The Role of Micronutrients in Human Papillomavirus Infection, Cervical Dysplasia, and Neoplasm

There is evidence that diet and nutrition are modifiable risk factors for several cancers. In recent years, attention paid to micronutrients in gynecology has increased, especially regarding Human papillomavirus (HPV) infection. We performed a review of the literature up until December 2022, aiming to clarify the effects of micronutrients, minerals, and vitamins on the history of HPV infection and the development of cervical cancer. We included studies having as their primary objective the evaluation of dietary supplements, in particular calcium; zinc; iron; selenium; carotenoids; and vitamins A, B12, C, D, E, and K. Different oligo-elements and micronutrients demonstrated a potential protective role against cervical cancer by intervening in different stages of the natural history of HPV infection, development of cervical dysplasia, and invasive disease. Healthcare providers should be aware of and incorporate the literature evidence in counseling, although the low quality of evidence provided by available studies recommends further well-designed investigations to give clear indications for clinical practice

COVID-19 and Pregnancy: An Updated Review about Evidence-Based Therapeutic Strategies

The COVID-19 pandemic posed a significant challenge for clinicians in managing pregnant women, who were at high risk of virus transmission and severe illness. While the WHO declared in May 2023 that COVID-19 is no longer a public health emergency, it emphasized that it remains a global health threat. Despite the success of vaccines, the possibility of new pandemic waves due to viral mutations should be considered. Ongoing assessment of the safety and effectiveness of pharmacological therapies is crucial in clinical practice. This narrative review summarizes the evidence-based therapeutic strategies for pregnant women with COVID-19, considering over three years of pandemic experience. The review discusses the safety and effectiveness of various drug regimens (antivirals, anticoagulants, corticosteroids, immunoglobulins, monoclonal antibodies, and therapeutic gases) and procedures (prone positioning and extracorporeal membrane oxygenation). Drugs with contraindications, inefficacy during pregnancy, or unknown adverse effects were excluded from our evaluation. The aim is to provide healthcare professionals with a comprehensive guide for managing pregnant women with COVID-19 based on lessons learned from the pandemic outbreak

Risk perception and affective state on work exhaustion in obstetrics during the COVID-19 pandemic

Amulticenter cross-sectional survey study involving four Italian University Hospitals was performed to test the hypothesis that negative affect and positive affect (affective dimensions) mediate the association between risk perception (perceived risk of infection and death; cognitive dimensions) and the feeling of work exhaustion (WE) among obstetrics healthcare providers (HCPs) during the Coronavirus Disease 2019 (COVID-19) pandemic. Totally, 570 obstetrics HCPs were invited to complete the 104-item IPSICO survey in May 2020. A theoretical model built on the tested hypothesis was investigated by structural equation modelling. The model explained 32.2% of the WE variance. Only negative affect mediated the association between cognitive dimensions and WE and also the association between WE and psychological well-being before the pandemic, experiences of stressful events, female gender, and dysfunctional coping. Non-mediated associations withWE were observed for work perceived as a duty, experience of stressful events, support received by colleagues, and the shift strategy. Only previous psychological well-being, support by colleagues, and shift strategies were inversely associated with WE. Based on study results, monitoring negative than positive affect appears superior in predicting WE, with practical implications for planning psychological interventions in HCPs at the individual, interpersonal, and organizational levels

Patologia ipertensiva in gravidanza e parto pretermine

Patologia ipertensiva in gravidanza e parto pretermin

Asherman's Syndrome after Uterine Artery Embolization: A Case of Embolic Spheres Displacement inside the Uterine Cavity

N

Reasons for exclusion from intravenous thrombolysis in stroke patients admitted to the Stroke Unit

Intravenous (IV) thrombolysis is the treatment in ischemic stroke, but only the minority of patients receive this medication. The primary objective of this study was to explore the reasons associated with the decision not to offer IV thrombolysis to stroke patients admitted to the Stroke Unit (SU). We conducted a retrospective analysis based on data collected from 876 consecutive stroke patients admitted to the SU\ua04.5\ua0h (p\ua0=\ua00.001) and unknown time of onset (or stroke present on awakening) (p\ua0=\ua00.004) were reasons listed in the current SPC of Actilyse reasons for exclusion even they occurred singly, whereas mild deficit (or rapidly improving symptoms) (p\ua080\ua0years (p\ua04.5\ua0h (p\ua0=\ua00.005), and unknown time of onset (p\ua0=\ua00.037), while severe pre-stroke disability (p\ua0=\ua00.025) and admission under non-stroke specialist neurologist assessment (p\ua0=\ua00.018) in patients with age\ua0>80\ua0years. There are often unjustified reasons for exclusion from IV thrombolysis in SU

Intrauterine manipulator during hysterectomy for endometrial cancer: a systematic review and meta-analysis of oncologic outcomes

Objective: To assess the effects on oncological outcomes of intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer. Data sources: A systematic literature search was performed by an expert librarian in multiple electronic databases from inception to January 31, 2023. Study eligibility criteria: We included all studies in the English language that compared oncologic outcomes (recurrence-free, cause-specific, or overall survival) between endometrial cancer patients who underwent total laparoscopic or robotic hysterectomy for endometrial cancer with versus without the use of an intrauterine manipulator. Studies comparing only peritoneal cytology status or lymphovascular space invasion were summarized for completeness. No selection criteria were applied to the study design. Study appraisal and synthesis methods: Four reviewers independently reviewed studies for inclusion, assessed their risk of bias, and extracted data. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for oncologic outcomes using the random effect model. Heterogeneity was quantified using the I2 tests. Publication bias was assessed by Funnel plot and Egger's test. Results: Out of 350 identified references, we included two randomized controlled trials and twelve observational studies for a total of 14 studies and 5,019 patients. The use of an intrauterine manipulator during hysterectomy for endometrial cancer was associated with a pooled HR for recurrence of 1.52 (95% CI: 0.99 - 2.33; p = 0.05; I2 = 31%; Chiˆ2 p-value = 0.22). Pooled HR for recurrence was 1.48 (95% CI: 0.25 - 8.76; p = 0.62; I2 = 67%; Chiˆ2 p-value = 0.08) when only randomized controlled trials were considered. Pooled HR for overall survival was 1.07 (95% CI: 0.65 - 1.76; p = 0.79; I2 = 44%; Chiˆ2 p-value = 0.17). The rate of positive peritoneal cytology or lymphovascular space invasion did not differ using an intrauterine manipulator. Conclusions: The intrauterine manipulator use during hysterectomy for endometrial cancer was not significantly associated with recurrence-free and overall survival nor with positive peritoneal cytology or lymphovascular space invasion, but further prospective studies are needed. Systematic review registration: PROSPERO: CRD42022310042

Regarding \u201cTrends and Risk Factors for Vaginal Cuff Dehiscence after Laparoscopic Hysterectomy\u201d

Trends and Risk Factors for Vaginal Cuff Dehiscence after Laparoscopic Hysterectom

Fertility-sparing management for endometrial cancer: review of literature

INTRODUCTION:Primary surgery is effective in low-risk EC. However, in young women, this approach compromises fertility. Therefore, fertility-sparing management in the case of atypical endometrial hyperplasia, or grade 1 endometrial cancer (EC) limited to the endometrium can be considered. EVIDENCE ACQUISITION:We performed a literature review to identify studies involving women with endometrial cancer or atypical hyperplasia who underwent fertility-sparing management. We conducted multiple bibliographic databases research between their inception to May 2020. EVIDENCE SYNTHESIS:Oral therapy with medroxyprogesterone acetate and megestrol acetate is recommended based on extensive experience, although without consensus on dosages and treatment length. The pooled complete response rate, recurrence rate, and pregnancy rate of EC were 76.3%, 30.7%, and 52.1%, respectively. Endometrial hyperplasia was associated with better outcomes. LNG-IUSs appears an alternative treatment, particularly in patients who do not tolerate oral therapy. In a randomized controlled trial, megestrol acetate plus Metformin guaranteed an earlier complete response rate than megestrol acetate alone for endometrial hyperplasia. Hysteroscopic resection followed by progestogens is associated with a higher complete response rate, live birth rate, and lower recurrence rate than oral progestogens alone. Pooled complete response, recurrence, and live birth rates were 98.1%, 4.8%, and 52.6%. CONCLUSIONS:Fertility preservation appears feasible in young patients with grade 1 EC limited to the endometrium or atypical endometrial hyperplasia. Progestins are the mainstay of such management. The addition of Metformin and hysteroscopic resection seems to provide some improvements. However, fertility preservation is not the standard approach for staging and treatment, potentially worsening oncologic outcomes

Sentinel lymph-node for endometrial cancer treatment: review of literature

INTRODUCTION:Endometrial cancer is the most common gynecologic malignancy and in two thirds of patients it is apparently uterine-confined at presentation. Lymph nodal status represents one of the main prognostic factors. Nodal evaluation with SLN mapping has gained more ground in clinical practice after the publication of different studies demonstrating the feasibility and accuracy of this technique. However, at the moment there are no RCTs available evaluating the long-term oncologic safety of SLN technique compared to LND. This review aims at summarizing the available evidence on oncologic outcomes between SLN mapping alone and LND. Differences in operative complications and long-term complications were also analyzed. EVIDENCE ACQUISITION:The literature search was conducted in the PubMed database and it focused on comparative studies published from inception to September 2020 analyzing differences in oncological outcomes or complications between nodal evaluation with SLN technique alone and nodal evaluation with lymphadenectomy. Comparative studies with more than 10 cases, published in English, were included. EVIDENCE SYNTHESIS:A total of 5 retrospective comparative studies have been identified reporting data on oncologic outcomes of patients who underwent SLN mapping alone vs LND. Non significative difference has been reported in terms of overall survival and recurrence free survival between the two groups. Six studies evaluated differences in terms of complications between the two techniques. A total of 2302 patients were identified. Post-operative complications were detected in 9.6% and 7.7% of patients who underwent lymphadenectomy and SLN mapping respectively and no significant difference was noted (p=0.3). Looking at major post-operative complications the rate in the LND group was significantly higher than in the SLN group (3.6% vs 1.5%, p= 0.02). Two of these six studies reported data on lymphatic long-term complications. The prevalence of lymphedema ranged from 0% to 1.3% in the SLN group and from 10% to 18% in the LND group. The absolute difference reported (13.35%) was similar to that found in the literature. CONCLUSIONS:SLN mapping in apparently uterine confined disease has been demonstrated to be a feasible and accurate technique for nodal evaluation and high-quality evidence support this. Moreover, SLN mapping resulted to be associated with less major post-operative and long-term complications when compared to LDN. Conversely, high-quality evidence is not available on long-term oncologic safety of this technique compared to the standard LND. Randomized trials are requested to provide reliable data on this aspect