Short-acting and Long-acting Opioids Utilization among Women Diagnosed with Endometriosis in the United States: A Population-based Claims Study.

STUDY OBJECTIVE: To determine the prevalence and pattern of opioid use in endometriosis and the characteristics of patients prescribed an opioid using medical insurance claims data. DESIGN: We performed a retrospective cohort analysis of data from the Truven MarketScan Commercial database for the period of January 1, 2011 to December 31, 2016. SETTING: The Truven database includes inpatient, outpatient, and prescription claims covering more than 115 million unique individuals and over 36 million inpatient hospital discharges across multiple payer types and all 50 states. PATIENTS: Women with endometriosis were defined as those with 1 inpatient or 2 outpatient codes for endometriosis. INTERVENTIONS: No interventions were assigned. Women who filled an opioid prescription within 12 months of diagnosis were placed in the opioid cohort and women who did not fill an opioid prescription were placed in the nonopioid cohort. MEASUREMENTS AND MAIN RESULTS: Baseline characteristics were evaluated 12 months preindex (date of the first diagnosis) and opioid use was assessed for 12 months after the index date. The dataset included 58 472 women with endometriosis. Of these, 61.7% filled an opioid prescription during the study period. More than 95% filled prescriptions for short-acting opioids (SAOs) only, 4.1% filled prescriptions for both SAOs and extended-release/long-acting opioids (LAOs), and 0.6% filled prescriptions for LAOs only. Patients who filled an opioid prescription had higher baseline comorbidities (especially gynecologic and chronic pain comorbidities) and endometriosis-related medication use compared with patients who did not fill an opioid prescription during the study period. Patients who filled both LAO and SAO prescriptions had the highest total days' supply of opioids, the proportion of days covered by prescriptions, and morphine equivalent daily dose. These patients also had the highest proportions of opioid switching and dose augmentation. Statistical trends in data were not substantially altered when analyses excluded patients with chronic pain comorbidities or surgical opioid prescriptions. CONCLUSION: Although opioids are not a recommended treatment for endometriosis, more than half of our cohort filled an opioid prescription within 1 year after a first recorded diagnosis of endometriosis. Patients who filled an opioid prescription tended to use more endometriosis-related medications and have a higher comorbidity burden. Additional research is necessary to better understand the reasons and outcomes associated with opioid utilization in endometriosis and to determine if there is a more effective pain management treatment plan for patients taking opioids.

Toxicity assessment of Leonuri Herba aqueous extract orally administered to rats for 13 consecutive weeks.

ETHNOPHARMACOLOGICAL RELEVANCE: The Leonuri Herba has been traditionally used for women's disease in Asian countries. AIM OF THE STUDY: The objective of the present study was to evaluate the subchronic toxicity of Leonuri Herba aqueous extract in male and female F344 rats. MATERIAL AND METHODS: Leonuri Herba aqueous extract was administered orally once daily at dose levels of 0, 125, 250, 500, 1000 and 2000 mg/kg/day for 13 weeks. Toxicological assessment was performed including mortality, clinical signs, body and organ weights, food consumption, ophthalmology, urinalysis, hematology, serum chemistry, gross findings and histopathologic examination. RESULTS: There were no treatment related differences in clinical signs, urinalysis, hematology and serum chemistry, except for a histopathologic examination. The squamous cell hyperplasia in the forestomach was observed in both sexes of rats given 2000 mg/kg/day of Leonuri Herba aqueous extract. CONCLUSION: In conclusion, the NOAEL (No Observed Adverse Effect Level) for Leonuri Herba aqueous extract was determined as 1000 mg/kg/day in both sexes of rats under the present experimental conditions. And the acceptable daily intake value for Leonuri Herba aqueous extract was calculated to be 10mg/kg body weight per day using a safety factor of 100 to the NOAEL.

A formal decision analysis identifies an optimal treatment strategy in a resource-poor setting.

OBJECTIVE: Decision analytic techniques use formal specifications of utility for the four fundamental decision events: true positives, false positives, true negatives, and false negatives. An optimal policy is the one with the lowest expected net cost. In this paper, decision analytic techniques for treatment selection based on patient characteristics are applied to a resource-poor setting. STUDY DESIGN AND SETTING: A cohort of 986 female sex workers in Antananarivo and Tamatave, Madagascar were tested for cervical infection at baseline and again 2 months later after presumptive treatment for gonorrhea and chlamydia. RESULTS: Three equivalent approaches to identify the optimal policy based on patient characteristic subgroups are demonstrated. Two of them require exhaustive searches of all possible alternatives. The third identifies the optimal policy as an analytic expression that compares a decision function with a threshold and leads to a closed-form solution. With this approach, the optimal policy can be expressed in four equivalent forms using basic epidemiological measures: likelihood ratio, predicted probability of disease, logistic regression parameters, and total risk score. CONCLUSION: These methods illustrate the application of a decision analysis to clinical epidemiology. Management of cervical infection for sex workers in Madagascar occurs under severe resource constraints, and therefore requires an algorithm for identifying optimal treatment regimens.

[Comparative assessment of the quality of life of reproductive age patients with endometriosis depending on the method of treatment].

The purpose of the study was to investigate the influence of endometriosis as well as certain widely-spread methods of its conservative hormonal and surgical treatment on the quality of life of the patients in reproductive age. 546 twenty to forty years old women have been examined: 371 patients with the first time diagnosed endometriosis (I group), 64 -- after conservative hormonal therapy (II group), 111 -- after radical surgery (III group) and 30 healthy women (control group). All women operated for endometriosis were assessed to determine the quality of life by the following scores: "unsatisfactory" -- 0 point, "satisfactory" -- 1 point, excellent -- 2 points. The average index of quality of life among all subjects was equal to 0,5+/-0,62 points (from 1,0+/-0,69 in the group of patients after one-sided ovariectomy or adnexectomy to 0,3+/-0,45 -- in patients after double adnexectomy with hysterectomy) that was 7,8 times (p<0,001) and 2,6 times less than the given indices in the control group and in the untreated patients correspondingly. So, endometriosis in reproductive age significantly deteriorates the quality of life of the patients in comparison with healthy women. This quality can't be fully restored by any of the analyzed methods of conservative hormonal treatment, radical surgery leads to its further significant deterioration requiring thus to continue searching for the most optimal approaches to the treatment and rehabilitation of patients with endometriosis in the reproductive age.

Place of amniocentesis in the assessment of preterm labour.

OBJECTIVE: To evaluate the benefits and indications for amniocentesis in cases of preterm labor with or without preterm rupture of membranes. METHOD: A review of the literature on amniocentesis in cases of intra-amniotic infection. RESULTS: Amniocentesis is an invasive method that allows the diagnosis of intra-amniotic infection. However, no randomized trials have been performed from which we can assess the benefits and complications of amniocentesis in preterm labor. CONCLUSION: The published data do not justify the routine practice of amniocentesis in preterm labor. More data are needed to evaluate the benefits and complications of this practice. Only randomized trials of patients in preterm labor, comparing those who undergo amniocentesis with those who do not, will clarify the indications for this procedure.

[Determination and assessment of the estrogen proliferation dosage on the human endometrium]. / Zur Problematik von Bestimmung und Beurteilung der Ostrogen-Aufbaudosis am menschlichen Endometrium.

The term, 'proliferation dosage' of an estrogen is defined differently in the gynecologic literature. In this article the authors were concerned critically with the methods of its determination. They came to the conclusion that under standardized conditions sufficiently sure and reproducible results can be received in postmenopausal women. 7 short acting and 3 long acting estrogens, some of which are clinically unknown substances, were examined using the following definition of proliferation dosage: 'Proliferation dosage is the amount of an estrogen which induces the signs of the late proliferation phase after being administered daily in the course of 10 to 14 days to postmenopausal women with atrophic endometrium.' In order to investigate the proliferating properties of 3 depot estrogens a modified test procedure was performed, derived from animal experiments' results and the planned clinical mode of application.