja(DGF *S* )
Dr.Harsha khullar(DGF *C* )
Dr Mamta mittal(DGF *N*)
Dr Leena Sreedhar(DGF *D*)
Dr.Dipti Nabh(DGF *E*)
Dr. Shama Batra(DGF *E*)
Dr Poonam Paul(DGF *SW*)
PAN DGF ( DELHI GYNAECOLOGIST FORUM) CME ON DYDROGESTERONE ON 3/2 /22
we need to update our knowledge regarding management of endometriosis.
Which is better: medications or surgery? let's see what can this talk tell us about
Vasundhara Hospital Jaipur is a premier specialty hospital for infertile couples, complete women care, high risk pregnancy management, located in heart of Jaipur.
Click to more info :- https://www.vasundharafertility.com/jaipur
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
There is a recent and strong trend in western countries to advocate single embryo transfer (eSET). The rational behind this trend is to avoid complications of multiple pregnancy after IVF. However, we would urgue that twin pregnancy is totally different from high order multiple pregnancy and the long term economic analysis of twin pregnancy has never been explored before. We tried to calculate the risks and benefits of twin pregnancy from a society perspectives. Based on our model, it seems that double embryo transfer (DET) is still a valid option.
Invited Lecture delivered by Dr Sujoy Dasgupta in the Annual Conference of ISAR (Indian Society of Assisted Reproduction) held at Kolkata in November, 2019
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Role of Dydrogesterone in Threatened Abortion Dr Sharda Jain Lifecare Centre
*EXPERINCE SHARING By EXPERTS*
Dr Uma Rai(DGF *E*)
Dr Sangeetaa Gupta(DGF *E*)
Dr Neerja Varshney(DGF *E*)
Dr Surjeet Kapoor(DGF *E*)
Dr Rupam arora(DGF *E*)
Dr Meenakshi Ahuja(DGF *S* )
Dr.Harsha khullar(DGF *C* )
Dr Mamta mittal(DGF *N*)
Dr Leena Sreedhar(DGF *D*)
Dr.Dipti Nabh(DGF *E*)
Dr. Shama Batra(DGF *E*)
Dr Poonam Paul(DGF *SW*)
PAN DGF ( DELHI GYNAECOLOGIST FORUM) CME ON DYDROGESTERONE ON 3/2 /22
we need to update our knowledge regarding management of endometriosis.
Which is better: medications or surgery? let's see what can this talk tell us about
Vasundhara Hospital Jaipur is a premier specialty hospital for infertile couples, complete women care, high risk pregnancy management, located in heart of Jaipur.
Click to more info :- https://www.vasundharafertility.com/jaipur
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
There is a recent and strong trend in western countries to advocate single embryo transfer (eSET). The rational behind this trend is to avoid complications of multiple pregnancy after IVF. However, we would urgue that twin pregnancy is totally different from high order multiple pregnancy and the long term economic analysis of twin pregnancy has never been explored before. We tried to calculate the risks and benefits of twin pregnancy from a society perspectives. Based on our model, it seems that double embryo transfer (DET) is still a valid option.
Evidence based medicine is now focusing on diagnostic tests: how accurate and useful could be ? sensitivity and specificity are no longer the important criteria for a test
how to investigate infertile couples? there are endless number of tests: How evidence based diagnosis would help us in this issue? this talk try to answer such questions?
There are many IVF centers over the globe, but itis time to make criteria, standards and parameters for establishing an IVF center. This talk may help in this
what is the efficacy of Dienogest for management of endometriosis? let's see what research can tell us
Is it better that other modalities of management?
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
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
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
IUI is a basic but effective form of fertiltiy treatment and can be a viable alternative to the expensive IVF / test tube baby treatment that is normally advised.
This presentation will be very useful for the practising gynecologists, IVF specialists and General practitioners who perform IUI.
Even patients on going through this presentation will be more educated about iui.
Please reach out to me on 9833032120 by whatsapp / Telegram or phone call or email on dalalsj@gmail.com for further details / treatment options.
The thin endometrium refers to the lining of the uterus, known as the endometrium, being insufficiently thick. This condition is typically characterized by a reduced thickness of the endometrial layer, which plays a crucial role in supporting the implantation and development of a fertilized egg during the menstrual cycle.
A thin endometrium is commonly associated with hormonal imbalances, such as low estrogen levels, which are vital for the growth and maintenance of the endometrial tissue. Inadequate blood flow to the uterus, chronic inflammation, or certain medical conditions can also contribute to this condition. Women with a thin endometrium may experience difficulties in achieving and maintaining pregnancy, as the thin lining may not provide an optimal environment for the embryo to implant and thrive.
Addressing the underlying causes of a thin endometrium often involves hormonal therapies to regulate estrogen levels, lifestyle modifications, and sometimes surgical interventions. Fertility treatments, such as in vitro fertilization (IVF), may be considered to overcome the challenges associated with a thin endometrium.
In conclusion, a thin endometrium can pose challenges to fertility and reproductive health, requiring a comprehensive approach to address the underlying factors and improve the chances of successful conception.
A benign tumor of muscular and fibrous tissues, typically developing in the wall of the uterus.
Prevalence varies among studies and countries (4.5-68.6%)
Nearly 20-30% Indian women in reproductive age group have fibroid uterus
At any given time, nearly 15-25 million Indian women have fibroid uterus
Understand fibroids in a better way
How to prevent occurrence of severe ovarian hyperstimulation in IVF. Is there a way ? this talk will present a pilot randomised study that may shed the light on this
IVF will remain the solution for infertile couples. But its future will dramatically be directed to fertile couples !!!! This talk will discuss these issues
platelet rich plasma is being used in infertility management extensively without sound evidence of its value. In this talk, we will discuss the real impact of using PRP in IVF
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
3. Why this talk?
• To update our knowledge
• A real breakthrough in management
of endometriosis
4. Changing trend
• orally administered drugs
• more convenient
• avoidance of injection site reactions
• more practical way to take advantage
of the drug’s dose-response curve to
optimize the risk-benefit ratio.
5. Q1: What is the problem
• Endometriosis has high rate of
recurrence up to 60% within 5 years
of surgery
6. Ideal Goal
• As stated by the ASRM,
“Endometriosis should be viewed as a
chronic disease that requires a life-long
management plan with the goal
of maximizing the use of medical
treatment and avoiding repeated
surgical procedures.” Fertil & Steril,
2008
10. Administration
• 2mg once-daily
• Can start at any day of menstrual cycle
• Must be continued regardless of vag.
Bleeding
11. Does it really works?
• it appears that at a dose of 2 mg
dienogest per day, ovulation is
inhibited but ovarian hormone
production is not completely
suppressed.
12. Animal studies – anti-proliferative effects
• Dienogest reduces endometrial implant volume1,2
Reduction of endometrial implants (cyst walls) in:
Control rat at proestrus stage Rat given dienogest
Control Dienogest
Katsuki Y et al. Eur J Endocrinol 1998; 138: 216–226. .1
Fischer OM et al. Gynecol Obstet Invest 2011; 72: 145–151. .2
Volume of endometrial implants (mm3)
*P<0.05 versus control
(1mg/kg per
day)
Volume of endometrial implants (mm3)
12
13. Human studies
Mean rAFS score
p<0.001; Visanne® group
3.6
reduced mean lesion score
Week 0 Week 24
rAFS, revised American Fertility Society.
Error bars represent mean ±SEM.
11.4
Visanne® significantly
by 7.8 at week 24
Figure adapted from Köhler G et al. Int J Gynaecol Obstet. 2010; 108: 21–25.
13
14. 14
Where is the evidence for
clinical efficacy?
Study type Study
duration
Sample size
(n)
Main efficacy
end-points
Publication
Open-label dose-range
finding
24-week 64
Lesion reduction
rAFS score with 2nd look
laparoscopy
Köhler et al. (2010)
Placebo-controlled double-blind
12-week 198
Pain relief: VAS
Strowitzki et al. (2010)
Open-label extension of
placebo-controlled study
53-week 168 Petraglia et al. (2012)
Open-label leuprolide
acetate- controlled
24-week 186
Strowitzki et al. (2010)
Strowitzki et al. (2012)
rAFS=revised American Fertility Society; VAS=visual analog scale.
Köhler G et al. Int J Gynaecol Obstet 2010; 108: 21–25.
Strowitzki T et al. Eur J Obstet Gynecol Reprod Biol 2010;151:193–198.
Petraglia F et al. Arch Gynecol Obstet 2012; 285(1):167‒173.
Strowitzki T et al. Hum Reprod 2010; 25: 633–641.
Strowitzki T et al. Int J Gynecol Obstet 2012; 117: 228–233.
15. For How Long?
• Based on Its relatively short half-life of
10 hours means that there is no risk of
accumulation after repeated dosing.
• Suggested for long term treatment
16. Potential benefits over
existing technologies
• Dienogest appears to be safe and
effective when taken for up to 2 years.
• Treatment of endometriosis with
dienogest is not inferior to that with
GnRH agonists.
17. 13
Estradiol level (pg/mL)
mean ± SEM
Estradiol level (pmol/L)
mean ± SEM
90
80
70
60
50
40
30
20
10
0
Weeks of treatment
0
100
- 350
24
- 300
- 250
- 200
- 150
- 100
- 50
- 0
Difference statistically
significant (P=0.0003)
Dienogest 2 mg
Leuprolide acetate
Adapted from Strowitzki T et al. Hum Reprod 2010.
18. Weeks of treatment
% change in BMD
bone mineral density
Visanne®
Strowitzki T et al. Hum Reprod 2010;25:633–641.
19
Bone mineral density did not decrease during 24 weeks of treatment with Visanne®
19. Contraindications (CVS &
liver)
• DVT
• Arterial and cardiovascular disease,
past or present (e.g. myocardial
infarction, cerebrovascular accident,
ischemic heart disease)
• Presence or history of severe hepatic
disease as long as liver function
values have not returned to normal
20. Limitations
• Uterine bleeding may be aggravated
with the use of Visanne®.
• Longer-term treatment (up to a year)
is required before a positive effect on
the number and duration of days/
episodes of bleeding or spotting (a
reduction) can be seen.
22. Proteolysis
• Currently available GnRH antagonists
are all peptide analogues of the GnRH
and therefore cannot be taken orally
as the protein structure of the
molecule undergoes proteolysis in the
GI tract before absorption
23. Elagolix
• small molecule, non-peptide GnRH
antagonists
• therefore can to be administered
orally.
24. Pharmacodynamics
• Elagolix causes a rapid, dose-dependent
suppression of pituitary
gonadotropins, mainly LH and to a
lesser extent FSH,
• reaching its peak effects 4-6 hrs after
oral administration.
25. Clinical trials
• 15 registered
• 14 company sponsored
• Only on patients with laparoscopically
proven endometriosis
26. Aim
• To evaluate the efficacy and safety of
GnRH antagonists for the treatment of
endometriosis related pain
27. Compared to
• S.C depo medroxyprogesterone
acetate (SC-DMPA) administered
every three months
• Duration 6 month only
28. Follow up
• for 6 month after end of the study
• Visual Analogue Scale (VAS)
• Composite Pelvic Signs and
Symptoms Scale (CPSSS)
• DEXA
29. Results : it works
• significant improvment compared to
the baseline, with the majority of
patients continuing to report beneficial
effects at 6 months after completion of
the study.
31. Menses
• About 25% of patients on Elagolix
developed amenorrhea within 8-week
period of administration
32. BMD !!!!!
• significant reduction in BMD at the
spine after 12 weeks, and at spine
and femur after 24 weeks.
33. Major benefits
• No contraindications (CVS, DVT)
• NO menstrual irregularities
34. Phase III trials
• Currently 2 phase III trials
• sponsored by Abbvie Pharmaceutical
Inc.
• Aiming to recruit 875 patients in US,
Canada and Puerto Rico, comparing
the effects of two different Elagolix
regimens (150 vs 250mg) for 6
months.
35. Future use? : needs trials!!
• uterine fibroids
• prevention of premature LH surge in
IVF cycles
• steroid-dependant malignancies such
as prostate cancer.
36. So
Dienogest
• Effective
• Up to 2 yrs
• Menstrual
irregularities
• contraindications
Elagolix
• Seems effective
• Up to 6 month
• BMD
• No reported
contraindications
37. Conclusion
• It seems that the age of injections is
fading away
• Orally administered medications for
endometriosis is now a reality
• Individualisation will be the basis for
choosing either dienogest vs Elagolix
38. Thank you
Dr. Hesham Al-Inany MD, PhD
e-mail : kaainih@yahoo.com