Postponed pregnancies and risks of very advanced maternal age

QUESTIONS UNDER STUDY To evaluate pregnancy outcome in pregnant women aged ≥45 years, termed very advanced maternal age (VAMA). METHODS We retrospectively compared the outcome of pregnancies in VAMA patients with controls aged 30 years at time of delivery. Subgroups of singleton and multiple pregnancies were also analysed. Incidences of maternal and fetal adverse outcomes were measured. Statistical significance was set at p 7 days (37.8% vs 15.1%; OR 3.42) was found. Infant complications such as prematurity (44.9% vs 16.2%; OR 4.2) and low birthweight <5th percentile (11.0% vs 5.6%; OR 2.1) were also increased. CONCLUSION Pregnant women of very advanced maternal age (≥45 years) have significantly increased maternal and fetal risks. Women postponing pregnancy or planning a pregnancy in very advanced age should be informed about these risks, in particular before artificial reproductive technologies are applied or "social freezing"

Diagnosis of vulvar lesions by non-invasive optical analysis: a pilot study

A procedure that could allow an early in vivo and non-invasive detection of vulvar lesions would be extremely useful. We tested an innovative optical method (Optiprobe), which uses a harmless, visible light source for the in vivo, on-line detection of minimal alterations in the structure of vulvar epithelium. A group of 3 female volunteers without gynecological symptoms were first screened to evaluate optical properties of normal vulvar tissue. Next, a group of 16 patients undergoing gynecological examination for vulvar lesions was evaluated by the Optiprobe at suspected sites before these sites were biopsied for histological analysis. Adjacent, non-involved sites were also measured to provide internal controls. Histological analysis of the biopsies identified one case that did not show obvious alterations, 4 cases of high-grade vulvar intraepithelial neoplasia (VIN), 5 cases of vulvitis, and 6 cases of lichen sclerosis (LS)

Primary breast lymphomas

The diagnosis, prognostic factors, and optimal management of primary breast lymphomas (PBL) is difficult. Seven patients recorded at the Geneva Cancer Registry between 1973–1998 were reviewed. Five patient had diffuse large B-cell lymphoma, one a follicular lymphoma and one a MALT-lymphoma. All patients had clinical and radiological findings consistent with breast cancer and underwent mastectomy, which is not indicated in PBL. Diagnosis should be established prior to operative interventions, as fine needle aspiration missed the diagnosis for one patient and intra-operative frozen sections for 3 patients in our study. Five-year and 10-year overall survivals were 57% and 15%, respectively. Of the 3 patients who died from PBL, 2 had tumors that were Bcl-2 positive but Bcl-6 negative. All 3 surviving patients have positive Bcl-2 and Bcl-6 immunostaining, which could be important prognostic factors if confirmed by a larger study

Preparing an obstetric unit in the heart of the epidemic strike of COVID-19: quick reorganization tips

COVID-19 is placing considerable strain on healthcare systems. Disaster and military medicine specialists were involved in the outbreak in Italy, after many units were overwhelmed. Health providers were caught off guard and personnel was unprepared to face this unprecedented threat. Local decisions accelerated the rate of the spread. Many countries declared a state of emergency and lockdown to contain the exponential transmission of the disease. The purpose of this review is to suggest quick key points of strategies to implement in obstetric units without delay to respond to the oncoming wave, based on experience and feedback from the field. It is essential in an emergency situation to understand what is at stake and prepare maternity wards in the best possible way

Accuracy of clinical diagnosis of anal sphincter defect: clinical evaluation vs 3D- transperineal ultrasound (3D-TPUS)

BACKGROUND Obstetric anal sphincter injuries (OASIS) are common and an important factor in the etiology of anal incontinence. The objective of this study was to evaluate, classify and compare the agreement of clinically diagnosed third-degree sphincter tears with 3D- transperineal ultrasound (3D-TPUS) realized within 3-7 days post-delivery. METHODS This is a retrospective observational study were 119 patients with third-degree obstetric anal sphincter tears were diagnosed and treated, 85 of those underwent a 3D-TPUS examination 3-7 days postpartum. We compared the proportion of third-degree perineal tears, classified with the clinical examination as Grade 3a+b and Grade 3c, with the 3D-TPUS. RESULTS In 16 patients with clinically diagnosed third-degree perineal tears Grade a and b, the ultrasound examination confirmed the lesion of the external anal sphincter (EAS) muscle, but in 9 patients (56% of the cases) we found a lesion of the internal anal sphincter (IAS) muscle, missed by clinical examination. In the remaining 69 patients with the third-degree perineal tears Grade c, the ultrasound examination confirmed both lesions (EAS and IAS muscles) in 56 women, but in 13 patients (19% of the cases) defects of the IAS muscle could not be confirmed by the ultrasound. CONCLUSIONS There was moderate agreement regarding diagnosis of perineal tears Grade 3a+b and Grade c between ultrasound and clinical examination, so a combined use of clinical and ultrasound knowledge can improve the possibility to find a gold standard in the diagnosis of OASIS

The Value of Semantics in Food and Wine Labeling: Research on Italian Wine Consumers

Semantics studies have been experiencing an ever-growing utilization and application in packaging, product labeling and, more broadly, in marketing strategies. Considering the food and wine sector, existing research on semantics application in labeling confirms its worth in influencing consumers’ perception of products. In this sense, it is a fundamental tool for managers to communicate the value of their brands. Nevertheless, further studies are still needed to understand how the visual aspects of the packaging generate the desired meanings among consumers, especially in Italy. The paper intends to fill this gap by applying a semiotic approach to study Italian wine consumers. Specifically, a close-ended questionnaire, with a free word association segment focused on the values perceived by consumers when looking at four digitally crafted wine bottle front labels, was utilized. Although the results show some discrepancies from current studies, this paper points out that the existing literature on the topic seems comprehensively applicable to Italian consumers. However, given the exploratory nature of the study, it would be necessary to extend the number of respondents to further validate the results obtained

The Value of Semantics in Food and Wine Labeling: Research on Italian Wine Consumers

Semantics studies have been experiencing an ever-growing utilization and application in packaging, product labeling and, more broadly, in marketing strategies. Considering the food and wine sector, existing research on semantics application in labeling confirms its worth in influencing consumers&rsquo; perception of products. In this sense, it is a fundamental tool for managers to communicate the value of their brands. Nevertheless, further studies are still needed to understand how the visual aspects of the packaging generate the desired meanings among consumers, especially in Italy. The paper intends to fill this gap by applying a semiotic approach to study Italian wine consumers. Specifically, a close-ended questionnaire, with a free word association segment focused on the values perceived by consumers when looking at four digitally crafted wine bottle front labels, was utilized. Although the results show some discrepancies from current studies, this paper points out that the existing literature on the topic seems comprehensively applicable to Italian consumers. However, given the exploratory nature of the study, it would be necessary to extend the number of respondents to further validate the results obtained

Postponed pregnancies and risks of very advanced maternal age

QUESTIONS UNDER STUDY To evaluate pregnancy outcome in pregnant women aged ≥45 years, termed very advanced maternal age (VAMA). METHODS We retrospectively compared the outcome of pregnancies in VAMA patients with controls aged 30 years at time of delivery. Subgroups of singleton and multiple pregnancies were also analysed. Incidences of maternal and fetal adverse outcomes were measured. Statistical significance was set at p 7 days (37.8% vs 15.1%; OR 3.42) was found. Infant complications such as prematurity (44.9% vs 16.2%; OR 4.2) and low birthweight <5th percentile (11.0% vs 5.6%; OR 2.1) were also increased. CONCLUSION Pregnant women of very advanced maternal age (≥45 years) have significantly increased maternal and fetal risks. Women postponing pregnancy or planning a pregnancy in very advanced age should be informed about these risks, in particular before artificial reproductive technologies are applied or "social freezing"

Antibiotic resistance patterns among group B Streptococcus isolates: implications for antibiotic prophylaxis for early-onset neonatal sepsis

STUDY/PRINCIPLES: Antibiotic prophylaxis of Group B Streptococcus (GBS) positive women during labour reduces the risk of early-onset neonatal sepsis. Penicillin is the first choice, and clindamycin and erythromycin are second choices for penicillin-allergic women. Resistance to these antibiotics is rising. The aims of this study were to evaluate the rates of clindamycin and erythromycin resistance among GBS-positive isolates cultures from pregnant women in the University Hospital of Geneva and to evaluate the legitimacy of new Centres for Disease Control and Prevention (CDC) recommendations for our context