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NEOADJUVANT CHEMOTHERAPY FOLLOWED BY RADICAL SURGERY VERSUS CONCURRENT CHEMO-RADIOTHERAPY IN THE TREATMENT OF LOCALLY ADVANCED CERVICAL CANCER: A MULTICENTER OBSERVATIONAL RETROSPECTIVE STUDY
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Determinants of genital shedding of human immunodeficiency virus: A review
No full textSexual transmission is the main route for Human Immunodeficiency Virus (HIV) spreading throughout the world. Heterosexual transmission of HIV is the predominant transmission modality among adults worldwide, while mother-to-child transmission accounts for the majority of HIV infections in children. Factors that affect genital tract shedding of the HIV virus or cell-associated provirus in women are probably important determinants of infectiveness, and hence of transmission risk during sexual contact or delivery. Cervical inflammation and genital ulcers have been associated with HIV shedding in the female genital tract. In fact, both ulcerative sexually transmitted infections (syphilis, chancroid and herpes) and non-ulcerative sexually transmitted infections (gonorrea and chlamydia) have been associated with high rates of transmission and acquisition of HIV. Bacterial vaginosis are associated with an increased prevalence of HIV1-RNA detection in cervicovaginal secretions. Although HIV infection is a well-known risk factor for cervical intraepithelial neoplasia (CIN), the influence of CIN on cervical shedding of HIV is poorly understood. Preliminary data suggest that CIN lesions represent a significant risk factor for genital HIV spreading. Additional factors associated with increased prevalence of HIV1-RNA detection are: advanced stage of the disease, hormonal contraceptive use, cervical ectopy, vitamin A deficiency, cervicitis and vulvovaginal candidiasis. In contrast to the lower female genital tract, the male genital tract is inaccessible to simple direct sampling. Poor detection and quantification of the HIV-1 virus in the semen have largely limited our knowledge of HIV infectivity in men. Symtomatic and asymptomatic urethritis are important cofactors for HIV shedding in the semen, suggesting that local genital tract infection are important determinants of HIV level in semen. Finally, the presence of HIV-RNA in blood strongly correlates with the detection of HIV-related nucleic acids in genital secretions but the shedding of HIV in the genital tract can occur in 20-30% of non-viremic subjects. © 2008 Bentham Science Publishers Ltd
Respiratory Syncytial Virus in Pregnancy: An Obstetrics View
No full textRespiratory syncytial virus (RSV) represents one of the most prevalent causes of lower respiratory tract infection in newborns and children by the time they are two years old, with a peak rate of hospitalization in those between two and three months of age and a high risk of morbidity and mortality, especially under the age of six months of life [...
Interaction between risk factors for fetal growth retardation associated with abnormal umbilical artery Doppler studies
No full textBackground. The role of antenatal risk factors associated with the occurrence of fetal growth restriction complicated by abnormal umbilical artery Doppler studies has not yet been studied extensively. We evaluated the role and the interactions of antenatal antecedents of fetal growth restriction complicated by abnormal umbilical artery end-diastolic velocities.
Methods. We compared antenatal variables in 183 pregnancies complicated by fetal growth retardation and abnormal umbilical artery Doppler studies and 549 appropriately grown fetuses with normal end-diastolic velocity waveform in the umbilical artery. Logistic regression was used to evaluate the association between antenatal. variables and fetal growth retardation and to test for interaction.
Results. In logistic models, increasing maternal age [odds ratio (OR) 1.06, 95% confidence interval(CI) 1.01-1.11], nulliparity (OR2.2, 95%CI 1.37-3.5), smoking during pregnancy (OR 2.56, 95%CI 1.56-4.22), preeclampsia (OR 27.5, 95% CI 15.1-49.9), first-trimester hemorrhage (OR 2.25, 95% CI 1.32-3.82) and low (< 0.2 kg/week) weight gain in pregnancy (OR 3.48, 95% CI 1.71-3.05) were significantly associated with an increased risk of fetal growth restriction complicated by abnormal Doppler studies. These risk factors were also significantly correlated with the occurrence of absent/reversed end-diastolic blood flow in the umbilical artery. Maternal smoking during pregnancy interacted negatively with preeclampsia but positively with a low weight gain in pregnancy.
Conclusions. The results of this study have shown that antenatal risk factors for intrauterine growth retardation (IUGR) complicated by abnormal Doppler studies are similar to those associated with the birth of a small-for-gestational-age infant. Preeclampsia, maternal smoking and low weight gain in pregnancy play a significant causal role in the origin of fetal growth restriction associated with abnormal uteroplacental blood flow
Insight into urogynecologic features of women with interstitial cystis/painful bladder syndrome.
No full textOBJECTIVE:
The prevalence of interstitial cystitis/painful bladder syndrome (IC/PBS) among gynecologic patients attending vulvar disease or pelvic pain clinics is higher than expected. The evaluation of gynecologic characteristics in patients with IC/PBS could be important to delineate a better therapeutic strategy.
METHODS:
We compared clinical gynecologic characteristics including localized and generalized vulvodynia and sexual activity of 47 women with a definite diagnosis of IC/PBS versus 47 negative controls.
RESULTS:
The prevalence of both generalized or localized vulvodynia was 85.1% (40 of 47) in the patients and 6.4% (3 of 47) in the control group (p<0.0001 by Fisher exact test). The mean visual analogue score on generalized or localized vulvodynia evaluated with the cotton swab test was 6.1+/-2.6 (SD) among women with IC/PBS and 0.6+/-1.7 in the control group (p<0.0001 with Mann-Whitney U test). Pain during intercourse was described as unbearable by 15 women with IC/PBS (31.9%) and 2 controls (4.3%; p=0.001 by Fisher exact test). Sexual function was significantly impaired in women with IC as measured by the median total score of the Female Sexual Function Index in comparison with controls (13.8 vs. 28.7; p<0.0001).
CONCLUSIONS:
Patients with a definite diagnosis of IC/PBS appear to have a high risk of vulvodynia with the associated negative implications for sexual activity. The establishment of a multidisciplinary approach with the involvement of the gynecologist appears to be a logical requisite for a correct treatment strategy for these patients
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