Hyoscine N-butyl Bromide Research Articles

Hyoscine-n-butylbromide in treating abdominal pain caused by gastroenteritis: a double-blind randomized placebo-controlled study.

Hyoscine-N-butylbromide (HBB) is an anticholinergic agent widely used to treat pain caused by spasms in the gastrointestinal and urogenital systems. The aim of this study was to compare the efficacy of HBB with a placebo in treating abdominal cramping pain caused by acute gastroenteritis in the emergency department (ED). This was a prospective, double-blind, placebo-controlled, randomized trial conducted in a single-center academic ED from September to November 2021. Patients aged 18-65 years with acute gastroenteritis symptoms were included. The study compared the efficacy of intravenous HBB (20 mg) to a placebo. The primary outcome was the absolute change in pain score at 30 min after treatment, with secondary outcomes including pain relief at 60 min, adverse events, and the need for rescue analgesics. Fifty patients were randomized (25 in each group). There was no significant difference in 30-min and 60-min pain scores between the groups. At 60 min, pain reduction and the need for rescue analgesia were similar in both groups. Changes in pain scores from admission to 30 and 60 min did not significantly differ between the groups. Intravenous HBB did not show a statistically or clinically significant difference in pain reduction compared to a placebo in patients with acute gastroenteritis and cramping abdominal pain in the ED.

Provider-reported use of butylscopolamine in gastrointestinal endoscopy in Germany.

Introduction The anti-cholinergic agent hyoscine-N-butylbromide (HBB) is used in gastrointestinal (GI) endoscopy to decrease motility and facilitate endoscopic procedures. Data from clinical studies to support this practice is limited especially for therapeutic procedures. Likewise, patterns of use among endoscopist are largely unclear. This study sought to assess usage of HBB among German-speaking endoscopists. Material and Methods We conducted an anonymous online survey among endoscopists in German-speaking countries. Results A total of 207 physicians participated in the survey. The majority (76.9%) were experienced endoscopists and 92.3% of respondents use HBB at least occasionally during procedures. The reported median stated frequency of HBB use varied greatly between different types of procedures and increased with the complexity of the procedure being performed. HBB was rarely used in diagnostic esophagogastroduodenoscopies (EGD) (median stated frequency 1% of procedures), while use frequency was significantly higher in EGD with endoscopic mucosal resection (EMR) (10%; p=0.002) and EGD with endoscopic submucosal dissection (ESD) (20%; p<0.001). Similarly, use frequency during diagnostic colonoscopy was lower (5%) compared to colonoscopy with EMR (20%, p=0.005) or ESD (42.5%, p<0.001). The highest use frequency was reported for ERCP (50%). The most frequently stated reason to use HBB was facilitation of the procedure (80.6%) followed by increasing diagnostic yield (58.3%). Conclusion German-speaking endoscopists commonly use HBB, most frequently to facilitate complex therapeutic procedures. Given there is almost no data supporting HBB use in therapeutic endoscopy, we suggest that more research is needed to evaluate benefits and risks of this practice.

Effects of Potentially Inappropriate Medications in Older Patients with Gastrointestinal System Cancer.

Potentially inappropriate medications (PIM) is a crucial problem in the geriatric population. The amount of prescription and unadherence increase because of the different problems encountered in cancer patients. Our aim was to evaluate the effects of PIM in patients with gastrointestinal system cancer and to investigate its relationship with chemotherapy side effects, mortality, and progression. This retrospective cohort study assessed 154 patients with gastrointestinal system cancer. Demographics and disease features, the presence of PIM according to the "TIME-to-STOP" criteria and baseline laboratory parameters were recorded. The effects of PIM on survival and adverse treatment events were evaluated. 66.9% of the cases were male and 33.1% were female. The mean age was 71.9±6.4 years. The most common side effects of chemotherapy are nausea, vomiting, kidney injury, and pain. The most frequently used prescriptions among the 98 PIMs were gliclazide, hyoscine N-butylbromide, simethicone, diphenoxylate atropine, and thiocolchicoside. PIM was detected in 68.1% of the participants. Chemotherapy side effects were more common in PIM group (p<0.001, odds ratio =5.6). PIM had no effect on mortality. Factors associated with mortality were age, stage, albumin, creatinine, operation history, and progression. A significant relationship was found between age, cancer stage, albumin, creatinine, operation history, and PIM in the regression model. There was no relationship between PIM and progression-free survival. Chemotherapy toxicity may increase with PIM detected on diagnosis. We suggest that PIM is an important factor in predicting the side effects of chemotherapy and minimizing the adverse effects.

Development and validation of chemometric-assisted spectrophotometric models for efficient quantitation of a binary mixture of supportive treatments in COVID-19 in the presence of its toxic impurities: a comparative study for eco-friendly assessment

The use of sustainable solvents has increased significantly in recent years due to advancements in green analytical methods. The number of impurities in the drug substance determines how safe the finished product is. Therefore, during the whole medication planning process, contaminants need to be closely watched. Using chemometric models, the concentrations of hyoscine N-butyl bromide (HYO) and paracetamol (PAR) were determined in the presence of three PAR impurities [P-nitrophenol (PNP), P-aminophenol (PAP), and P-chloroacetanilide (PCA), as well as DL-tropic acid (TRO) as a HYO impurity]. It was possible to isolate and measure these dangerous impurities. Fever and spasms associated with COVID-19 are reported to be considerably reduced when PAR and HYO are taken together. Artificial neural networks, principal component regression, multivariate curve resolution-alternating least squares, and partial least squares are the four chemometric-assisted spectrophotometric models that were created and verified. All of the proposed methods’ quantitative analytical potency was assessed using recoveries%, root mean square error of prediction, and standard error of prediction. For PAR, HYO, PNP, PCA, TRO, and PAP, respectively, the indicated approaches were used in the ranges of 4.00–8.00, 16.00–24.00, 1.00–5.00, 0.40–0.80, 4.00–12.00, and 2.00–6.00 µg/mL. They are able to get around difficulties like collinearity and spectral overlaps. After statistical testing, there was no discernible difference between the recommended methods and the published one. The degree of greenness of the established models was evaluated using three different green assessment methods. In the presence of their harmful impurities, PAR and HYO could be identified using the recommended methods.

Chromatographic impurity profile assessment of dual action binary combination: Ecological analysis with comparative statistics

The level of impurities in drug substances effects on safety of finished product so it must be carefully monitored during the whole medication manufacturing. The combination of paracetamol (PAR) and hyoscine N- butylbromide (HYO) has analgesic and antispasmodic action. In this research, PAR and HYO were determined using green HPLC in the presence of impurities (P-aminophenol (PAP), P-nitrophenol (PNP), and P-chloroacetanilide (PCA)) as PAR impurities. These toxic impurities were successfully separated along with additional quantification. The optimum chromatographic separation was achieved by using Zorbax® Eclipse XDB column C18 (250 mm 4.6 mm, 5 μm) as the stationary phase and acetonitrile:0.01 M phosphate buffer (pH = 5.0) at a ratio of 30:70 v/v as the mobile phase with isocratic elution, pumped at 1.5 mL/min. A UV lamp was used for detection at 210.0 nm. The retention times for PAP, PAR, HYO, PNP, and PCA were 1.35, 1.95, 3.52, 7.07, and 8.47 min, respectively. This method was reliable for linearity ranges of 10.00–300.00 μg/mL for PAR, 5.00–50.00 μg/mL for HYO and 5.00–50.00 μg/mL for the three impurities. Student's F-test and t-test method was used in the statistical comparison between established and reported methods. The result found there was statistically indistinguishable after being fully validated in accordance with ICH requirements. The proposed approach was demonstrated to be more environmentally friendly than the reported one in terms of the use of potentially harmful chemicals, energy consumption, and waste generation. In addition, the established technique is suitable for impurity profiling while the reported one is not so.

LC-MS/MS approach for simultaneous assessment of hyoscine N-butyl bromide and ketoprofen in biological fluids and pharmaceuticals.

The mixture of hyoscine N-butyl bromide (HBB) and ketoprofen (KTP) is commonly used for the handling of abdominal spasms and pain relief. There are two challenges that restrict the simultaneous assessment of HBB and KTP in biological fluids and pharmaceuticals. The first issue is the difficulty of elution of HBB and the second one is the presence of KTP as a racemic mixture in all pharmaceutical formulations, which obscures its appearance as a single peak. An ultrasensitive and highly efficient liquid chromatography-mass/mass spectrometric (LC-MS/MS) method is designed and validated for the first concurrent assessment of HBB and KTP in spiked human serum and urine, and pharmaceutical formulations. The estimated linearity ranges for HBB and KTP were respectively, 0.5-500 and 0.05-500 ng/ml, with excellent correlation coefficients. Validation results showed that the value of relative standard deviations were <2% for HBB and KTP. The mean extraction recoveries for HBB and KTP were, respectively, 91.04 and 97.83% in Spasmofen® ampoules; 95.89 and 97.00% in spiked serum; and 97.31 and 95.63% in spiked urine. The presented innovative chromatographic approach was utilized for the measurement of trace amounts of coexisting pharmaceuticals in pharmacokinetics studies and routine therapeutic medication monitoring.

Comparative effectiveness of interventions for managing urological postoperative catheter-related bladder discomfort: a systematic review and network meta-analysis

BackgroundCatheter-related bladder discomfort (CRBD) is a common postoperative bladder pain syndrome. Many drugs and interventions for managing CRBD have been studied, but their comparative effectiveness remains controversial. We made a study to assess the comparative effectiveness of interventions included Ketorolac, Lidocaine, Chlorpheniramine, Gabapentin, Magnesium, Nefopam, Oxycodone, Parecoxib, Solifenacin, Tolterodine, Bupivancaine, Dexmedetomidine, Hyoscine N-butyl bromide, Ketamine, Penile nerve block on urological postoperative CRBD.MethodsWe performed a network meta-analysis via Aggregate Data Drug Inormation System software included 18 studies with 1816 patients and assessed the risk of bias by Cochrane Collaboration tool. The incidence of moderate to severe CRBD at 0, 1, and 6 h after surgery and the incidence severe CRBD at 1 h after surgery were compared.ResultThe number of best rank is 0.48(Nefopam) and 0.22(Nefopam) in the incidence of moderate to severe CRBD at 1 h and incidence severe CRBD at 1 h. More than half of studies at unclear or high risk of bias.ConclusionNefopam reduced the incidence of CRBD and prevented severe events, but limited by the small number of studies for each intervention and heterogeneous patients.

Hyoscine N-butylbromide inhalation: they know, how about you?

Hyoscine N-butylbromide inhalation: they know, how about you?

Effect of addition of antispasmodic to local and systemic analgesics on pain perception during hysterosalpingography: a randomized controlled trial

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tubal factor is responsible for most of the causes of infertility, especially in our environment, and hysterosalpingography (HSG) is the investigation of choice for assessing tubal patency.&lt;strong&gt; &lt;/strong&gt;Objective of current study was to evaluate the effect of the addition of intramuscular hyoscine-N-butyl bromide (HBB) to local and systemic analgesics on pain perception during hysterosalpingography.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This randomized controlled trial was conducted at the radiology departments and infertility clinics of four health institutions in Bayelsa State, Nigeria, from January 2020 to April 2022. One thousand and forty infertile women undergoing hysterosalpingography were randomized into four groups, and each group administered four different pain relief methods. Pain scores at different steps of the procedure were recorded. Data were analysed using the Statistical Product and Service Solutions for Windows®, version 25. Student’s t-test was used to compare sample means, while the chi-square test was used to compare the proportion of women in the two study groups, who expressed pain during the procedure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The Paracervical block+HBB appeared to the most effective agent for pain relief in the study as women receiving this medication indicated the least pain intensity scores at all levels of the procedure except at the insertion of the speculum. The differences observed in the indicated pain intensity scores were also statistically significant (p&amp;lt;0.05).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our study revealed that adding HBB, an antispasmodic agent, to diclofenac and paracervical block significantly reduces pain perception during HSG compared to using diclofenac and paracervical block alone.&lt;/p&gt;

Antiperistaltic effect and safety of l-menthol for esophagogastroduodenoscopy in the elderly with contraindication to hyoscine-N-butylbromide

Hyoscine-N-butylbromide (HBB) is the most used antiperistaltic agent during esophagogastroduodenoscopy (EGD). However, almost half of the elderly have a contraindication to HBB. We aimed to evaluate l-menthol’s antiperistaltic effect and safety for EGD in the elderly with contraindication to HBB. This prospective, randomized, double-blind, placebo-controlled study screened 86 elderly patients (≥ 65 years old) scheduled to undergo EGD, and 52 of them with contraindication to HBB were enrolled. The participants were randomized to receive l-menthol (n = 26) or a placebo (n = 26), which was locally sprayed on the gastric antrum endoscopically. The proportion of patients with no or mild peristalsis after medication and at the end of EGD was significantly higher in the l-menthol group (76.9%) than in the placebo group (11.5%, p < 0.001). l-Menthol administration significantly reduced peristaltic grade, improved contraction parameters, and eased intragastric examination relative to the placebo (p < 0.001, respectively). Hemodynamic changes, adverse events, and discomfort levels of patients were similar between the two groups. l-Menthol is an effective and safe alternative antiperistaltic medication for EGD in elderly patients with contraindication to HBB. Further large, randomized trials are required to clarify whether l-menthol can lead to better detection yield in the elderly.Clinical trial registration: The study was registered at ClinicalTrials.gov (NCT04593836).

Association of intravenous antispasmodics (hyoscine-N butyl bromide) injection with obstetric lacerations at vaginal delivery

Aim: To study whether hyoscine-N butyl bromide injection affects the incidence of obstetric lacerations at vaginal birth.&#x0D; Materials and methods: This retrospective cohort study consists of 15806 term pregnant women who undergone vaginal delivery, in Tepecik Training and Research Hospital, İzmir between January 2018 and December 2020. Patients who received intravenous injection of Hyoscine-N-butylbromide during the active period of labor were compared with those who did not in terms of the incidence of obstetric laceration.&#x0D; Results: The data of a total of 9216 deliveries meeting the study criteria were analyzed. Hyoscine-N-butylbromide was used in 4014 of these deliveries(HBD), and it was not used in 5202 of these deliveries. In both primigravid and multigravid patients in the HBD group, the first stage of delivery was found to be shorter than in patients who did not receive spasmolytics(p &lt;0.001).There was no difference between the groups in terms of the second stage of labor. Intravenous injection of Hyoscine-N-butylbromide in the active phase of labor significantly reduced 1st and 2nd degree obstetric lacerations in primigravid patients, but had no effect on 3rd and 4th degree obstetric lacerations.&#x0D; Conclusion: Hyoscine-N-Butylbromide shortens the active phase of labor and reduces minor obstetric lacerations in primigravid women.

Diclofenac Potassium Alone Versus Diclofenac Potassium with Hyoscine-N-butyl Bromide (HBB) in Reduction of Pain in Women Undergoing Office Hysteroscopy: A Double Blind Randomized, Placebo-Controlled Trial.

To compare between oral diclofenac potassium alone versus a combination of it with hyoscine-N-butyl bromide (HBB) in reduction of pain in women undergoing office hysteroscopy. Randomized, double-blind controlled trial. Kasralainy hospital (atertiary hospital). Sixty-Four patients undergoing office hysteroscopy were randomly divided into 2 groups (study group and placebo group) in the ratio of 1:1. Group 1 (study group = 32 participants) received two oral HBB tablets and one tablet of diclofenac potassium and group 2 (placebo group = 32 participants) received two oral placebo tablet similar in size, structure and color to buscopan in addition to the diclofenac tablet. The patient was given the drugs 30-60min before the procedure. There was statistically significant difference between the two groups in the pain score immediately during entry (p value = 0.001) and after 30min of the procedure (p value = < 0.001). And there was a statistically significant difference as regards the side effects (gastric irritation) of the medications (p value = 0.04) between the women participating in the two groups. The combination of diclofenac potassium and HBB helps a lot in decreasing the pain and discomfort during and after performing office hysteroscopy but with more gastric side effects.

Different interventions for preventing postoperative catheter-related bladder discomfort: a systematic review and meta-analysis.

Catheter-related bladder discomfort (CRBD) is a common complication of intraoperative urinary catheterization. Various studies have evaluated the efficacy of different interventions in postoperative CRBD. The present review was performed to assess the efficacy of these interventions. PubMed, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases were systematically searched to identify randomized controlled trials (RCTs) investigating the efficacy of different drugs for the prevention of postoperative CRBD. This review evaluated the incidence and severity of CRBD after different interventions at 0, 1, 2, and 6h postoperatively. Forty-five studies including 31 different drugs were analyzed. Eleven drugs were investigated in more than two RCTs, of which dexmedetomidine, gabapentin, tolterodine, tramadol, ketamine, nefopam, oxybutynin, pregabalin, and pudendal nerve block (PNB) generally showed significantly higher efficacy than controls postoperatively. Solifenacin only showed significant efficacy compared with the control at 0h, and intravenous lidocaine only showed significant efficacy compared with the control at 6h. There were insufficient trials to draw conclusions regarding atropine, butylscopolamine, chlorpheniramine, clonidine, darifenacin, diphenhydramine, glycopyrrolate, intravesical bupivacaine, ketamine-haloperidol, pethidine-haloperidol, ketorolac, lidocaine-prilocaine cream, magnesium, hyoscine n-butyl bromide, oxycodone, paracetamol, parecoxib, trospium, resiniferatoxin, or amikacin. However, all but pethidine-haloperidol and chlorpheniramine showed some efficacy at various time points compared with controls. This review suggests that dexmedetomidine, gabapentin, tolterodine, tramadol, ketamine, nefopam, oxybutynin, pregabalin, and PNB are effective in preventing postoperative CRBD. Considering the efficacy and adverse effects of all drugs, dexmedetomidine and gabapentin were ranked best.

Comparison of paracetamol and hyoscine-N-butylbromide in the treatment of abdominal pain and cramps due to acute gastroenteritis

Background and objective: Hyoscine-N-butyl bromide (HBB) and paracetamol (acetaminophen)are widely used in emergency departments for abdominal pain and cramps. However, there is not enough data on the efficacy, safety, and superiority of each other in treating acute gastroenteritis (AGE) related abdominal pain and cramps. In this study HBB and paracetamol were compared for the treatment of abdominal pain and cramps related to acute gastroenteritis. Materials and methods: The study was conducted in a tertiary university hospital emergency department as a prospective, randomized-controlled, and double-blind study. Intravenous (IV) 1000 mg paracetamol and IV 20 mg hyoscine-N-butyl bromide (HBB) were used to treat abdominal pain and cramps related to AGE. Visual analogue scale (VAS) was used to evaluate the degree of abdominal pain before and after treatment. Results: HBB and paracetamol groups consisted of 123 and 158 cases respectively. In both groups, it was observed that the VAS score gradually decreased from the 0th hour to the 1st and 2nd hours (p&lt;0.001).When comparing each time within itself, it was observed that HBB and paracetamol measurements had similar values (p&gt;0.05). No severe side effects were observed in any of the patients. Conclusion: HBB and paracetamol were used for symptomatic treatment in AGE patients presenting with abdominal pain and cramps. A significant reduction in pain and cramps was achieved in both patient groups. There was no difference between the two drugs in terms of treatment efficacy and side effects. IMC J Med Sci 2022; 16(1): 009 *Correspondence: Hasan Gümüşboğa, Department of Emergency, Şehitkamil State Hospital, Gaziantep, Turkey, Posta code: 27500; Email: profhasan@hotmail.com; ORCID:0000-0003-2097-7102.

Anticonvulsive evaluation and histopathological survey of thalidomide synthetic analogs on lithium-pilocarpine-induced status epilepticus in rats.

Background and purpose:Status epilepticus is a severe neurological disorder that can be life-threatening. Thalidomide and its analogs have shown promising results to confront pentylenetetrazole-induced seizures. This study aimed to evaluate the potential effects of three synthesized thalidomide derivatives on lithium-pilocarpine-induced status epilepticus.Experimental approach:To induce status epilepticus, rats received lithium chloride (127 mg/kg, i.p.) and pilocarpine HCl (60 mg/kg, i.p.) 20 h after lithium chloride injection. Thirty min before pilocarpine HCl administration, rats received hyoscine N-butyl bromide (1 mg/kg, i.p.) and concurrently one of the test compounds (5B, 5C, and 5D), diazepam, thalidomide, or vehicle (4% DMSO) to evaluate their anti-epileptic effects. Epileptic seizures scores were assessed through the Racine scale. Twenty-four h after injection of pilocarpine, brain samples were extracted for further histopathological evaluation.Findings/Results:Results revealed that among tested compounds (5B, 5C, and 5D), only compound 5C (1 mg/kg) exhibited excellent anti-epileptic activity comparable to diazepam (10 mg/kg). Compound 5D (100 mg/kg) only demonstrated comparable anti-epileptic activity to thalidomide (1 mg/kg). Compound 5B did not have any anti-epileptic activity even at the dose of 100 mg/kg. The histopathological survey showed that compound 5C has more neuroprotective effects than diazepam and thalidomide in the cortex of the brain. In the cornu ammonis 1 region, thalidomide had higher protective properties and in the cornu ammonis 3 and dentate gyrus areas, diazepam had higher efficacy to prevent necrosis.Conclusion and implications:Compound 5C is a good candidate for further studies regarding its potency, compared to thalidomide and diazepam.

EFFECT OF HYOSCINE-N-BUTYL BROMIDE ON CERVICAL EFFACEMENT AND DILATION DURING NORMAL LABOR

Background: Labor is a multifactorial and dynamic process which involves myometrial contraction, cervical ripening and dilation and the expulsion of the fetus and placenta in an orderly manner. Objective: To study the efficacy and safety of Hyoscine-N-butyl bromide (HNBB) on enhancement of cervical effacement and dilation during normal labor, duration of labor and mode of delivery compared to the control group. Patients and methods: This was a randomized un blinded controlled trial was conducted on pregnant women in active phase of first stage of labor from those attendant labor ward of Obstetrics and Gynecology Department at Sohag General Hospital. 200 pregnant women were recruited to this study and divided into 2 equal groups. Study group received Buscopan 20 mg diluted in 9 ml saline slowly intravenously and control group received 10 mL normal saline. Results: The mean duration of active phase of labor in the study group and control group was found to be 186 and 338 minutes respectively (p value = 0.0001). No significant difference was observed in the duration of second and third stage of labor, mode of delivery, birth weight, Apgar score and color of the liquor in both the groups. Conclusion: Administration of HNBB i.v. significantly reduced the duration time of cervical dilation in the active phase of first stage of labor, thereby reducing the total duration of labor. Hyoscine –N- butyl bromide is a new aid in the management of uncomplicated labor for a convenient shorter and safer physiological delivery making it more tolerable for the mother.

Value of bowel preparation techniques for prostate MRI: a preliminary study

BackgroundBowel preparation before multiparametric MRI (mpMRI) of the prostate is performed widely, despite contradictory or no evidence for efficacy.PurposeTo investigate the value of hyoscine N-butylbromide (HBB), microenema (ME) and ‘dietary restrictions’ (DR) for artifact reduction and image quality (IQ) in mpMRI of the prostate.Study typeRetrospective.PopulationBetween 10/2018 and 02/2020 treatment-naïve men (median age, 64.9; range 39.8–87.3) who underwent mpMRI of the prostate were included. The total patient sample comprised of n = 180 patients, who received either HBB, ME, were instructed to adhere to DR, or received a combination of those measures prior to the MR scan.Field strength/sequenceT2-weighted imaging (T2w), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI) scanned on two 3T systems.AssessmentA radiologist specialized in urogenital imaging (R1) and a senior radiology resident (R2) visually assessed IQ parameters on transversal T2w, DWI and ADC maps on a 5-point Likert-like scale.Statistical testsGroup comparison between IQ parameters was performed on reader level using Kruskal–Wallis and Mann–Whitney U tests. Binary univariate logistic regression analysis was used to assess independent predictors of IQ. Interrater agreement was assessed using Intraclass Correlation Coefficient (ICC).Results‘DWI geometric distortion’ was significantly more pronounced in the HBB+/ME−/DR− (R1, 3.6 and R2, 4.0) as compared to the HBB−/ME+/DR− (R1, 4.2 and R2, 4.6) and HBB+/ME+/DR− (R1, 4.3 and R2, 4.7) cohort, respectively. Parameters ‘DWI IQ’ and ‘Whole MRI IQ’ were rated similarly by both readers. ME was a significant independent predictor of ‘good IQ’ for the whole MRI for R1 [b = 1.09, OR 2.98 (95% CI 1.29, 6.87)] and R2 [b = 1.01, OR 2.73 (95% CI 1.24, 6.04)], respectively.Data conclusionME seems to significantly improve image quality of DWI and the whole mpMRI image set of the prostate. HBB and DR did not have any benefit.

Does hyoscine N-butylbromide shorten the active phase in labor? A meta-analysis of randomized controlled trials.

The objective of the study is to evaluate the therapeutic effect of hyoscine N-butylbromide (HBB) in active phase of labor and its safety to mother and fetus. A systematic literature search was conducted on Cochrane Library, Pubmed, EMBASE, CINAHL, ClinicalTrials.gov and three databases in Chinese up to March 31, 2020. Randomized controlled trials (RCTs) of HBB administration during the active phase for shortening of spontaneous labor at term compared with placebo were included. Two reviewers assessed the methodological quality and data extraction independently. We calculated pooled risk ratios (RRs), mean differences (MDs) and 95% confidence intervals (CIs) using Review Manager 5.3 software. Intention-to-treat principles and random-effects model were adopted for analysis and pool results. In total, 1448 women from 9 RCTs were included in the meta-analysis. The HBB group exhibited significantly decreased durations of active phase (MD -61.1 min; 95% CI: -87.7 to -34.4, I2: 96%), the second stage (MD -2.0 min; 95% CI: -3.4 to -0.5, I2: 62%), and third stage (MD -0.7 min; 95% CI: -1.1 to -0.3, I2: 51%). Intravenous (IV) HBB group and intramuscularly (IM) HBB group were compared to the control group (MD -60.9 min; 95% CI -87.7 to -34.1, I2: 96%). No significant differences were observed in Cesarean section, post-partum hemorrhage, instrumental labor, Apgar scores or any adverse effects. Hyoscine N-butylbromide had a significant effect of shortening the duration of the active phase of labor without adverse effects. We recommend a single dose of intravenous administrated HBB when a woman undergoes labor augmentation.

A Prospective Study of Factors Associated with Abdominal Pain in Patients during Unsedated Colonoscopy Using a Magnifying Endoscope.

Objective With the advent of endoscopic treatment, the detailed diagnosis of colorectal neoplasms made using magnifying colonoscopy has become increasingly important. However, insertion difficulty causes pain in unsedated colonoscopy. The aim of this prospective observational study was to clarify the factors associated with a patient's pain in unsedated colonoscopy using a magnifying endoscope. Methods Patient pain was assessed using a numerical rating scale (0-10) immediately after the procedure. We defined 5 as mild enough pain that patients would not be reluctant to undergo another colonoscopy. Acceptable pain was defined as 5 or less and severe pain was defined as 8 to 10. Univariate and multivariate linear regression analyses were performed using the pain scale score as a dependent variable. Results A total of consecutive 600 patients undergoing unsedated colonoscopies were evaluated to assess their abdominal pain. The completion rate was 99.5% (597/600). The mean pain scale score was 3.88±2.38. The rate of acceptable pain was 80.5% (483/600). The rate of severe pain was 6.7% (40/600) including the incomplete cases. A comparison of polyp-positive and polyp-negative cases revealed no marked difference in patient pain (3.82±2.24 vs. 3.94±2.49, respectively; p=0.590) or insertion time (6.62±3.98 vs. 6.29±4.21, p=0.090), while more observation time was needed in polyp-positive cases than in polyp-negative ones (16.30±4.95 vs. 13.08±4.69, p<0.01). Univariate and multivariate linear regression analyses revealed that an older age, colectomy, antispasmodic agent use, and a small-diameter endoscope were significant factors associated with less patient pain. In particular, a small-diameter endoscope induces significantly more acceptable pain than a non-small diameter endoscope [85.63% (274/320) vs. 73.93% (207/280), p=0.00003]. Conclusion Unsedated colonoscopy using a magnifying endoscope by an expert may result in acceptable pain levels. The use of an antispasmodic agent, particularly hyoscine N-butyl bromide, and a small-diameter endoscope are recommended for reducing abdominal pain during unsedated colonoscopy.

The effect of hyoscine n- butylbromide on labor progress: A systematic review

BackgroundThe objective of this systematic review and meta-analysis was to assess the effectiveness of hyoscine n-butylbromide in labor progress.MethodsThe databases including PubMed, the Cochrane Library, Science-Direct, Scopus and Web of Science were searched for studies published up to December 2019. Articles that published as randomized controlled trials (RCTs), and full-text articles published in English or other languages were included and participants were primi or multigravida women who were in active phase of labor. The intervention included HBB compared to placebo (normal saline) that was used during active phase of labor. Pooled estimates were measured using the fixed or random effect model, while the overall effect was reported in a mean difference (MD). All data were analyzed using Review Manager 5.3.ResultsTwenty studies involving 3108 women were included in meta-analysis. Based on subgroup analysis by parity, use of HBB significantly reduced the duration of the first stage of labor in primigravida women (MD = − 57.73; 95% CI: [− 61.48, − 53.60]) and in multigravida women (MD = − 90.74; 95% CI: [− 97.24, − 84.24]). Administering HBB could reduce the second stages of labor in primigravidas and multigravidas about 6 min and 4 min respectively. Also, HBB reduced the duration of the third stage of labor in multigravidas about 3 min. APGAR score at one and 5 min after birth was not affected. The main maternal adverse effect was tachycardia and dry mouth. Labor duration in studies in which the participants were primi-and multigravida was not presented based on separate parities except for four papers, and the route of HBB administration was not the same across all studies.ConclusionsAlthough, the effect of HBB was minimal when multigravidas and primigravidas women were considered together, the HBB was clinically effective in primigravida and multigravida women for shortening the first and the second stages of labor. Also, HBB could reduce the length of the third stage of labor in multigravidas.