RESUMEN
Several studies have emphasized poor pregnancy outcomes associated with active lupus nephritis at the onset of conception. A few controversial studies have compared pregnancy outcome in patients with inactive lupus nephritis at conception and those without a history of lupus nephritis. This study aimed to find out if quiescent lupus nephritis at the onset of conception carries an increased risk of pregnancy complications compared to pregnancies without a history of lupus nephritis. This is a prospective cohort study carried out at the Rheumatology/Obstetrics Conjoint Clinic of Kasr Al-Ainy Hospital between January 2006 and December 2017. A total of 119 pregnancies were included: 72 pregnancies in group I (with a history of lupus nephritis) and 47 pregnancies in group II (non-renal systemic lupus erythematosus). They were subjected to full history taking, monthly clinical examination and laboratory investigations. In total, 16 (22.2%) renal pregnancies had renal flares at the onset of conception. Maternal complications, specifically renal flares, were reported in 36 (50%) pregnancies in group I and 13 (27.7) pregnancies in group II, with a significant difference (p = 0.015). No significant differences were found concerning the frequency of pregnancy-related maternal and fetal complications between the two groups. When data were re-analyzed after excluding patients experiencing renal flares during the 6 months preceding pregnancy, there were no significant differences regarding the frequency of maternal and fetal complications between renal and non-renal pregnancies. In conclusion, lupus nephritis, per se, is not a risk factor for poor pregnancy outcome; rather, it is the lupus nephritis activity at the onset of pregnancy.
Asunto(s)
Riñón/patología , Nefritis Lúpica/fisiopatología , Complicaciones del Embarazo/fisiopatología , Resultado del Embarazo , Adulto , Egipto , Femenino , Humanos , Nefritis Lúpica/diagnóstico , Preeclampsia/diagnóstico , Embarazo , Complicaciones del Embarazo/diagnóstico , Atención Prenatal , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
STUDY QUESTION: Which is better, Tramadol or Celecoxib, in reducing pain associated with outpatient hysteroscopy? SUMMARY ANSWER: Both Tramadol and Celecoxib are effective in reducing pain associated with outpatient hysteroscopy but Celecoxib may be better tolerated. WHAT IS KNOWN ALREADY: Pain is the most common cause of failure of outpatient hysteroscopy. A systematic review and meta-analysis showed that local anaesthetics were effective in reducing pain associated with hysteroscopy but there was insufficient evidence to support the use of oral analgesics, opioids and non-steroidal anti-inflammatory drugs, to reduce hysteroscopy-associated pain and further studies were recommended. STUDY DESIGN, SIZE, DURATION: This was a randomized double-blind placebo-controlled trial with balanced randomization (allocation ratio 1:1:1) conducted in a university hospital from May 2014 to November 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS: Two hundred and ten women who had diagnostic outpatient hysteroscopy were randomly divided into three equal groups: Group 1 received oral Tramadol 100 mg, group 2 received Celecoxib 200 mg and group 3 received an oral placebo. All the drugs were given 1 h before the procedure. A patient's perception of pain was assessed during the procedure, immediately afterwards and 30 min after the procedure with the use of a visual analogue scale (VAS). MAIN RESULTS AND THE ROLE OF CHANCE: There was a significant difference in the pain scores among the groups during the procedure, immediately afterwards and 30 min after the procedure (P< 0.001, 0.001, <0.001 respectively). Tramadol had significantly lower pain scores when compared with the placebo during the procedure (mean difference = 1.54, 95% confidence interval (CI) (0.86, 2.22), P < 0.001), immediately after the procedure (mean difference = 1.09; 95% CI (0.5, 1.68), P < 0.001) and 30 min later (mean difference = 0.95, 95% CI (0.48, 1.41), P < 0.001). Celecoxib administration also led to significantly lower pain scores than the placebo during the procedure (mean difference = 1.28, 95% CI (0.62, 1.94), P < 0.001), immediately after the procedure (mean difference = 0.72; 95% CI (0.13, 1.32), P = 0.016) and 30 min later (mean difference = 0.77, 95% CI (0.3, 1.24), P = 0.001). There were no significant differences in pain scores between Tramadol and Celecoxib at any time. Time until no pain differed significantly among the groups (P = 0.01); it was shorter with both Tramadol and Celecoxib groups when compared with placebo (P = 0.002 and 0.046, respectively). The procedure failed to be completed in one patient in the placebo group but no failure to complete the procedure occurred in Tramadol and Celecoxib groups. Four women in the Tramadol group reported nausea but no side effects were reported with Celecoxib group and no complications were reported in any group of patients. LIMITATIONS, REASONS FOR CAUTION: All results were based on the subjective perception of pain, which varies among individuals and is related to the individuals' previous pain experience and level of anxiety. WIDER IMPLICATIONS OF THE FINDINGS: Tramadol and Celecoxib are effective in reducing pain in outpatient hysteroscopy. Celecoxib may be better tolerated as no side effects were reported in the study, however further research on a larger sample size is required before drawing firm conclusions about lack of side effects. STUDY FUNDING/COMPETING INTERESTS: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector. All authors declare no conflict of interest. TRIAL REGISTRATION NUMBER: www.clinicaltrials.gov - NCT02071303.
Asunto(s)
Analgésicos Opioides/farmacología , Celecoxib/farmacología , Inhibidores de la Ciclooxigenasa 2/farmacología , Histeroscopía/efectos adversos , Dolor/prevención & control , Tramadol/farmacología , Adulto , Analgésicos Opioides/administración & dosificación , Celecoxib/administración & dosificación , Inhibidores de la Ciclooxigenasa 2/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Pacientes Ambulatorios , Dolor/etiología , Dimensión del Dolor , Tramadol/administración & dosificación , Resultado del Tratamiento , Adulto JovenRESUMEN
Incorporation of amino acids by mitochondria and its subfractions from mammary gland of the goat during lactation was studied in vitro. Assessment of distribution of radioactivity incorporated by intact mitochondria into its subfractions revealed maximum specific activity in the inner membrane. During lactation the inner membrane of mitochondria exhibited further stimulation in such incorporation. Matrix was the next active fraction whereas outer membrane and peripheral space had negligible radioactivity. In isolated submitochondrial fractions from mammary gland incubated with radioactive amino acids under similar conditions of assay, the inner membrane was the most potent subfraction in incorporation. In mammary tissue during lactation this fraction was the most active site. The relative sequence of the subfractions appeared to remain unaltered in lactation and was in the order of inner membrane greater than matrix greater than outer membrane greater than peripheral space. The ratio of specific activity in inner to outer membrane appears to increase significantly during lactation.