High success rate and considerable adverse events of pelvic prolapse surgery with Prolift: A single center experience

ObjectivesThe aim of this study was to analyze short-term outcomes of pelvic prolapse surgery using Prolift transvaginal mesh in a teaching hospital.Materials and MethodsThirty-four patients who received prolapse surgery with Prolift were followed up for 7–26 months. Assessment included pre- and postoperative Pelvic Organ Prolapse Quantification (POP-Q) stage, and Urogenital Distress Inventory (UDI)-6, and Incontinence Impact Questionnaire (IIQ)-7 scores. Surgical characteristics and adverse events during follow-up were also recorded.ResultsObjective and subjective data were available for 29 patients. The overall anatomical success rate was 96.5 % (28/29) after a mean of 18 ± 6.3 months follow-up. The POP-Q, UDI, and IIQ all improved significantly after surgery. Uterine sparing prolapsed surgery with Prolift unexpectedly yielded a cure rate of 100%. Ten adverse events occurred during and after prolapse surgery with dyspareunia (3/34) as the most common, followed by bladder injury (2/34).ConclusionsProlapse surgery with Prolift yielded a good anatomical outcome and satisfactory symptom improvement at different periods of follow-up, especially in uterus-sparing prolapse surgery. However, adverse events were not uncommon, and patients should be fully informed of all possible adverse events prior to surgery.     

537例经产妇分娩方式及难产因素分析

目的:分析经产妇分娩方式及难产因素,探讨经产妇各项剖宫产指征的合理性,寻求降低经产妇剖宫产率的对策,提高经产妇母儿安全水平。方法:将1999年3月～2009年2月无妊娠合并症的537例经产妇按分娩时间分为前5年组和后5年组,对其基本特征、分娩方式、难产主要因素进行分析比较。结果:后5年组与前5年组比较,经产妇年龄呈明显增加趋势;自然分娩率、阴道助产率、臀位助产率降低,剖宫产率增高;臀位妊娠发生率无变化,瘢痕子宫比例明显增加,其剖宫产率均明显增高。结论:应加强经产妇的围产期保健及高危妊娠管理,重视有阴道助产史和胎儿体重较前次分娩新生儿体重有较大增加的孕妇的产程,避免发生母儿并发症;通过降低臀位妊娠和瘢痕子宫经产妇的剖宫产率,可以合理降低经产妇的剖宫产率。     

Cardiovascular disease prevention in women: A rapidly evolving scenario

The past decade has witnessed a long overdue recognition of the importance of CVD in women, accompanied by an increasing awareness of gender differences in risk factors, natural history, preventive strategies, treatment, and prognosis of CVD. Reflecting the disease burden and the specific aspects of CVD in women, the American Heart Association has developed women-specific evidence-based guidelines and consensus documents for CVD prevention. The most recent update of these guidelines, published in 2011, is a milestone in the field and shows the rapidly evolving scenario of CVD prevention in women. We discuss some novel aspects of the 2011 update. The new guidelines change the focus from evidence-based to effectiveness-based, with consideration of both benefits and harms/costs of preventive interventions. The guidelines also introduce “ideal cardiovascular health” as the lowest category of risk, which implies the need of communitywide preventive, educational and policy initiatives to promote healthy lifestyles in the general population. Furthermore, the guidelines emphasize long-term overall CVD risk rather than short-term coronary risk. We also address several barriers and open questions in the evaluation and implementation of these guidelines, including how to increase the small proportion of women with ideal cardiovascular health; how to increase implementation and compliance with the recommendations; how to provide effectiveness-based recommendations for lifetime prevention goals based on short-term trials; how to obtain the best possible evidence in women; how to identify subgroups of women with different cardiovascular risk profiles or who may require tailored preventive strategies; and how to adapt current guidelines to international settings, particularly to low- and middle-income countries.     

Human enterovirus D68 in clinical and sewage samples in Israel

BackgroundSince mid-August 2014, North America experienced a wide outbreak of Enterovirus D68 (EV-D68) associated with severe respiratory illness in children. Several other countries also reported cases of EV-D68 in 2014.ObjectivesThe aim of this study was to determine whether EV-D68 circulated in Israel in 2014, caused severe respiratory illness in children and was the causative agent of Acute Flaccid Paralysis.Study designArchived clinical respiratory samples from a cohort of 710 hospitalized pediatric patient’s (<10 years old) with respiratory illness were screened for clade B specific EV-D68 by real-time PCR. The patients were seen at four medical centers covering the entire country between August and November 2014. We also evaluated 49 patient stool samples from 26 AFP cases during 2014 for presence of EV-D68. In addition, RNA from sewage samples collected throughout Israel during the same study period was also tested for EV-D68. Partial VP1 sequencing was performed on all positive samples.ResultsOf the 710 clinical samples evaluated, 7 (1%) were positive for EV-D68. Two patients were from the central part of Israel, while the rest was from the southern part. The majority of the patients did not have any underlying disease. Not only that, but, none of the 26 suspected AFP cases had EV-D68 nucleic acid in their stool samples. EV-D68 RNA was detected in 9 out of 93 sewage samples, mainly from Southern Israel. Sequence analysis of EV-D68 VP1 gene from both sewage and clinical samples indicated that the Israeli EV-D68 RNA belonged to Clade B which was genetically similar to 2014 circulating European and North American EV-D68 virus.ConclusionsEV-D68 circulated in Israel during the 2014 summer-fall season and caused hospitalization of a small percent of the patients with respiratory illness.