The quality of life of patients with genital warts: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Genital warts, which are caused by infection with human papillomavirus (HPV), are one of the most common sexually transmitted diseases in Europe. Although genital warts are commonly perceived as a non-serious condition, treatment is often long, of varying effectiveness and the recurrence rate is high. Very few studies have been performed on the personal consequences of genital warts. The aim of this qualitative study, set in Denmark, was to examine the ways in which genital warts may affect patients' quality of life.</p> <p>Methods</p> <p>To obtain an in-depth understanding of patients' perceptions of genital warts, we used qualitative focus-group interviews with five men and five women aged between 18 and 30 years who had genital warts. The interview guide was based on a literature review that identified important issues and questions. The data were analysed using a medical anthropological approach.</p> <p>Results</p> <p>Patients' experiences were related to cultural conceptions of venereal diseases and the respective identities and sexuality of the sexes. The disease had negative psychological and social effects both for men and for women and it affected their sex and love lives, in particular. The psychological burden of the disease was increased by the uncertain timeline and the varying effectiveness of treatment. We identified a need for more patient information about the disease and its psycho-sexual aspects.</p> <p>Conclusions</p> <p>The men and women participating in this study considered their quality of life to be significantly lowered because of genital warts. The experiences described by the participants give insights that may be valuable in treatment and counselling.</p> <p>The quadrivalent HPV vaccine that has now been added to the childhood vaccination programme for girls in Denmark for the prevention of cervical cancer can also prevent 90% of cases of genital warts. Our results suggest that HPV vaccination could considerably reduce the largely unacknowledged psychological and social burden associated with genital warts, in men as well as women.</p

Sidestream dark field images of the microcirculation:intra-observer reliability and correlation between two semi-quantitative methods for determining flow

BACKGROUND: Since analysis of Sidestream Dark Field images still requires subjective interpretation, we wanted to determine intra-observer repeatability and to estimate the correlation between different evaluation methods. METHODS: Fifty-four Sidestream Dark Field videos were analyzed twice by the same blinded observer using validated software. Vessels were detected, generating the parameter Total Vessel Density (TVD), and flow was determined by (i) classifying each vessel separately, generating the parameters Perfused Vessel Density (PVD) and Proportion of Perfused Vessels (PPV), and by (ii) the “Boerma” method, generating a Microvascular Flow Index (MFI) by quadrants. RESULTS: Intraclass Correlation Coefficients (ICCs) were above 0.9 for TVD and above 0.8 for PDV and PPV. MFI(by quadrants) had the lowest reliability (ICC = 0.52 for capillaries and ICC = 0.59 for all vessels), significantly lower than for PVD (ICC = 0.89, p < 0.001 for capillaries and ICC = 0.90, p < 0.001 for all vessels) and PPV (ICC = 0.82, p = 0.003 for capillaries and ICC = 0.83, p = 0.01 for all vessels). Correlation coefficient (r) between PPV and MFI(by quadrants) corrected for measurement error was 0.39 (0.10 – 0.64) for capillaries and 1.01 (0.85 – 1.16) for all vessels. CONCLUSIONS: Intra-observer reliability for full evaluation of Sidestream Dark Field images was good for vessel detection and for flow classification but significantly poorer for the faster “Boerma” method. Furthermore, the Boerma method is likely to estimate different aspects of capillary flow than do the standard methods

Cerebral Effects of Commonly Used Vasopressor-Inotropes: A Study in Newborn Piglets

<div><p>Background</p><p>Despite widespread use in sick infants, it is still debated whether vasopressor-inotropes have direct cerebral effects that might affect neurological outcome. We aimed to test direct cerebrovascular effects of three commonly used vasopressor-inotropes (adrenaline, dopamine and noradrenaline) by comparing the responses to those of nonpharmacologically induced increases in blood pressure. We also searched for reasons for a mismatch between the response in perfusion and oxygenation.</p><p>Methods</p><p>Twenty-four piglets had long and short infusions of the three vasopressor-inotropes titrated to raise mean arterial blood pressure (MAP) 10 mmHg in random order. Nonpharmacological increases in MAP were induced by inflation of a balloon in the descending aorta. We measured cerebral oxygenation (near-infrared spectroscopy), perfusion (laser-Doppler), oxygen consumption (co-oximetry of arterial and superior sagittal sinus blood), and microvascular heterogeneity (side stream dark field video microscopy).</p><p>Results</p><p>Vasopressor-inotropes increased cerebral oxygenation significantly less (p≤0.01) compared to non-pharmacological MAP increases, whereas perfusion was similar. Furthermore, cerebral total hemoglobin concentration increased significantly less during vasopressor-inotrope infusions (p = 0.001). These physiologic responses were identical between the three vasopressor-inotropes (p>0.05). Furthermore, they induced a mild, although insignificant increase in cerebral metabolism and microvascular heterogeneity (p>0.05). Removal of the scalp tissue did not influence the mismatch (p>0.05).</p><p>Conclusion</p><p>We demonstrated a moderate vasopressor-inotrope induced mismatch between cerebral perfusion and oxygenation. Scalp removal did not affect this mismatch, why vasopressor-inotropes appear to have direct cerebral actions. The statistically nonsignificant increases in cerebral metabolism and/or microvascular heterogeneity may explain the mismatch. Alternatively, it may simply reflect a vasopressor-inotrope-induced decrease in the arterial-to-venous volume ratio as detected by near-infrared spectroscopy.</p></div

The experimental protocol.

<p>Baseline and steady state measurements included duplicate blood samples for metabolic measurements in all piglets and video microscopic examination of the cortical microvascular heterogeneity in of the 12 piglets. Blood pressure fluctuations were induced pharmacologically and nonpharmacologically to evaluate a possible direct drug induced effect on cerebral perfusion and oxygenation. PR, pulse rate; MAP, mean arterial blood pressure; SaO₂, arterial oxygen saturation; LDF, laser Doppler flow; OI, oxygenation index; NIRS, near infrared spectroscopy.</p

Comparison of the effects of adrenaline, dopamine and noradrenaline on cerebral perfusion and oxygenation.

<p>Values are reported in median [25^th–75^th].</p

Short infusions of the vasopressors.

<p>Example of pharmacologically (first 10 min) and nonpharmacologically (last 10 min) induced changes in mean arterial blood pressure (MAP) and corresponding changes in cerebral perfusion (LDF in % from baseline) and oxygenation (OI measured with near infrared spectroscopy). Pharmacologically induced changes consisted of two repeated infusions lasting 2½ minute, interspaced with pauses lasting 2½ minute to reach baseline levels. This was followed by nonpharmacological MAP fluctuations induced by balloon inflations: the thoracic aorta balloon was inflated 10 times, and inflations lasted 30 sec interspaced by 30 sec pauses. The vertical line represents a 10 min pause between the induced changes in MAP.</p

Steady state responses during vasopressor infusion.

<p>Values are reported in median [25^th–75^th].</p