Seasonal Variation in the Incidence of Severe Preeclampsia in Mediterranean Climatic Conditions

The aim of the study was to evaluate possible involvement of environmental factors in the incidence of preeclampsia. A retrospective observational study on the seasonal variation of severe preeclampsia, derived from the intensive obstetric care unit files over a 48-month period, was undertaken. Obstetrics were studied and all deliveries and number of severe preeclamptic patients were recorded. The extracted data were then divided into four groups, based on the four main seasons of the year. The rates of severe preeclampsia, occurring in each season, were compared. Although there is a trend of higher incidence during summer, statistical difference was not significant (unpaired t -test: p=0.1250 for preeclampsia p=0.1250 for total deliveries, and paired t -test: p=0.0027 for severe preeclampsia p=0.0002 for total deliveries), perhaps due to the small numbers of the studied groups. In this study we found a prevalence of preeclampsia during summer when the weather is warmer than the other seasons. This finding may provide new possible mechanisms in the pathogenesis of preeclampsia

Uterine inversion after controlled cord traction during caesarean section: A case report

Introduction: Inversion of the uterus during caesarean section is a rare but life-threatening complication of the procedure that requires immediate treatment, which is reversion and awareness due to the very serious adverse effects that it may have. Materials and Methods: The authors present a case of a 34-year-old para 1 woman of Greek ethnicity who underwent a scheduled caesarean section at 39 weeks of gestation. During the procedure, a uterine inversion occurred as a controlled cord traction was applied in order to achieve placental detachment, after the delivery of the baby. It was managed by immediate manual uterine reversion, which was performed after exteriorization of the uterus. There were no adverse effects. Conclusion: Uterine inversion during caesarean section is a serious complication, but fortunately very rare. However, the obstetrician should be aware that the complication should be quickly identified and act without hesitation because it is critical for the well being of the patient

An Asymptomatic Patient with an Additional Cardiac Chamber Giant Left Atrial Appendage

We present the case of an asymptomatic 54-year-old male, referred to our department for a follow-up cardiological consultation. Echocardiography assessment showed an unknown cavity adjacent to the lateral wall of the left ventricle. A large left atrial appendage was revealed in further investigations, and the treatment option was proved to be an impasse

Proportion of excision and cervical healing after large loop excision of the transformation zone for cervical intraepithelial neoplasia

To determine how the proportion of the cervical volume excised affects cervical regeneration. Design Prospective observational study. Setting University Hospital. Population Women planning to undergo excisional treatment for cervical intraepithelial neoplasia who wish to have future pregnancies. Methods The cervical volume (and dimensions) is calculated with magnetic resonance imaging (MRI) before treatment. The volume (and dimensions) of the cone is assessed before fixation by a volumetric tube and a ruler; the percentage (%) of excision is computed. Cervical regeneration is estimated by repeat MRI at 6months. Main outcome measures Cervical regeneration in relation to proportion of excision. Statistical analysis was performed by box plots and analysis of variance. Results A total of 48 women have been recruited; 29 have completed 6months follow up. Both the total cervical volume (from MRI) before treatment and the volume of the excised/ablated cone varied substantially. The estimated proportion of excision varied significantly between 4% and 39% (median 11%). Multivariate linear regression revealed that the proportional deficit at 6months post-treatment was determined mainly by the proportion of the excised volume. Conclusions Careful assessment of risks and benefits of treatment is essential when deciding to treat women who wish to have future pregnancies. Assessment of the proportion of the cervical volume and length excised might identify those that need further surveillance during future pregnancy. © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology

Expression of HPV-related biomarkers and grade of cervical intraepithelial lesion at treatment

Objectives New human papillomavirus (HPV)-related biomarkers may allow better identification of clinically significant lesions that warrant excision and, conversely, identification of the false positive cases that have been overreported by traditional techniques. The aim of this study was to investigate how the expression of several HPV-related biomarkers correlates to the severity of the lesion at treatment. Design Prospective observational study. Setting University Hospital (2009-2011). Population All women submitted for excisional treatment. Methods A liquid-based cytology sample was obtained before treatment and was tested for HPV typing, mRNA E6 & E7 with NASBA or flow cytometry and p16. All women had histological diagnosis in the form of excisional cone (gold standard). Main outcome measures Correlation of HPV biomarker positivity rates to the grade of the lesion at treatment histology. Results Two hundred women were recruited: 23 were found to have negative histology (11.5%), 79 (39.5%) CIN1, 50 (25.0%) CIN2 and 48 (24.0%) CIN3. All biomarkers (HPV DNA typing, HR HPV, single HPV 16/18, mRNA E6 & E7 expression and p16) revealed an increased linear positivity rate with increasing severity and grade of the lesion (chi-squared test for trend p < 0.05). This was stronger for HPV (all and high-risk) followed by mRNA with NASBA, flow cytometry, HPV 16/18 and ultimately p16 immunostaining. Conclusions The linear correlation between various HPV-related biomarkers and the grade of the lesion suggests that these biomarkers may prove to be useful in the prediction of CIN grade and, as a result, the need for treatment. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology

Personalised management of women with cervical abnormalities using a clinical decision support scoring system

Objectives To develop a clinical decision support scoring system (DSSS) based on artificial neural networks (ANN) for personalised management of women with cervical abnormalities. Methods We recruited women with cervical abnormalities and healthy controls that attended for opportunistic screening between 2006 and 2014 in 3 University Hospitals. We prospectively collected detailed patient characteristics, the colposcopic impression and performed a series of biomarkers using a liquid-based cytology sample. These included HPV DNA typing, E6&E7 mRNA by NASBA or flow cytometry and p16INK4a immunostaining. We used ANNs to combine the cytology and biomarker results and develop a clinical DSSS with the aim to improve the diagnostic accuracy of tests and quantify the individual's risk for different histological diagnoses. We used histology as the gold standard. Results We analysed data from 2267 women that had complete or partial dataset of clinical and molecular data during their initial or followup visits (N = 3565). Accuracy parameters (sensitivity, specificity, positive and negative predictive values) were assessed for the cytological result and/or HPV status and for the DSSS. The ANN predicted with higher accuracy the chances of high-grade (CIN2 +), low grade (HPV/CIN1) and normal histology than cytology with or without HPV test. The sensitivity for prediction of CIN2 or worse was 93.0%, specificity 99.2% with high positive (93.3%) and negative (99.2%) predictive values. Conclusions The DSSS based on an ANN of multilayer perceptron (MLP) type, can predict with the highest accuracy the histological diagnosis in women with abnormalities at cytology when compared with the use of tests alone. A user-friendly software based on this technology could be used to guide clinician decision making towards a more personalised care. © 2016 Elsevier Inc

Molecular epidemiology of HPV infection using a clinical array methodology in 2952 women in Greece

The molecular epidemiology of human papillomavirus (HPV) infection in a sample of Greek women (n=2952, mean age 42.2±13.3years) was examined. HPV prevalence was 50.7% (95% confidence interval, 48.8-52.6). The most frequent HPV types were HPV 53, 51 and 66 (10.2%, 9.4% and 9.3%, respectively). HPV positivity was associated with age, age of sexual debut, number of sexual partners and duration of sexual relationship, while marriage or multiparity protected against infection (all p<0.001). Follow-up of this cohort will assist in predicting the effect of vaccination with the new HPV vaccines on future screening with HPV-based tests for cervical cancer. © 2011 European Society of Clinical Microbiology and Infectious Diseases