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Fulltext Progestogen for treating threatened miscarriage

Wahabi HA, Fayed AA, Esmaeil SA, Bahkali KH

Cochrane Database Syst Rev, 2018 Aug 06;8(8):CD005943.
PMID: 30081430 DOI: 10.1002/14651858.CD005943.pub5

BACKGROUND: Miscarriage is a common complication encountered during pregnancy. It is defined as spontaneous pregnancy loss before 20 weeks' gestation. Progesterone's physiological role is to prepare the uterus for the implantation of the embryo, enhance uterine quiescence and suppress uterine contractions, hence, it may play a role in preventing rejection of the embryo. Inadequate secretion of progesterone in early pregnancy has been linked to the aetiology of miscarriage and progesterone supplementation has been used as a treatment for threatened miscarriage to prevent spontaneous pregnancy loss. This update of the Cochrane Review first published in 2007, and previously updated in 2011, investigates the evidence base for this practice.
OBJECTIVES: To determine the efficacy and the safety of progestogens in the treatment of threatened miscarriage.
SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (8 August 2017) and reference lists of retrieved trials.
SELECTION CRITERIA: Randomised, quasi-randomised or cluster-randomised controlled trials, that compared progestogen with placebo, no treatment or any other treatment for the treatment of threatened miscarriage in women carrying singleton pregnancy.
DATA COLLECTION AND ANALYSIS: At least two review authors assessed the trials for inclusion in the review, assessed trial quality and extracted the data and graded the body of evidence.
MAIN RESULTS: We included seven trials (involving 696 participants) in this update of the review. The included trials were conducted in different countries, covering the full spectrum of the World Bank's economic classification, which enhances the applicability of evidence drawn from this review. Two trials were conducted in Germany and Italy which are high-income countries, while four trials were conducted in upper-middle income countries; two in Iran, one in Malaysia and the fourth in Turkey, and the seventh trial was conducted in Jordan, which is a lower-middle income country. In six trials all the participants met the inclusion criteria and in the seventh study, we included in the meta-analysis only the subgroup of participants who met the inclusion criteria. We assessed the body of evidence for the main outcomes using the GRADE tool and the quality of the evidence ranged from very low to moderate. Downgrading of evidence was based on the high risk of bias in six of the seven included trials and a small number of events and wide confidence intervals for some outcomes.Treatment of miscarriage with progestogens compared to placebo or no treatment probably reduces the risk of miscarriage; (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.47 to 0.87; 7 trials; 696 women; moderate-quality evidence). Treatment with oral progestogen compared to no treatment also probably reduces the miscarriage rate (RR 0.57, 95% CI 0.38 to 0.85; 3 trials; 408 women; moderate-quality evidence). However treatment with vaginal progesterone compared to placebo, probably has little or no effect in reducing the miscarriage rate (RR 0.75, 95% CI 0.47 to 1.21; 4 trials; 288 women; moderate-quality evidence). The subgroup interaction test indicated no difference according to route of administration between the oral and vaginal subgroups of progesterone.Treatment of preterm birth with the use of progestogens compared to placebo or no treatment may have little or no effect in reducing the rate of preterm birth (RR 0.86, 95% CI 0.52 to 1.44; 5 trials; 588 women; low-quality evidence).We are uncertain if treatment of threatened miscarriage with progestogens compared to placebo or no treatment has any effect on the rate of congenital abnormalities because the quality of the evidence is very low (RR 0.70, 95% CI 0.10 to 4.82; 2 trials; 337 infants; very-low quality evidence).
AUTHORS' CONCLUSIONS: The results of this Cochrane Review suggest that progestogens are probably effective in the treatment of threatened miscarriage but may have little or no effect in the rate of preterm birth. The evidence on congenital abnormalities is uncertain, because the quality of the evidence for this outcome was based on only two small trials with very few events and was found to be of very low quality.
Fulltext Evaluation of chemopreventive effects of Acanthus ilicifolius against azoxymethane-induced aberrant Crypt Foci in the rat colon

Almagrami AA, Alshawsh MA, Saif-Ali R, Shwter A, Salem SD, Abdulla MA

PLoS One, 2014;9(5):e96004.
PMID: 24819728 DOI: 10.1371/journal.pone.0096004

Acanthus ilicifolius, a mangrove medicinal plant, is traditionally used to treat a variety of diseases. The aim of this research is to assess the chemoprotective outcomes of A. ilicifolius ethanolic extract against azoxymethane (AOM) induced colonic aberrant crypt foci (ACF) in rats.
The role of tourism, transportation and globalization in testing environmental Kuznets curve in Malaysia: new insights from quantile ARDL approach

Sharif A, Afshan S, Chrea S, Amel A, Khan SAR

Environ Sci Pollut Res Int, 2020 Jul;27(20):25494-25509.
PMID: 32350832 DOI: 10.1007/s11356-020-08782-5

This paper uses the quantile autoregressive distributed lag (QARDL) model to analyze the impact of economic growth, tourism, transportation, and globalization on carbon dioxide (CO2) emissions in the Malaysian economy. The QARDL model is employed utilizing quarterly data from 1995Q1 to 2018Q4. The results demonstrate that economic growth is significantly positive with CO2 emissions at lower to upper quantiles. Interestingly, tourism has a negative effect on CO2 emissions at higher quantiles. Moreover, globalization and transportation services are positive, with CO2 emissions at upper-middle to higher quantiles. Furthermore, we tested the environmental Kuznets curve, and the outcomes confirm the presence of the inverted U-shaped curve in the Malaysian economy. The results of this study suggest that ecotourism is beneficial for economic growth in underdeveloped areas; it increases employment opportunities and, thus, achieves a win-win situation for protection and development. The government should encourage the low-carbon development of ecotourism and achieve green development of both tourism and the economy.
Chemoprevention of colonic aberrant crypt foci by Gynura procumbens in rats

Shwter AN, Abdullah NA, Alshawsh MA, Alsalahi A, Hajrezaei M, Almaqrami AA, et al.

J Ethnopharmacol, 2014 Feb 12;151(3):1194-1201.
PMID: 24393787 DOI: 10.1016/j.jep.2013.12.044

ETHNOPHARMACOLOGICAL RELEVANCE: Gynura procumbens is commonly used as a traditional medicinal plant in Malaysia for treatment of many diseases. To investigate the chemopreventive properties of Gynura procumbens on azoxymethane (AOM)-induced aberrant crypt foci (ACF) in rats.
METHODS: Five groups of adult male rats were used in this experiment. Normal/control group; the rats were injected subcutaneously with 15 mg/kg of sterile normal saline once a week for two weeks, and orally administered with 10% Tween 20 (5 mL/kg). Carcinogen and treatment groups; the rats were injected subcutaneously each with 15 mg/kg body weight AOM once a week for 2 weeks and were continued to be fed for two months, respectively with 10% Tween 20, 500 and 250mg/kg body weight plant extracts. Reference group; the rats were injected subcutaneously with 15 mg/kg body weight AOM once a week for 2 weeks, and injected intraperitoneally with fluorouracil 35 mg/kg body weight for five consecutive days.
RESULT: Total ACF detected in methylene blue stained whole mounts of rat colon were 21, 23and 130 in rats fed with 500, 250 mg/kg body weight treatment and carcinogen groups, respectively. Treatment with high and low doses of the plant extract led to83.6% and 82.2% decrease in the total crypts in the groups fed 500 mg/kg and 250 mg/kg Gynura procumbens respectively compared to carcinogen group. Immunohistochemical staining of ACF showed suppressed azoxymethane induced colonic cell proliferation and Bcl-2 expression. Glutathione-S-transfarase and superoxide dismutase activities were higher in treated rats compared to carcinogen groups.
CONCLUSION: Gynura procumbens reduced the incidence of AOM induced ACF. The findings showed that Gynura procumbens may have antiproliferative and antioxidative properties. Moreover, Gynura procumbens possesses the medicinal properties to prevent colon cancer.