World Wide Web Resources on Obstetrical and Gynecological Infections

Modern information and communications technology has provided medical students and practitioners around the world with a new, valuable, and easy-to-use way to retrieve potentially useful information. Using previously described by our research group methodology, we generated a list of 50 Internet resources in the field of obstetrical and gynecological infections. We believe that the availability of such a list will help in the education of students and clinicians interested in obstetrical and gynecological infections

A cross sectional study investigating dynamic balance when stepping in children with cerebral palsy

Background: Children with Cerebral Palsy (CP) have altered anticipatory postural adjustments (APAs) during gait initiation. These APAs may affect dynamic balance in tasks such as stepping. Research questions: How are APAs in children with CP affected during stepping to precise targets? How do children with CP modulate APAs when stepping to medial and lateral targets? What is the association between APAs and symptom severity, movement quality and impairment profile? Method: Children undertook a stepping task to laterally and medially placed targets with either leg, in a randomised order. Movement of the centre of pressure (COP) and markers at the pelvis and foot were measured via a force plate and 3D motion analysis. Motion of the centre of mass (COM) was estimated via pelvic markers. APAs were assessed prior to leading leg lift-off in medio-lateral and antero-posterior directions. Stepping error was calculated. Baseline characteristics of children with CP included Gross Motor Function Measure (GMFM), Quality Function Measure (QFM), leg muscle hypertonia (Tardieu test) and strength (manual dynamometry). Results: Sixteen ambulant children with CP (12.2 years ± 2.2) and 14 typically developing (TD) children (11.6 years ± 2.9) were assessed. In children with CP, APAs in the medio-lateral direction were 20–30% smaller. Children with CP were less able to modulate their APAs with steps to medial and laterally placed targets, than TD children. Medio-lateral COP motion was associated with movement quality assessed by QFM subsections, GMFM (correlation coefficient r = 0.66–0.80) and hip abductor strength (r = 0.75). Antero-posterior APAs were significantly smaller when stepping with the non-paretic leg in children with CP. APA size was positively related to the length of the contralateral, paretic gastrocnemius (r = 0.77). Stepping error was higher in children with CP and inversely correlated to the size of the medio-lateral APA. Discussion: Children with CP show smaller medio-lateral APAs especially when stepping to medially placed targets. APA size may be limited by proximal muscle strength and gastrocnemius length

The impact of vaginal laser treatment for genitourinary syndrome of menopause in breast cancer survivors : a systematic review and meta-analysis

Introduction Genitourinary syndrome of menopause (GSM) is caused by hypo-estrogenism, resulting in vaginal dryness, pain, dyspareunia, and urinary tract infection. It is more severe and common in breast cancer (BC) survivors owing to the severity of induced menopause following treatment (ie, chemotherapy, GnRH agonists/anti-estrogen therapy). It has a detrimental effect on quality of life. The gold standard therapy is topical estrogen, which is highly effective; however, it is contraindicated in patients with BC owing to concerns with recurrence. Recently, vaginal laser therapy has been used to restore vaginal mucosal thickness, lubrication, and elasticity with good effect in menopausal women with GSM. The aim of this study is to assess the impact of vaginal laser therapy on BC-associated GSM. Materials and Methods This study is a systematic review and meta-analysis. Results A total of 48 papers were identified, revealing 10 observational studies of GSM symptoms before and after vaginal laser therapy with no randomized trials. Vaginal laser was effective in treating GSM in BC survivors with improvement in the Vaginal Health Index and the Visual Analogue Scale score for dyspareunia and vaginal dryness, sexual function, and overall satisfaction in the short term with minimal adverse events. Conclusion Vaginal laser may be effective in treating GSM in BC survivors in the short term, but there are no long-term data on safety and efficacy. More research is needed looking at longer term follow-up, health economic costs, and sub-group analysis as well as the complex interplay between GSM and the other negative impacts of BC therapy on intimate relationships

Azithromycin-chloroquine and the intermittent preventive treatment of malaria in pregnancy

In the high malaria-transmission settings of sub-Saharan Africa, malaria in pregnancy is an important cause of maternal, perinatal and neonatal morbidity. Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) reduces the incidence of low birth-weight, pre-term delivery, intrauterine growth-retardation and maternal anaemia. However, the public health benefits of IPTp are declining due to SP resistance. The combination of azithromycin and chloroquine is a potential alternative to SP for IPTp. This review summarizes key in vitro and in vivo evidence of azithromycin and chloroquine activity against Plasmodium falciparum and Plasmodium vivax, as well as the anticipated secondary benefits that may result from their combined use in IPTp, including the cure and prevention of many sexually transmitted diseases. Drug costs and the necessity for external financing are discussed along with a range of issues related to drug resistance and surveillance. Several scientific and programmatic questions of interest to policymakers and programme managers are also presented that would need to be addressed before azithromycin-chloroquine could be adopted for use in IPTp

Candidiasis, Bacterial Vaginosis, Trichomoniasis and Other Vaginal Conditions Affecting the Vulva

info:eu-repo/semantics/publishedVersio

Investigating the role of laser techniques for the treatment of women with genitourinary syndrome of menopause

AIM OF THE STUDY: The aim of the current study is to assess the effectiveness of microablative fractional CO2-laser therapy for the management of genitourinary syndrome of menopause (GSM). METHODS: Three intravaginally administered therapies of CO2 – laser (1 therapy/month) were applied in postmenopausal women with ≥1 moderate/severe intensity of GSM symptoms. Women had to have clinical signs of GSM as well. Primary outcomes of the study were the Vaginal Maturation Value (VMV) and the Vaginal Health Index (VHI). Secondary outcomes were symptoms from the lower genital [by a 10-cm Visual Analogue Scale (10-cm VAS)] and lower urinary tract system (by validated condition specific questionnaires), sexual health [by Female Sexual Function Index (FSFI)], women’s quality of life and impression regarding the CO2-laser therapy, pH of the vaginal fluid and the vaginal microenvironment. All comparisons were performed between values of outcomes before the initiation of the laser therapy (baseline) and 1-month following the completion of the protocol (12-weeks follow-up). RESULTS: Fifty-three postmenopausal women (mean age 57.2±5.4) were eligible to be included in the current protocol. At 12-weeks follow-up all outcomes (primary and secondary) were statistically and clinically significantly improved compared to the baseline. Thus, VMV improved from 11.7±15.6 at baseline to 44.2±13.7 at 12-weeks follow-up (p-value <0.001), dyspareunia decreased from 7.7±2.5 to 2.3±2.2 (p-value <0.001), dryness decreased from 6.1±3.1 to 1.7±1.9 (p-value <0.001), while sexual health increased from 13.7± 8.1 to 25.9±4.6 (p-value <0.001). At the end of the therapeutic protocol all women (100%) declared very satisfied/satisfied with the treatment, while 90% of women reported that they felt very much better/much better in comparison to the baseline. CONCLUSION: The efficacy of CO2-laser was assessed for the first time with a holistic approach using objective and subjective measures. The results of this study indicate that intravaginally administered CO2-laser therapy is promising for the management of GSM as it may improve the local pathophysiology as well as all GSM symptoms. High quality randomized controlled trials are needed for the results of this study to be confirmed.ΣΚΟΠΟΣ ΤΗΣ ΜΕΛΕΤΗΣ: Ο σκοπός της παρούσας μελέτης είναι η αναζήτηση της αποτελεσματικότητας της ενδοκολπικής θεραπείας με CO2 - laser στην αντιμετώπιση του ουρογεννητικού συνδρόμου της εμμηνόπαυσης σαν ολότητα. ΜΕΘΟ∆ΟΛΟΓΙΑ: Τρεις ενδοκολπικές θεραπείες με CO2 – laser (1 θεραπεία/μήνα) εφαρμόστηκαν σε εμμηνοπαυσιακές γυναίκες με ≥1 μέτριας/σοβαρής έντασης συμπτωμάτων ουρογεννητικού συνδρόμου της εμμηνόπαυσης. Πρωτεύοντα αποτελέσματα της μελέτης ήταν ο δείκτης ωριμότητας του κολπικού επιθηλίου και ο δείκτης υγείας του κόλπου. ∆ευτερεύοντα αποτελέσματα της μελέτης ήταν τα συμπτώματα από το κατώτερο γεννητικό (10 εκατοστών αναλογική κλίμακα) και κατώτερο ουροποιητικό σύστημα (ειδικά ερωτηματολόγια εκτίμησης συμπτωμάτων από το κατώτερο ουροποιητικό), η σεξουαλική υγεία (δείκτης σεξουαλικής λειτουργικότητας των γυναικών), η ποιότητα ζωής και η άποψη των γυναικών για την θεραπεία, το pH του κολπικού υγρού και η μικροβιολογική χλωρίδα του κόλπου. Όλες οι βασικές συγκρίσεις έγιναν ανάμεσα στα δεδομένα πριν την έναρξη του πρωτοκόλλου με τα αντίστοιχα 1 μήνα μετά την 3η θεραπεία (12 εβδομάδες παρακολούθησης). ΑΠΟΤΕΛΕΣΜΑΤΑ: Πενήντα τρεις εμμηνοπαυσιακές γυναίκες (μέση τιμή ηλικίας 57.2±5.4) πληρούσαν τα κριτήρια εισαγωγής στην μελέτη. Στις 12 εβδομάδες παρακολούθησης όλα τα αποτελέσματα (πρωτεύοντα και δευτερεύοντα) βελτιώθηκαν με στατιστικά και κλινικά σημαντικό τρόπο. Ενδεικτικά, ο δείκτης ωριμότητας του κολπικού επιθηλίου αυξήθηκε από 11.7±15.6 πριν την έναρξη του πρωτοκόλλου σε 44.2±13.7 στις 12 εβδομάδες παρακολούθησης (p-value <0.001), η δυσπαρεύνια μειώθηκε από 7.7±2.5 σε 2.3±2.2 (p-value <0.001), η ξηρότητα μειώθηκε από 6.1±3.1 σε 1.7±1.9 (p-value <0.001), ενώ η σεξουαλική υγεία αυξήθηκε από 13.7± 8.1 σε 25.9±4.6 (p-value <0.001). Κατά την ολοκλλήρωση του πρωτοκόλλου το 100% των γυναικών δήλωσε ότι ήταν πολύ ικανοποιημένες/ικανοποιημένες από την θεραπεία ενώ το 90% των γυναικών δήλωσε ότι ένιωθε πάρα πολύ καλύτερα/πολύ καλύτερα μετά την θεραπεία. ΣΥΜΠΕΡΑΣΜΑΤΑ: Η διερεύνηση της αποτελεσματικότητας του CO2-laser με ολιστικό τρόπο, λαμβάνοντας υπ’οψην αντικειμενικές και υποκειμενικές παραμέτρους όπως πραγματοποιήθηκε στο παρόν πρωτόκολλο, επιτελείται για πρώτη φορά σε διεθνές επίπεδο. Μάλιστα, υπήρξαν ενδείξεις ότι η χρήση του CO2-laser για την αντιμετώπιση του ουρογεννητικού συνδρόμου της εμμηνόπαυσης φαίνεται να αποτελεί μια πολλά υποσχόμενη θεραπεία εφόσον φαίνεται ότι μπορεί να βελτιώσει τόσο τη τοπική φυσιολογία των εμμηνοπαυσιακών γυναικών όσο και όλων των συμπτωμάτων του ουρογεννητικού συνδρόμου της εμμηνόπαυσης. Απαιτείται όμως περαιτέρω διερεύνηση

Η διερεύνηση του ρόλου των τεχνικών φωτομικροεξάχνωσης για την αντιμετώπιση των γυναικών με ουρογεννητικό σύνδρομο της εμμηνόπαυσης

ΣΚΟΠΟΣ ΤΗΣ ΜΕΛΕΤΗΣ: Ο σκοπός της παρούσας μελέτης είναι η αναζήτηση της αποτελεσματικότητας της ενδοκολπικής θεραπείας με CO2 - laser στην αντιμετώπιση του ουρογεννητικού συνδρόμου της εμμηνόπαυσης σαν ολότητα. ΜΕΘΟΔΟΛΟΓΙΑ: Τρεις ενδοκολπικές θεραπείες με CO2 – laser (1 θεραπεία/μήνα) εφαρμόστηκαν σε εμμηνοπαυσιακές γυναίκες με ≥1 μέτριας/σοβαρής έντασης συμπτωμάτων ουρογεννητικού συνδρόμου της εμμηνόπαυσης. Πρωτεύοντα αποτελέσματα της μελέτης ήταν ο δείκτης ωριμότητας του κολπικού επιθηλίου και ο δείκτης υγείας του κόλπου. Δευτερεύοντα αποτελέσματα της μελέτης ήταν τα συμπτώματα από το κατώτερο γεννητικό (10 εκατοστών αναλογική κλίμακα) και κατώτερο ουροποιητικό σύστημα (ειδικά ερωτηματολόγια εκτίμησης συμπτωμάτων από το κατώτερο ουροποιητικό), η σεξουαλική υγεία (δείκτης σεξουαλικής λειτουργικότητας των γυναικών), η ποιότητα ζωής και η άποψη των γυναικών για την θεραπεία, το pH του κολπικού υγρού και η μικροβιολογική χλωρίδα του κόλπου. Όλες οι βασικές συγκρίσεις έγιναν ανάμεσα στα δεδομένα πριν την έναρξη του πρωτοκόλλου με τα αντίστοιχα 1 μήνα μετά την 3η θεραπεία (12 εβδομάδες παρακολούθησης). ΑΠΟΤΕΛΕΣΜΑΤΑ: Πενήντα τρεις εμμηνοπαυσιακές γυναίκες (μέση τιμή ηλικίας 57.2±5.4) πληρούσαν τα κριτήρια εισαγωγής στην μελέτη. Στις 12 εβδομάδες παρακολούθησης όλα τα αποτελέσματα (πρωτεύοντα και δευτερεύοντα) βελτιώθηκαν με στατιστικά και κλινικά σημαντικό τρόπο. Ενδεικτικά, ο δείκτης ωριμότητας του κολπικού επιθηλίου αυξήθηκε από 11.7±15.6 πριν την έναρξη του πρωτοκόλλου σε 44.2±13.7 στις 12 εβδομάδες παρακολούθησης (p-value &lt;0.001), η δυσπαρεύνια μειώθηκε από 7.7±2.5 σε 2.3±2.2 (p-value &lt;0.001), η ξηρότητα μειώθηκε από 6.1±3.1 σε 1.7±1.9 (p-value &lt;0.001), ενώ η σεξουαλική υγεία αυξήθηκε από 13.7± 8.1 σε 25.9±4.6 (p-value &lt;0.001). Κατά την ολοκλλήρωση του πρωτοκόλλου το 100% των γυναικών δήλωσε ότι ήταν πολύ ικανοποιημένες/ικανοποιημένες από την θεραπεία ενώ το 90% των γυναικών δήλωσε ότι ένιωθε πάρα πολύ καλύτερα/πολύ καλύτερα μετά την θεραπεία. ΣΥΜΠΕΡΑΣΜΑΤΑ: Η διερεύνηση της αποτελεσματικότητας του CO2-laser με ολιστικό τρόπο, λαμβάνοντας υπ’οψην αντικειμενικές και υποκειμενικές παραμέτρους όπως πραγματοποιήθηκε στο παρόν πρωτόκολλο, επιτελείται για πρώτη φορά σε διεθνές επίπεδο. Μάλιστα, υπήρξαν ενδείξεις ότι η χρήση του CO2-laser για την αντιμετώπιση του ουρογεννητικού συνδρόμου της εμμηνόπαυσης φαίνεται να αποτελεί μια πολλά υποσχόμενη θεραπεία εφόσον φαίνεται ότι μπορεί να βελτιώσει τόσο τη τοπική φυσιολογία των εμμηνοπαυσιακών γυναικών όσο και όλων των συμπτωμάτων του ουρογεννητικού συνδρόμου της εμμηνόπαυσης. Απαιτείται όμως περαιτέρω διερεύνηση.AIM OF THE STUDY: The aim of the current study is to assess the effectiveness of microablative fractional CO2-laser therapy for the management of genitourinary syndrome of menopause (GSM). METHODS: Three intravaginally administered therapies of CO2 – laser (1 therapy/month) were applied in postmenopausal women with ≥1 moderate/severe intensity of GSM symptoms. Women had to have clinical signs of GSM as well. Primary outcomes of the study were the Vaginal Maturation Value (VMV) and the Vaginal Health Index (VHI). Secondary outcomes were symptoms from the lower genital [by a 10-cm Visual Analogue Scale (10-cm VAS)] and lower urinary tract system (by validated condition specific questionnaires), sexual health [by Female Sexual Function Index (FSFI)], women’s quality of life and impression regarding the CO2-laser therapy, pH of the vaginal fluid and the vaginal microenvironment. All comparisons were performed between values of outcomes before the initiation of the laser therapy (baseline) and 1-month following the completion of the protocol (12-weeks follow-up). RESULTS: Fifty-three postmenopausal women (mean age 57.2±5.4) were eligible to be included in the current protocol. At 12-weeks follow-up all outcomes (primary and secondary) were statistically and clinically significantly improved compared to the baseline. Thus, VMV improved from 11.7±15.6 at baseline to 44.2±13.7 at 12-weeks follow-up (p-value &lt;0.001), dyspareunia decreased from 7.7±2.5 to 2.3±2.2 (p-value &lt;0.001), dryness decreased from 6.1±3.1 to 1.7±1.9 (p-value &lt;0.001), while sexual health increased from 13.7± 8.1 to 25.9±4.6 (p-value &lt;0.001). At the end of the therapeutic protocol all women (100%) declared very satisfied/satisfied with the treatment, while 90% of women reported that they felt very much better/much better in comparison to the baseline. CONCLUSION: The efficacy of CO2-laser was assessed for the first time with a holistic approach using objective and subjective measures. The results of this study indicate that intravaginally administered CO2-laser therapy is promising for the management of GSM as it may improve the local pathophysiology as well as all GSM symptoms. High quality randomized controlled trials are needed for the results of this study to be confirmed

EVALUATION OF COMMERCIAL AMPLIFICATION KIT FOR DETECTION OF LEGIONELLA-PNEUMOPHILA IN CLINICAL SPECIMENS

A commercial kit (EnviroAmp) designed to detect the DNA of Legionella species in environmental water samples using PCR and reverse dot hybridization was applied to clinical specimens. Results correlated well with culture for bronchoalveolar lavages. In addition, this test was easy to perform and showed good sensitivity

Laser therapy for the genitourinary syndrome of menopause. A systematic review and meta-analysis

This study aimed to identify and then synthesize all available data regarding the efficacy of laser therapy for postmenopausal women with genitourinary syndrome of menopause (GSM) with/without urinary incontinence (UI). PubMed, Scopus, Web of Science, Cochrane Library and ClinicalTrials.gov were searched in October 2016. The keywords were “laser genitourinary syndrome of menopause”, “laser vulvovaginal atrophy”, “laser vaginal atrophy” and “laser women incontinence”. Quality of reporting and risk of bias of the included studies were assessed according to STROBE and MINORs checklists, respectively. Quality of the body of evidence was evaluated with the GRADE approach. Fourteen studies involving 542 participants were included in this systematic review and meta-analysis. All GSM symptoms (dryness/dyspareunia/itching/burning/dysuria/urgency/frequency) and UI decreased significantly and consistently in all available publications. The pooled mean differences for the various symptoms were: dryness −5.5(95%CI:−6.7,−4.4;7studies;I2:0%), dyspareunia −5.6(95%CI:−6.8,−4.5;7 studies;I2:0%), itching −4(95%CI:−5.7,−2.2;6 studies;I2:79%), burning −3.9(95%CI:−5.9,−2;6 studies;I2:87%), dysuria −2.9(95%CI:−5.1,−0.7;4 studies;I2:90%) and UI −4.9(95%CI:−6.4,−3.4;2 studies;I2:0%). Because urgency/frequency was assessed by different methodologies the data could not be meta-analyzed. Furthermore, KHQ, UDI-6, MCS12/PCS12, FSFI, overall sexual satisfaction and measurements of the effect of laser therapy on the local pathophysiology improved significantly. In conclusion, laser therapy for postmenopausal women with GSM appears promising. It may reduce symptom severity, improve quality of life of postmenopausal women and restore the vaginal mucosa to premenopausal status. However, the quality of the body of evidence is “low” or “very low” and, thus, evidence-based modification of current clinical practice cannot be suggested. © 2017 Elsevier B.V