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Practice exam 3: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Oral – easy to administer, compliance not guaranteed.Patch – avoids first-pass effect and mimics the natural route of oestrogen delivery in premenopausal women, skin reactions.Subcutaneous implant – compliance guaranteed, risk of tachyphylaxis.
The menopause
Published in Michael J. O’Dowd, The History of Medications for Women, 2020
Bishop (1938) reported his clinical experience of subcutaneous estrogen implants in estrogen replacement therapy (thus avoiding the ‘first-pass’ liver effect), and that treatment modality was later popularized by Greenblatt (1949). Eventually, estrogen was available in tablet form; transdermally as a patch; parenterally as a cream; percutaneously; or directly to the vagina; and as a subcutaneous implant. Estrogen therapy remains the best treatment for the menopause and progestogen (oral norethisterone) administration was found to be the next most effective (Appleby, 1962).
Androgen production over the female life span
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
H. M. Buckler, W. R. Robertson
The concept of adrenal androgen replacement in older women is now the subject of increasing investigation and a number of therapeutic strategies (oral medication, intramuscular injection, implants, transdermal patch-based delivery) are now available. For example, the fall in adrenal DHEA and DHEAS secretion has lead to the treatment of women of advancing age with DHEA, and this results in the restoration of circulating T and Adione to premenopausal levels29 and is reported to be associated with an increased feeling of wellbeing. Further, the treatment of women with testosterone (100 or 50 mg) as well as estradiol implants has been shown to improve sexual function and have beneficial effects on bone density6,30). The long duration of subcutaneous implant therapy may not always be appropriate when initiating T treatment in women because of potential side-effects such as worsening of hirsutism or acne.
The influence of hormonal contraception on depression and female sexuality: a narrative review of the literature
Published in Gynecological Endocrinology, 2022
Laura Buggio, Giussy Barbara, Federica Facchin, Laura Ghezzi, Dhouha Dridi, Paolo Vercellini
In 2016, Skovlund et al. [66] published a large prospective cohort study aimed at investigating the association between HC and mood disorders. The authors combined data from two Danish registries, the National Prescription Register and the Psychiatric Central Research Registry. A total of 1,061,997 women aged between 15 and 34 were included in the analysis, excluding women who had a prior diagnosis or treatment of depression, other psychiatric disorders, cancer, venous thrombosis or a history of infertility. The mean follow-up period was 6.4 years. Compared with nonusers, COC users had an adjusted incidence rate ratio (RR) for the first use of an antidepressant of 1.34 (95% CI: 1.27–1.40). Considering the different compounds, the highest risk was associated with the medroxyprogesterone acetate depot [RR 2.7 (95% CI: 2.45–2.87)], the subcutaneous implant [RR 2.1 (95% CI: 2.01–2.24)], the patch [RR 2.0 (95% CI: 1.76–2.18)], and the vaginal ring [RR 1.6 (95% CI: 1.55–1.69)]. The relative risks for the first use of antidepressants [RR 1.4 (95% CI, 1.34–1.46)] and for the first diagnosis of depression [RR 1.5 (95% CI, 1.36–1.64)] peaked after six months of HC use. Interestingly, when age-stratified analyses were conducted, adolescents aged between 15 and 19 years reported a higher risk of initiating antidepressant therapy [RR 1.8 (95% CI: 1.72–1.88)].
Long-lasting treatment for moderate-severe depressed facial scars: skin and hair derived new autologous tissue filler with subcision
Published in Journal of Dermatological Treatment, 2022
Qi Chen, Yue Yang, Jiao Zhang, Qingguo Zhang
Garbis et al. (22) first came up with the idea of using hair as a filler material for reconstruction and cosmetic surgery in 1996. Hong et al. (23) implanted sterile hair into face to correct face defect. Autologous keratin deprived from hairs is first reported by Tachibana in 2001 (24). As to the many distinct advantages of keratin (remarkable biocompatible, stable molecular structure and the mechanism of promoting cell regeneration), more researches focus on its potential value in regenerative medicine (25–26). Our previous study turned out hair-derived material after processing showed an intrinsic capacity with preferable fluidity and glutinousness for injection, with a good biocompatibility and absence of cytotoxicity or mutagenicity. Animal subcutaneous implant models did not show any local or systemic adverse reactions in the observation period. In the absorbance model, hair fiber particle showed preferable augmentation effect which preserved at least 50% of original volume during the observation (10). And this new filler has already been used in clinical trial for dealing with neck wrinkles and tear through and also showed good therapeutic effect in our early work (11,12).
Afamelanotide for prevention of phototoxicity in erythropoietic protoporphyria
Published in Expert Review of Clinical Pharmacology, 2021
Debby Wensink, Margreet A.E.M. Wagenmakers, Janneke G. Langendonk
The first study was performed in five patients (CUV010), receiving a subcutaneous implant at a dose of 20 mg, given twice at an interval of 60 days [68]. The dosage interval was chosen based on very limited data, and understanding of clinical behavior of patients with the expectation that elevated melanin levels would stay above baseline after 60 days, and the implant would be fully resorbed. This was not studied in an evidence-based manner since no dose ranging studies have been performed. The primary endpoint of photoprovocation was time until intolerable pain on the dorsum of the hand following exposure to a standardized white light source, a xenon arc lamp with UV filters. There was an 11 times increase in time to response after photoprovocation at day 120 compared to baseline, this increase did not correlate with increased melanin density. Reported adverse events were short-term nausea and headache. A second phase II study (CUV030) was a randomized controlled trial (n = 77) using 16 mg subcutaneous implants every 60 days, 3 doses in total. No peer-reviewed publication was found for this trial. The sponsor reported to the EMA: following treatment, more direct sunlight exposure between 10:00 and 15:00 hours on days when no pain was experienced, though no difference between groups for overall time spent outdoors or number of severe phototoxic reactions was observed [65,69].