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

Postpartum depression: Prevention and multimodal therapy

A woman goes through many biological (hormonal, physical), psychological (emotional), and socio-cultural changes during pregnancy. Furthermore, changes also occur in the mother\u27s familial and interpersonal world after childbirth. While some mothers have positive emotions at birth, such as joy and pleasure, others complain of negative experiences varying from sadness and depression to psychosis. Thus, the risk of depression is higher for women during the postpartum period, having a tendency to decrease in most cases over the first 2 weeks after delivery. Unfortunately, this favorable evolution does not happen in about 1 in 4-7 women, who develops postpartum depression. Postpartum depression has generally the same features as any common depressive episode encountered at any other time in life. However, assessment of depressive symptoms in the parental period implies not only general tools (such as the Depression Scale of the Center for Epidemiological Studies or the Beck Depression Inventory), but also a specific evaluation using the Edinburgh Postnatal Depression Scale. Taking into account all changes that occur during the peripartum period, a multimodal approach for postpartum depression would be recommended, including an appropriate lifestyle (walks, ambient environments), counseling, cognitive-behavioral therapy, and finally antidepressant medication when required. As a conclusion, postpartum depression may range from a mild and reversible episode to a severe and persistent form. Antepartum and postpartum screening, an early diagnosis, and a tailored approach to depression are essential for better results and prognosis related to both mother and child

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

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

Best therapeutic practices in the management of obstetric sepsis

Background. Physiological changes that occur during pregnancy make maternal sepsis a difficult condition to diagnose and treat, still having a fairly high mortality rate. Consequently, an early diagnosis and prompt therapeutic management of sepsis can significantly decrease mortality. The purpose of this study is to review literature data that present current practices in the management of obstetric sepsis. Methods. To collect the data required for the study, we performed a search of published articles in the PubMed and Google Scholar databases related to obstetric sepsis. Research paper articles from the period 2012-2022 were included in the analysis. In addition, 145 articles from the period 2012-2022 were evaluated, with the aim of finding out in which situations the risk of maternal death is higher. Thus, the analysis included a total number of 151 articles, which were divided into two distinct stages. Results. The risk of maternal death is higher among patients with the human immunodeficiency virus (HIV), followed by Escherichia coli, genital tract infection, cancer, drug users and in the case of patients with chronic liver disease. Conclusions. After analyzing the data, we found that prompt and focused antibiotic therapy as well as fluid resuscitation are essential to increase the chances of survival of these patients

Management of systemic lupus erythematosus in pregnancy

Systemic lupus erythematosus is one of the most common autoimmune disorders affecting young women. Pregnant women with lupus are generally at higher risk for certain pregnancy complications than women without comorbidities. Even so, a pregnancy with lupus can be carried to term in optimal conditions if it is properly managed by a doctor. Monitoring is generally recommended six months after the onset of lupus symptoms, and ideally there should be no active lupus symptoms prior to conception. General screening tests should include the anti-phospholipid, anti-Ro and anti-La antibodies. Women who are positive for these antibodies have an increased risk of congenital heart block in the fetus. In addition, pregnant women with lupus have an increased risk of spontaneous abortion, intrauterine fetal growth restriction, pre-term birth, while neonatal lupus syndrome is a major fetal condition. The maternal risks are faced with disease flares, pre-eclampsia and other complications. Treatment options during pregnancy are limited to a few safe medications. For example, prednisone is unlikely to cause fetal malformations, but it increases the risk of diabetes and high blood pressure in the mother. Consequently, a careful multidisciplinary monitoring is essential for optimal results in pregnancy with lupus

Postpartum depression: Prevention and multimodal therapy

A woman goes through many biological (hormonal, physical), psychological (emotional), and socio-cultural changes during pregnancy. Furthermore, changes also occur in the mother's familial and interpersonal world after childbirth. While some mothers have positive emotions at birth, such as joy and pleasure, others complain of negative experiences varying from sadness and depression to psychosis. Thus, the risk of depression is higher for women during the postpartum period, having a tendency to decrease in most cases over the first 2 weeks after delivery. Unfortunately, this favorable evolution does not happen in about 1 in 4-7 women, who develops postpartum depression. Postpartum depression has generally the same features as any common depressive episode encountered at any other time in life. However, assessment of depressive symptoms in the parental period implies not only general tools (such as the Depression Scale of the Center for Epidemiological Studies or the Beck Depression Inventory), but also a specific evaluation using the Edinburgh Postnatal Depression Scale. Taking into account all changes that occur during the peripartum period, a multimodal approach for postpartum depression would be recommended, including an appropriate lifestyle (walks, ambient environments), counseling, cognitive-behavioral therapy, and finally antidepressant medication when required. As a conclusion, postpartum depression may range from a mild and reversible episode to a severe and persistent form. Antepartum and postpartum screening, an early diagnosis, and a tailored approach to depression are essential for better results and prognosis related to both mother and child

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