Genetic Variability and Phylogeny of High Risk HPV Type 16, 18, 31, 33 and 45 L1 Gene in Greek Women

The present study explores nucleotide variability, phylogeny and association with cervical neoplasia in high risk HPV types 16, 18, 31, 33 and 45 collected from Greek women. Of the 1894 women undergoing routine cervical cytology examination, 160 samples test positive for single infections of HPV type 16 (n = 104), HPV 31 (n = 40), HPV 33 (n = 7), HPV 18 (n = 5), and HPV 45 (n = 4) were typed by microarrays method, amplified by PCR then sequenced and phylogenetically analyzed. For HPV 16, 9 variants with nucleotide variations were included into the study. For HPV 31, 33, 18 and 45, nucleotide variations were identified in 6, 4, 2 and 3 variants, respectively. The Bayesian inference and Maximum Parsimony methods were used in order to construct the phylogenetic trees. When types were analyzed independently HPV 16 (European and non-European) and HPV 18 (African and non-African) formed distinct clades. The genomic characterization of HPV variants will be important for illuminating the geographical relatedness and biological differences and for the determination of their risk

Constructing a protocol for the evaluation of residents' competency with office hysteroscopy

There is an increasing need for clinician self-evaluation. The need becomes bigger when it comes to assess residents in operative procedures; office hysteroscopy in its current form is one of the best examples to teach and to assess them. We propose a simple protocol for the evaluation of residents in office hysteroscopy that can be used as a platform for future improvement. This will improve their learning experience and ensure that they do not miss any steps of the procedure. As each task is outlined on the evaluation checklist, it is easier to objectively demonstrate the strengths and deficiencies of each one with respect to the given procedure. This can be the basis for application of extra attention and highlights the areas in which each individual needs to improve. The advantage of recording parameters, such as duration of the procedure and pain scores, is that they can serve as tools that demonstrate acquisition of experience and of confidence. © 2013 Springer-Verlag Berlin Heidelberg

Promoter Methylation of p16INK4A, hMLH1, and MGMT in Liquid-Based Cervical Cytology Samples Compared with Clinicopathological Findings and HPV Presence

Cervical cancer is a common cancer inflicting women worldwide. Even though, persistent infection with oncogenic Human Papillomavirus (HPV) types is considered the most important risk factor for cervical cancer development, less than 5% of women with HPV will eventually develop cervical cancer supporting that other molecular events, like methylation-dependent inactivation of tumor suppressor genes, may cocontribute in cervical carcinogenesis. We analyzed promoter methylation of three candidate genes (p16, MGMT, and hMLH1) in 403 liquid-based cytology samples. Methylation was commonly identified in both benign and pathologic samples and correlated with higher lesion grade determined by cytological, colposcopical, or histological findings, with HPV DNA and mRNA positivity of specific HPV types and p16INK4A protein expression. Overall accuracy of methylation is much lower than traditional diagnostic tests ranking it as an ancillary technique with more data needed to identify the exact value of methylation status in cervical carcinogenesis

Office hysteroscopy: current trends and potential applications: a critical review

Office hysteroscopy is an excellent method of identifying and treating intracavitary uterine lesions. It has become easy to learn and perform; as an aid of modern technological applications, it is safe, accurate, provides immediate results under direct visualisation, and offers the additional benefit of histological confirmation and the discomfort of patients is minimal. We applied an extended literature search to explore the special features and details of the technique itself, as it evolved since it first appeared 30 years back. Our initial goal was to examine potential changes/improvements of the modality, in terms of the instrumentation used and the technique itself, the indications of use, its incorporation in daily practice, and patients’ and clinicians’ acceptability

Ovarian SAHA syndrome is associated with a more insulin-resistant profile and represents an independent risk factor for glucose abnormalities in women with polycystic ovary syndrome: A prospective controlled study

Background: SAHA syndrome is characterized by the tetrad: seborrhea, acne, hirsutism, and androgenetic alopecia. No previous study has examined the prevalence of glucose abnormalities in ovarian SAHA and explored whether it may be an independent risk factor for glucose abnormalities. Objective: In a prospective controlled study, we investigated the spectrum of glucose abnormalities in ovarian SAHA and explored whether it is associated with a more insulin-resistant profile. Methods: In all, 316 patients with a diagnosis of polycystic ovary syndrome (PCOS) (56 with SAHA) and 102 age-matched healthy women were examined and underwent a 2-hour oral glucose tolerance test. Serum glucose homeostasis parameters, hormones, and adipokines were determined. Results: SAHA prevalence was 17.7% in patients with PCOS and predominance of the severe PCOS phenotype. Ovarian SAHA was independently associated with a more insulin-resistant profile (higher homeostatic model assessment of insulin resistance score, lower quantitative insulin sensitivity check index [QUICKI] and MATSUDA indices, and relative hypoadiponectinemia), and represented an independent risk factor for glucose abnormalities regardless of anthropometric features, age, and PCOS phenotype. Limitation: There was no performance of skin biopsies. Conclusion: The prompt recognition of SAHA syndrome in women with PCOS permits an earlier diagnosis and surveillance of metabolic abnormalities, especially in Mediterranean PCOS population exhibiting a lower prevalence of glucose abnormalities

The incidence of prolonged pregnancy in a Greek District Obstetrics & Gynaecology department: the respective roles of General Practitioners and Obstetrics Specialists

To assess some aspects and the incidence of post-term pregnancies (PTP) delivered in our Department from 01/01/1991 to 31/12/2002 and to indicate the possible ways in which the General Practitioner could contribute in order to improve health care outcomes. Patients and Methods. We studied the data from the Delivery Room registry of the Obstetric and Gynecologic Department of “Tzaneio” General Hospital of Piraeus. The last menstrual period was used for the estimation of gestational age. All women with prolonged pregnancy (76), were from the Attica region (which has about 5 million inhabitants), 53 of them were residents of rural areas, 16 were residents of the suburbs and 7 were residents of Athens. None of them had consulted an Ob/gyn or a GP until the last few weeks of pregnancy. Fetal and maternal data regarding the pregnancy outcome were evaluated, including vacuum delivery, caesarean section rate, and infant’s gender, number of previous gestations, birth weight, macrosomia, antepartum, intrapartum and postpartum death. Results. PTP neonates (76), were delivered after 42 weeks of gestation among 7818 total deliveries, a percentage of 0.97%. The median age of women was 25 years of age. Of 76 neonates, 42 were born with vaginal delivery, 9 with vacuum extraction and 25 with caesarean section. The distribution of sex was 34 boys and 42 girls. The median gestational age was 42 weeks and 3 days. The median birth weight was 3,518.28 g. We had no stillbirths and we had one early neonatal death. Conclusions. Less than 1% (0.97%) of post-term pregnancies is a very low percentage. This may represent the monitoring of cases reaching the 41st week of pregnancy with elective labour induction since 1998. The very low percentage of women who consulted an Ob/gyn or family physician during the gestational period, as well as the extremely low percentage of women who underwent the recommended fetal and maternal controls, indicate that the General Practitioner should be aware of these low rates and low standards of maternal care, of the low informational status (in terms of maternal health care services) of women living in rural areas (most of the women with prolonged pregnancies lived in rural areas, where there is no easy access to an Ob/Gyn) and assume a more active and more responsible role in monitoring pregnancy in close collaboration with a specialist

Dehydroepiandrosterone-Sulfate, Insulin Resistance and Ovarian Volume Estimation in Patients With Polycystic Ovarian Syndrome

Objective: To investigate the potential association of DHEA-S with metabolic and hormonal alterations and with disorders of ovarian morphology. Materials and methods: The present study was based on women with PCOS that attended the Gynaecological Endocrinology – Paediatric and Adolescence Endocrinology Department of our clinic. Overall, 321 patients who met the Rotterdam ESHRE/ ASRM – Sponsored criteria for the definition of PCOS were included. Women’s personal medical history was recorded, anthropometric parameters were assessed and blood was drawn for analysis of metabolic and hormonal parameters. A gynaecological ultrasound was also performed to evaluate ovarian morphology. Results: Correlation analysis revealed a significant negative correlation of DHEA-S with the mean volume of the right and left ovary and with the maximum volume of the largest ovary. This finding remained significant after adjusting for age and BMI (β ± SE = -0.39 ± 0.17, p = 0.023 in the case of mean ovarian volume and β ± SE = -0.36 ± 0.17, p = 0.032 in the case of the maximum volume of the maximum ovarian volume). Conclusion: The findings of our study reveal a clear negative association of DHEA-S with ovarian volume. To date, however, current evidence in this field are restricted to experimental animal models. Future clinical studies are needed in this field to corroborate our findings