Human papilloma virus-related premalignant and malignant lesions of the cervix and anogenital tract in immunocompromised women

The number of immunocompromised patients is rising, and immunodeficiency is an independent risk factor for the development of premalignant and malignant lesions of the cervix and anogenital tract. The aim of this review was to summarize and update data on human papilloma virus (HPV) infections and HPV-based anogenital lesions detected in patients who were immunocompromised due to both organ transplantation and human immunodeficiency virus (HIV) infection. The incidence of HPV infections among solid organ recipients and HIV positive females is reported to be significantly higher when compared with age-matched healthy controls- i.e. higher by up to 65% and 46.6% respectively, vs 38% in the controls. These infections are also more often chronic, high risk HPV and multitype. Data suggest that HPV infections in these patients might not only occur more frequently, but that the course of the infection might also lead to faster oncogenesis. However, the treatment options for malignancies are limited; and this implies the need for intense primary and secondary prevention regimens. As infections with HPV types other than 16 and 18 and multitype infections are particularly frequently discovered in immunocompromised patients, they would probably benefit most from a nonavalent vaccine. Gynecological screening should be performed annually, including cervical smears and/ or HPV testing. In the group of non-responders, self-sampling methods should be considered

Personalized embryo transfer (pET) guided by endometrial receptivity (ER) assessment — a possibility to increase effectiveness of IVF procedures. Review of available methods

The continuous development of assisted reproductive techniques (ART) implies the search for solutions that could increase the effectiveness of available methods. In the context of in vitro fertilization (IVF), a significant proportion of failures are due to unsuccessful embryo transfers. At this stage the most important issue is proper dialogue between implanting embryo and the maternal endometrium. Therefore, it seems justified to assess endometrial receptivity (ER), defined as the tissue's ability to accept an embryo to attach and invade into the mucosa. Window of implantation (WOI), is a certain period in which implantation of the properly developed embryo is possible. The cause of endometrial receptivity disorders is believed to be the disturbed expression of cytokines and endometrial surface proteins, the presence of which has been proven in commonly diagnosed diseases such as endometriosis or chronic endometritis. Despite many years of research on endometrial receptivity, the area of ​​diagnostic methods enabling clinical monitoring of ER still remains undeveloped. The aim of this study is to review the utility of selected markers and the available methods of ER assessment, ranging from noninvasive ultrasound, through endometrial fluid analysis, to genomic studies based on endometrial biopsy, in order to increase the effectiveness of IVF. Such an approach could potentially be a significant step towards personalizing medical procedures especially in patients diagnosed with repeated implantation failure (RIF)

Intrauterine growth restriction in pregnant women after kidney transplantation as a marker of preeclampsia

Objectives: Delayed motherhood is associated with an increasing number of comorbidities such as glomerulonephritis, systemic lupus erythematosus, and diabetic nephropathy. Women after renal transplant belong to the group of patients who require a highly individualized approach to treatment and diagnosis. The aim of the study was to validate the commonly used diagnostic criteria for preeclampsia which seem to be irrelevant in patients with chronic renal insufficiency.Material and methods: The course of pregnancy and delivery were retrospectively analyzed in 48 renal transplant patients. Two patients were excluded. Group I included 23 patients with eutrophic neonates, while Group II consisted of 23 patients with fetal hypotrophy (birth weight of < 10th percentile).Results: The duration of pregnancy was 34.5 and 35 weeks in Groups I and II, respectively. Mean birth weight in Groups I and II was 2608.64 g and 2046.30 g, respectively (p = 0.002). Mean weight percentile in Groups I and II was 36.57 and 2.91, respectively (p < 0.000). Proteinuria in the first half of pregnancy occurred in 16 and 14 patients from Groups I and II, respectively, and increased in the second half of pregnancy in 6 and 6 patients from Groups I and II, respectively. Patients from Group II were more prone to urinary tract infections (0.43 vs. 0.79; p = 0.02).Conclusions: Current diagnostic criteria for preeclampsia are insufficient in case of pregnant women after kidney transplant. General criteria should be applied with special care in women with chronic kidney disease or in patients with systemic lupus erythematosus. As a predictive factor of neonatal morbidity, intrauterine growth restriction seems to be more valuable than typical markers of kidney function

Barley malt-based composition as a galactagogue — a randomized, controlled trial in preterm mothers

Objectives: Delayed or insufficient breast milk production, as well as low milk supply, is still a challenging problem toovercome, particularly in the case of preterm delivery. Herbal galactagogues might be a good way to increase milk supply,however, there is a lack of clinical studies confirming their efficacy and safety.The aim of this study was to verify the safety and effectiveness as a galactagogue of the unique galactagogue compositionbased on barley malt with β -glucan and lemon balm.Material and methods: The study included 117 mothers of preterm infants randomly divided into the GalactagogueGroup given galactagogue and the Placebo Group. A complete data set was obtained for 80 participants, divided equallybetween two groups.Volume of milk expressed by mothers during the first two weeks after delivery was the primary outcome and safetyof the product was the secondary outcome.Results: Volume of milk recorded on participants’ last visit in the Galactagogue Group was significantly higher than in thePlacebo Group (95 mL vs 62.5 mL, p = 0.049). The total expressed milk volume during the study was 4209 ± 335 mLin the Placebo Group vs 6036 ± 498 mL (p = 0.003) in the Galactagogue Group.Conclusions: Supplementation with unique Galactagogue composition was safe and increased milk output which allowedachieving target minimal volume of 500 mL per day in first week of lactation in preterm mothers

Randomized comparison of two methods of the epidural space identification during regional labour analgesia

Objectives: Conventional loss of resistance (LOR) technique for identifying the epidural space (EDS) predominantly depends on experience of the anaesthetist. A technique using automated syringe for EDS identification was invented as an alternative to the traditional method. The aim of the study was to compare the efficacy and risk for complications between automatic LOR syringe — Epimatic® (Vygon, Ecouen, France) and conventional LOR — Perifix® (B.Braun Melsungen AG, Melsungen, Germany) techniques for EDS identification.  Material and methods: A total of 170 patients were enrolled into the study and 153 cases were analysed. Number of at- tempts, time to EDS identification, ease of EDS identification, complication rate and patient procedure-related discomfort were evaluated and compared.  Results: No statistically significant differences were found in the number of needle insertion attempts (1.3 in both groups), time to EDS identification (31 sec. vs. 27 sec.), efficacy of epidural analgesia (100% in both groups), or complication rate between both groups.  Conclusions: The automatic and the conventional LOR techniques are comparable in terms of efficacy and safety for the epidural space identification.

The Impact of Endometriosis on the Quality of Life and the Incidence of Depression—A Cohort Study

The objective was to evaluate the quality of life and the incidence of depression among women suffering from endometriosis. Afterwards, the dependency between pelvic pain, its severity and stages of endometriosis were analyzed. The study protocol included women of reproductive ages with confirmed endometriosis. The stage of disease was conferred according to the ASRM (American Society of Reproductive Medicine) classification. Women fulfilled two questionnaires: “WERF EPHect Clinical Questionnaire” and self-prepared survey about fertility disorders. The study group comprised of 246 respondents. A total of 77.2% of women were symptomatic. The most common complaints were chronic pelvic pain (CPP, 71.1%), dysmenorrhea (69.0%) and dyspareunia (45.2%). Intensity of pain was independent from the stage of endometriosis. The incidence of infertility and the time to conceive increased with the stage of disease (stage 1—52.8%, 3.4 years; stage 2—66.7%, 4.1 years; stage 3—61.3%, 3.7 years; stage 4—96%, 6.1years; p = 0.02 and 0.03, respectively). The prevalence of depression was positively correlated with the beginning of dyspareunia (14.5 vs. 19.6 years old., p = 0.002). CPP (OR(odds ratio) = 3.8, 95% CI 1.2–12.8, p = 0.04) and painful defecation (OR = 7.7, 95% CI 1.4–42.3, p = 0.01) increased the risk of depression. Symptoms related to endometriosis and severity of pain correlate with the prevalence of depression. Stage of endometriosis is significantly related to the prevalence of infertility

Parasitic fibroid of greater omentum in 31-years old woman

Uterine leiomyomas are the most common benign tumors of the uterine smooth muscle. The latest FIGO classification, considering both their location and the degree of ingrowth into the uterine muscle, distinguishes eight classes of fibroids [1]. The location of leiomyomas in connection with their size may determine the characteristic symptoms: abdominal pain, pressure symptoms, difficulties in getting pregnant, recurrent miscarriages. Among the case reports there are also descriptions of the so-called parasitic leiomyomas [2]. The paper presents a case report of a parasitic leiomyoma in a young woman who has not been operated on in the abdominal or pelvic organs so far

Should the patients with endometriosis be treated as a risk group of pregnancy complications? Single center experience and literature review and literature review

Objectives: Multidirectional influence of endometriosis on fertility impairments is well known. Altered implantation and placentation among affected patients raised concerns regarding possible negative influence on the course of pregnancy. The primary objective of the study was to assess the course of gestation and the incidence of pregnancy complications among women with endometriosis. It also aimed to determine whether the method of conception might impact the primary results. Material and methods: A single-center cohort study included 64 women with confirmed endometriosis and 296 healthy controls. Data concerning treatment of endometriosis related infertility, course of pregnancy and perinatal outcomes were evaluated. Results: Patients with endometriosis were older than controls (33.6 +/- 4.2 y vs 31.8 +/- 4.6, p = 0.01) and more often gave birth for the first time (87.5% vs 43.9%, p = 0.001). The age at the time of first delivery was significantly higher within the study group (33.1 y +/- 4.1 vs 29.9 +/- 4.6, p < 0.001). In the study, 81.2% of patients with endometriosis had the diagnosis of infertility. Patients suffering from endometriosis were significantly more prone to spontaneous placental abruption during pregnancy and delivery (4.7 vs 0.3%, odds ratio = 14.5). Several complications occurred more often in endometriotic patients (gestational diabetes mellitus, small-for-gestational-age and anemia); however, without statistical significance. The risk of pregnancy complications was independent from stage of endometriosis and way of conception. The incidences of adverse neonatal outcomes (preterm delivery, low Apgar score, lower birth weight) were similar in both groups. Conclusions: Endometriosis may adversely affect perinatal outcomes, especially due to increased risk of placenta abruption and operative delivery. Stage of endometriosis and method of conception does not enhance these complications

Oxidative Stress Markers Differ in Two Placental Dysfunction Pathologies: Pregnancy-Induced Hypertension and Intrauterine Growth Restriction

Aim. Pregnancy-induced hypertension (PIH) and intrauterine growth restriction (IUGR) are both multisystemic disorders of pregnancy that cause perinatal morbidity and mortality. Recently, researchers focused on the role of oxidative stress (OS) as a pathophysiological mechanism in the development of these pathologies. The aim of this study was to compare OS in placental-related pathologies (PIH and IUGR) and uncomplicated pregnancies. We also investigated which salivary OS markers reflect systemic oxidative status and which only reflect the state of the oral cavity. Material and Methods. A total of 104 pregnant women (n=104; 27 with PIH, 30 with IUGR, and 47 controls) were evaluated. Malondialdehyde (MDA), total antioxidant capacity (ORAC), aldehyde dehydrogenase (ALDH), and activity of glutathione peroxidase (GPx) and glutathione transferase (GST) in plasma/whole blood and/or saliva were analysed. Dietary nutrient intake was calculated using a Semiquantitative Food Frequency Questionnaire (SFFQ). Oral health was assessed to eliminate patients with bleeding, severe periodontitis, and other dental pathologies. Results. In the IUGR group, increased concentration of ORAC was observed both in saliva and plasma. Also, lower plasma levels of MDA in IUGR compared to the control group was detected. No sign of oxidative stress was confirmed in the PIH group. The examined groups did not differ regarding diet and markers of inflammation. ORAC in saliva was correlated with its level in plasma. No such correlations for MDA were observed. In the IUGR group, there were no differences in OS markers in plasma, but there was a lower ALDH level in the blood compared to the control group. It confirms OS occurrence in IUGR. In IUGR, a higher activity of salivary ALDH was probably due to worse oral health. Conclusion. Oxidative stress differs between IUGR and PIH groups: the presence of oxidative stress was confirmed only in the IUGR group. Salivary ORAC can be used to estimate ORAC in plasma. The activity of salivary ALDH reflects the state of the oral cavity