Warty carcinoma of uterine cervix - review of the literature and case report

Introduction. The Histological Classification of Epithelial Tumors of the Uterine Cervix of the World Health Organization includes inter alia warty carcinoma as a variant of squamous cell carcinoma. Until now several case reports and studies have shown that this particular cancer is associated with human papillomavirus/ HPV infection. Case presentation. A 58-year-old woman presented with a vegetant cervical tumour. Biopsy samples were collected from the tumour, and the histological exam successively confirmed the warty cell carcinoma. Additional tests revealed the presence of single human papillomavirus/ type-45. An immunohistochemistry exam was performed in order to confirm the diagnosis, and also to highlight the relationship between the potential causal factors and the morphological appearance. This allowed the confirmation of the diagnosis, and added new elements able to define the characteristics of this form of cancer. The treatment included radiotherapy and radical hysterectomy with anexectomy, and pelvic lymphadenectomy. The evolution was favorable, with no signs of local recurrence or metastasis in the past five years. Conclusions. Warty carcinoma, relatively similar to condyloma acuminatum or verrucous carcinomas, has specific immune-histochemical features that differentiate it from other variants of squamous cell carcinoma. The HPV genotype 45 can be considered a causative factor in the pathogenesis of cervical warty carcinoma. Even so, warty carcinoma appears not to be caused by a specific HPV subtype (or a combination of several specific genotypes), being rather a multifactorial affection

Patients’ perception of childbirth according to the delivery method: The experience in our clinic

Introduction: The aim of this study is to identify the way in which childbirth in general, and the delivery method in particular, influenced the maternal psychosocial status and the perception upon birth during postpartum. Material and method: We conducted a cohort type 2 prospective study. We included patients who had given birth at “Bucur” Maternity of Hospital “St. John” Bucharest from the 1st of January 2017 until the 1st of January 2018. Results: The majority of the patients (21.05%) who chose to give birth vaginally assigned the maximum degree (10) to the difficulty of birth. The patients who gave birth through cesarean section experienced the feeling of sadness in a higher percentage than those who gave birth vaginally (30.52% versus 21.05%). Among the patients who were in favor of having more children, 85.45% preferred the same delivery method. All the patients who gave birth vaginally wished to have other children using the same method, while 81.4% from the patients who gave birth through cesarean section were in favor of more children. Conclusion: The patients’ perception of childbirth was a subjective parameter. Further studies with standardized questionnaires should be applied for more reliable results

The Accuracy of Cytology, Colposcopy and Pathology in Evaluating Precancerous Cervical Lesions

Cervical cancer (CC) is the third most common cancer in the world, and Romania has the highest incidence of cervical cancer in Europe. The aim of this study was to evaluate the correlation between cytology, colposcopy, and pathology for the early detection of premalignant cervical lesions in a group of Romanian patients. Methods: This observational type 2 cohort study included 128 women from our unit, “Bucur” Maternity, who were referred for cervical cancer screening. Age, clinical diagnosis, cytology results, colposcopy impression, and biopsy results were considered. Colposcopy was performed by two experienced examiners. The pathological examination was performed by an experienced pathologist. Results: The cytology found high-grade squamous intraepithelial lesions in 60.9% of patients, low-grade squamous intraepithelial lesions in 28.1%, atypical squamous cells for which a high-grade lesion could not be excluded in 9.4%, and atypical squamous cells of undetermined significance, known as repeated LSIL, in 1.6%. The first evaluator identified low-grade lesions in 56.3%, high-grade lesions in 40.6%, and invasion in 3.1% of patients. The second evaluator identified low-grade lesions in 59.4%, high-grade lesions in 32.0%, and invasion in 8.6% of patients. The pathological exam identified low-grade lesions in 64.1%, high-grade lesions in 25%, and carcinoma in 14% of patients. The colposcopic accuracy was greater than the cytologic accuracy. Conclusions: Colposcopy remains an essential tool for the identification of cervical premalignant cancer cells. Standardization of the protocol provided an insignificant interobserver variability and can serve as support for further postgraduate teaching

The Impact of SARS-CoV-2 Infection on Premature Birth—Our Experience as COVID Center

Information about the impact of SARS-CoV-2 infection on pregnant women is still limited and raises challenges, even as publications are increasing rapidly. The aim of the present study was to determine the impact of SARS-CoV-2 infection on preterm birth pregnancies. We performed a prospective, observational study in a COVID-only hospital, which included 34 pregnant women with SARS-CoV-2 infection and preterm birth compared with a control group of 48 healthy women with preterm birth. The rate of cesarean delivery was 82% in the study group versus 6% for the control group. We observed a strong correlation between premature birth and the presence of COVID-19 symptoms (cough p = 0.029, fever p = 0.001, and chills p = 0.001). The risk for premature birth is correlated to a lower value of oxygen saturation (p = 0.001) and extensive radiologic pulmonary lesions (p = 0.025). The COVID-19 pregnant women with preterm delivery were older, and experienced an exacerbation of severe respiratory symptoms, decreased saturation of oxygen, increased inflammatory markers, severe pulmonary lesions and decreased lymphocytes

Warty carcinoma of uterine cervix - review of the literature and case report

Introduction. The Histological Classification of Epithelial Tumors of the Uterine Cervix of the World Health Organization includes inter alia warty carcinoma as a variant of squamous cell carcinoma. Until now several case reports and studies have shown that this particular cancer is associated with human papillomavirus/ HPV infection. Case presentation. A 58-year-old woman presented with a vegetant cervical tumour. Biopsy samples were collected from the tumour, and the histological exam successively confirmed the warty cell carcinoma. Additional tests revealed the presence of single human papillomavirus/ type-45. An immunohistochemistry exam was performed in order to confirm the diagnosis, and also to highlight the relationship between the potential causal factors and the morphological appearance. This allowed the confirmation of the diagnosis, and added new elements able to define the characteristics of this form of cancer. The treatment included radiotherapy and radical hysterectomy with anexectomy, and pelvic lymphadenectomy. The evolution was favorable, with no signs of local recurrence or metastasis in the past five years. Conclusions. Warty carcinoma, relatively similar to condyloma acuminatum or verrucous carcinomas, has specific immune-histochemical features that differentiate it from other variants of squamous cell carcinoma. The HPV genotype 45 can be considered a causative factor in the pathogenesis of cervical warty carcinoma. Even so, warty carcinoma appears not to be caused by a specific HPV subtype (or a combination of several specific genotypes), being rather a multifactorial affection

Patients’ perception of childbirth according to the delivery method: The experience in our clinic

Introduction: The aim of this study is to identify the way in which childbirth in general, and the delivery method in particular, influenced the maternal psychosocial status and the perception upon birth during postpartum. Material and method: We conducted a cohort type 2 prospective study. We included patients who had given birth at “Bucur” Maternity of Hospital “St. John” Bucharest from the 1st of January 2017 until the 1st of January 2018. Results: The majority of the patients (21.05%) who chose to give birth vaginally assigned the maximum degree (10) to the difficulty of birth. The patients who gave birth through cesarean section experienced the feeling of sadness in a higher percentage than those who gave birth vaginally (30.52% versus 21.05%). Among the patients who were in favor of having more children, 85.45% preferred the same delivery method. All the patients who gave birth vaginally wished to have other children using the same method, while 81.4% from the patients who gave birth through cesarean section were in favor of more children. Conclusion: The patients’ perception of childbirth was a subjective parameter. Further studies with standardized questionnaires should be applied for more reliable results

The analysis of risk factors associated with women\u27s urinary incontinence; literature review

Urinary incontinence (UI) is a common condition among women. Approximately 50% of them had an involuntary loss of urine at least once in their lifetime. It can be present during sexual activity, contributing to sexual dysfunction and often associated with anxiety or even depression, thus having a negative impact on the quality of life. The incidence of UI is related to the existence of predisposing factors. The best known are: age, weight, family history, race/ ethnicity, number of pregnancies and mode of birth, history of genitourinary interventions and factors related to ordinary habits: smoking, caffeine consumption, oral contraceptives. Studies on middle-aged women have revealed that BMI, parity, age, hysterectomy, smoking, race/ ethnicity and diabetes are factors often associated with urinary incontinence. Future studies are needed to further explore the risk factors for urinary incontinence

Stress and anxiety among physicians and nurses in Romania during the COVID-19 pandemic

Objective. This study aimed at identifying the stress and anxiety levels among physicians and nurses working in Romanian hospitals during the COVID-19 pandemic. Methods and Results. We conducted an online survey with a questionnaire completed by 169 healthcare providers aged between 25 and 69 years from COVID and non-COVID hospitals. There were 87.6% physicians and 12.4% nurses, with 61.5% women and 38.5% men. Clinicians experienced high levels of stress in 2.7% of the cases, medium stress in 68.9% of the cases, and low stress in 28.4% of the cases. Women experienced more stress (2.9% high level, 66.3% medium level) than men (1.5% high level, 64.6% medium level), while men are more anxious (73.8% high level, 26.2% medium level) than women (63.6% high level, 33.7% medium level). In both COVID and non-COVID healthcare providers, the stress score directly correlates with the anxiety score. Overall, during this period, the responders felt stressed and anxious (p=0.001). Conclusions. The COVID-19 pandemic is a strong reason for increased stress and anxiety among physicians and nurses. Men are more anxious and women more stressed. The stress and anxiety scores are different according to the hospital type

The diagnostic algorithm in pre-invasive cervical lesions

The screening for pre-invasive cervical lesions has significantly decreased the incidence of cervical neoplasm. It is recommended to be performed starting with the age of 21 with a frequency of 3-5 years and it consists of pap smear testing and HPV genotyping, and, if required, it can be continued with colposcopy or biopsy followed by pathological assessment. The importance of the early diagnosis of pre-invasive cervical lesions has led to several studies on this topic. The paper analyzed the modern literature published on the PubMed and Scopus databases. Reference studies have found that most intraepithelial lesions are caused by the presence of HPV. Other commonly associated factors are immunosuppression, multiparity and other viral infections. HPV infection can be prevented by vaccination. It is recommended for people between 11 and 26 years old and also over 27 years old if they associate risk factors. A meta-analysis performed on patients diagnosed with CIN2 revealed a lower recurrence rate in vaccinated women than in unvaccinated women. Other studies have shown the transient nature of HPV infection and spontaneous regression of pre-invasive lesions. The early diagnosis of pre-invasive lesions is necessary for the initiation of therapeutic and follow-up behavior as soon as possible, with the aim of reducing the incidence of cervical cancer. This is possible and easy to access through national health programs

Caesarean section versus vaginal birth in the perception of woman who gave birth by both methods

The increase in the number of births by Caesarean section is a phenomenon whose global expansion is generated by numerous factors and especially by the contemporary perceptions of women regarding childbirth meeting the interests of the professionals in the field. However, the opinion of many women towards the benefits of Caesarean delivery is often not based on the experience or information from reliable sources. This study aimed at sharing the experience of women who gave birth both vaginally and by Caesarean section, focusing on their perception of these events. The study included 26 women and the conclusion of the vast majority (77%) was that natural birth is preferable and they would recommend it as the first option to future mothers. In addition, the analysis of the cases in which, on the contrary, they would recommend birth by Caesarean section (23%) revealed that they objectively had births that had not been optimally managed and hence, the recommendation for careful, professional evaluation of the conditions of birth for each case. Reaching an optimal rate of Caesarean sections is an objective that can be achieved through correct information, health education and the correct management of the cases