Does marriage between first cousins have any predictive value for maternal and perinatal outcomes in pre-eclampsia?

AIM: To assess the consequences of consanguineous unions between first cousins on the severity of pre-eclampsia and associated perinatal morbidity. METHODS: Six hundred and eighty-six women admitted with a diagnosis of pre-eclampsia were included. The study group consisted of 62 preeclamptic women with a union between first cousins. The remaining patients admitted throughout the same period (n = 624) served as controls. The groups were compared regarding the presence of severe pre-eclampsia, hemolysis elevated liver enzymes low platelets (HELLP) syndrome, eclampsia, placental abruption, hematological complications, renal failure, requirement for antihypertensive or magnesium sulfate treatments, cesarean section for acute fetal distress, birthweight, Apgar scores, perinatal mortality and neonatal morbidity including admission to the neonatal intensive care unit, respiratory distress syndrome, sepsis, convulsions, intracranial hemorrhage, hypoglycemia, hypocalcemia, and jaundice. Student's t-test, chi(2)-test and logistic regression analysis were used for statistical evaluation. RESULTS: Univariate analysis yielded significant differences in parity (P = 0.034), maternal platelet counts (P = 0.02), and maternal serum potassium levels (P = 0.016) among the groups. Respiratory distress syndrome was more frequent (P = 0.043) in infants of unrelated couples. Multivariate analysis, controlling for the confounding factors, revealed that marriages between first cousins had no effect on any of our outcome variables including neonatal respiratory distress syndrome. CONCLUSIONS: Third-degree consanguinity in terms of a union between first cousins seems to have no effect on the development of maternal and perinatal complications in established pre-eclampsia.     

Qualitative research in fertility and reproduction: Does it have any value?

Quantitative researchers may argue that a finding or result is more likely to be accepted as a fact if it is quantified (expressed in numbers), than if it is not (Black, 1994). 'There is little or no scientific evidence, for example to support the well-known "fact" that one couple in 10 is infertile, yet most of us are happy to accept uncritically such simplified, reductionist, and blatantly incorrect statements, so long as they contain at least one number' (Greenhalgh & Taylor, 1997, p. 740). Interest in qualitative methods and their wider exposure in health care has led to necessary scrutiny of this type of research (Mays & Pope, 2000). This article compares the basic purpose and focus of quantitative and qualitative research, and draws attention to the relative lack of qualitative research in fertility and reproduction compared to quantitative methods. The authors highlight the strengths and weaknesses of both methods and promote qualitative methods as a valuable tool in fertility and reproduction related studies.     

Does progesterone to oocyte index have a predictive value for IVF outcome? A retrospective cohort and review of the literature

The potential adverse effect of Serum progesterone (SP) elevation on the day of hCG administration is a matter of continued debate. Our study aimed to evaluate the relative value of progesterone to a number of aspirated oocytes ratio (POI) to predict clinical pregnancy (CP) and live birth (LB) in fresh IVF cycles and to review the relevant literature. A retrospective analysis of GnRH Antagonist IVF-ET cycles. POI was calculated by dividing the SP on the day of hCG by the number of aspirated mature oocytes. A multivariate logistic regression analysis was performed to evaluate the predictive value of POI for CP and LB. Cycle outcome parameters included clinical pregnancy, live-birth and miscarriage. A total of 2,693 IVF/ICSI cycles were analyzed. POI was inversely associated with CP adjusted OR 0.063 (95% CI 0.016–0.249, p?p?p?相似文献   

Varicocele repair: does it still have a role in infertility treatment?

PURPOSE OF REVIEW: To review the role of varicocele repair in the treatment of male infertility. RECENT FINDINGS: Varicocele is a common finding among men with infertility and its repair has been a mainstay of surgical therapy in these men. Although each year multiple discoveries are made concerning the mechanism of varicocele-induced infertility, the exact pathophysiologic mechanism remains unknown. This study will update significant findings in regard to the pathophysiology of varicocele-induced infertility, such as increased expression of the aquaporin receptor and new findings related to testicular blood flow and vas deferens motility. Recent information concerning the effects of apoptosis and oxidative stress are also reviewed. With regard to the efficacy of varicocele repair, previous meta-analysis of the available data has been misleading due to improper selection criteria. Available clinical data are critically evaluated, with a focus on new meta-analyses that contradict the findings of the Cochrane database review, a study that has been accepted by many as evidence against varicocele repair. SUMMARY: We conclude that varicocele repair not only is an effective treatment for appropriately selected patients but can also be the most cost effective option.     

Twin pregnancy: is it a risk factor for long-term cardiovascular disease?

Objective: To investigate whether twin pregnancy increases the risk for long-term maternal cardiovascular disease (CVD).

Study design: A retrospective population-based cohort study compared the incidence of long-term CVD in a cohort of women with and without a previous twin delivery.

Setting: Deliveries occurred between the years 1988 and 2012.

Patients: Patients who had a twin birth between years 1988 and 2012 were included in the study, patient that had a singleton delivery included in the control group.

Main outcome measures: CVD was divided into four categories according to severity and type. Kaplan–Meier survival curve was used to estimate cumulative incidence of cardiovascular hospitalizations. Cox proportional hazards model was used to estimate the adjusted hazard ratios (HR) for CVD.

Results: During the study period, there were 100?387 women that met the inclusion criteria, 4.6% (n?=?4647) delivered twins at least once during the period. The incidence of CVD was 1% in women who had a twin delivery and 1.12% in women who had a singleton delivery. There was no difference in the cumulative incidence of cardiovascular hospitalizations among women who had twin deliveries as compared with singletons. When performing a Cox proportional hazard model, a history of twin delivery did not increase the risk for long-term maternal cardiovascular hospitalizations (adjusted HR?=?1.0, 95% CI?=?0.8–1.1, p?=?0.698).

Conclusions: Twin pregnancy is not associated with an increased risk for long-term maternal CVD.     

Is there a role for antenatal TRH therapy for the prevention of neonatal lung disease?

Unfortunately, surfactant therapy is not routinely available to infants in some parts of the world because of its cost. It is the hypothesis of this article that in situations where surfactant is not available, there may be a role for antenatal thyrotropin-releasing hormone (TRH) plus glucocorticoid therapy. Data from randomized clinical trials, which compared therapy with antenatal glucocorticoid plus TRH to that with glucocorticoid alone were extracted and subjected to meta-analysis. The trials that incorporated surfactant therapy were analyzed separately from those in which surfactant was not used. In addition, because surfactant therapy was only available to some patients in the Australian ACTOBAT trial, each group analysis was performed with and without the ACTOBAT data. A characteristic of the earlier presurfactant trials is that few were designed for "intention to treat" analysis. In most of these studies, it was decided a priori to include babies who delivered within a specified time period after hormone therapy. The addition of TRH did not decrease respiratory distress syndrome in those trials in which surfactant therapy was used. In the presurfactant trials, respiratory distress syndrome was significantly decreased when "intention to treat" data were examined, as well as in those infants who delivered between 1 and 10 days after maternal therapy. There was also a significant decrease in oxygen dependency at 28 days after birth, and in oxygen dependency or death at this time, in those infants who delivered 1 to 10 days after treatment. Antenatal TRH had no significant effect of on neonatal complications such as air leak, intraventricular hemmorhage, patent ductus arteriosus, retinopathy of prematurity, or necrotizing enterocolitis. However, TRH did produce transient suppression of the pituitary thyroid axis. There were also a variety of transient complications in the mothers, including nausea, vomiting or flushing, light-headed feeling, and increased blood pressure. The authors conclude that the implementation of appropriate antenatal glucocorticoid treatment is the first priority. Once this has been established, the data presented here suggest that addition of antenatal TRH should be considered in those situations where surfactant is not available.     

Diagnosis of gestational diabetes mellitus: is it time for a new critical value?

OBJECTIVE: To identify the value for the 1-hour glucose tolerance test (GTT) that would maintain 100%, 90% and 75% sensitivity for identifying abnormal 3-hour GTT results in prenatal patients from an East Coast, urban, university hospital setting. STUDY DESIGN: Two hundred forty-two women who underwent the 3-hour GTT during pregnancy between January 1, 2004, and February 1, 2005, at a university hospital laboratory and private laboratories were included. The preceding 1-hour GTT results were obtained from these women, and a receiver operating characteristic (ROC) curve was constructed to identify a 1-hour GTT cutoff value that would maintain 100%, 90% and 75% sensitivity. A subgroup analysis was performed of patients of Asian ethnicity. This study was approved by the institutional review board. RESULTS: To maintain 100% sensitivity of the 1-hour GTT in predicting an abnormal 3-hour GTT, the 1-hour GTT cutoff value could be raised to 144 mg/dL in our population. For 90% and 75% sensitivities, the values were 150 and 156 mg/dL, respectively. There was no clinically significant difference in ROC curve evaluation between Asian and non-Asian groups. CONCLUSION: Raising the current level of 135 mg/dL for a 1-hour GTT to potentially decrease the need for the 3-hour GTT should be considered if larger patient series yield findings similar to those in our population.     

Pre-eclampsia: Is it a different disease in primiparous and multiparous women?

The aim of this study was to evaluate differences in clinical and laboratory parameters and differences in the complication rates between pre-eclamptic primiparous and pre-eclamptic multiparous women. A prospective case series of 112 primiparous and 186 multiparous women with pre-eclampsia was conducted at Princess Badea Teaching Hospital; a large tertiary public health service hospital in Irbid, North Jordan. A uniform medical and surgical management protocol was implemented. The main outcome measures included antenatal, intrapartum and puerperal, maternal and foetal complications. Multiple maternal and foetal demographic, clinical and laboratory parameters were studied. As expected, the primiparous were younger than the multiparous women. After adjusting for maternal age, regression analysis revealed no difference in the systolic or diastolic blood pressure in the two groups. It was also demonstrated that there was no statistically significant difference in the clinical presentation, haematological and biochemical parameters or ultimate maternal outcome between the two groups. After adjusting for babies’ sex and gestational age, it was demonstrated that there was no statistically significant difference in the following: gestational age at delivery, foetal weight, stillbirth, admission rate to neonatal intensive care unit, neonatal death rate within the first four weeks after birth and incidence of intrauterine growth restriction between the two groups     

Is there a role for pelvic lymph node debulking in advanced cervical cancer?

OBJECTIVES: The objectives of this study were to characterize the prognostic features of micropapillary serous ovarian carcinoma (MPSC), examine the clinical impact of surgical staging, and define the role of cytoreductive surgery for patients with advanced disease. METHODS: Fifty-one patients with MPSC were identified from hospital and tumor registry databases. Demographic, operative, pathologic, and follow-up data were abstracted retrospectively. Survival curves were generated using the Kaplan-Meier method, and statistical comparisons were performed using the log rank test, logistic regression analysis, and the Cox proportional hazards regression model. RESULTS: The median age at diagnosis was 45 years, and follow-up extended to a median of 43.0 months. Stage I/II disease was present in 25.5% of patients and no disease-related deaths were observed in this group. Stage III disease was discovered in 29.4% of patients with tumor clinically confined to the ovaries. Stage III/IV disease (74.5% of cases) was associated with median progression-free and overall survival times of 32.8 and 114.2 months, respectively. Menopausal status and the anatomic extent of disease were significantly associated with survival outcome. However, the strongest independent predictor of survival for patients with advanced disease was the amount of residual tumor. Median overall survival for patients with optimal cytoreduction (residual disease 1 cm residual tumor (P < 0.0002). CONCLUSIONS: MPSC carries a significant risk of extraovarian spread; however, adequately sampled Stage I/II disease is associated with a favorable prognosis. Optimal cytoreduction is associated with improved survival and should be the primary therapeutic objective for patients with advanced-stage MPSC.     

Is there a place for auricular therapy in the realm of nursing?

Several theories, such as the 'homuncular reflex theory' 'delta reflex theory', and 'meridian theory' point to the fact that the ear is related to all parts of the human body and internal organs. Being one of the approaches in traditional Chinese medicine, auricular therapy is a therapeutic method by which specific points on the auricle are punctured or pressed. Auricular therapy can activate meridians and collaterals, regulate the Qi and blood, help to achieve the balance between Yin and Yang status of internal organs, and is therefore suitable for treating many disorders of the body. Successful examples of previous studies using this therapy including insomnia, weight reduction, hypertension, treatment of addiction, and pain reduction. However, inconsistency in the treatment protocol among studies, or the use of combined therapies, makes it impossible to draw a strong causal relationship between this therapy and the treatment effect. More appropriate clinical trials are therefore necessary to understand in depth the therapeutic effect of auricular therapy. Ideally, these trials can take place in the context of nursing practice so as to explore the application of this therapy in the realm of nursing, and to enable nurses to make a more effective contribution to primary health care.     

Is there a place for a less extensive radical surgery in locally advanced cervical cancer patients?

OBJECTIVE: The aim of this study was to assess the association among the pathological status of different lymph node groups and parametrium in a single institutional population of 103 locally advanced cervical cancer (LACC) cases who underwent surgery after a neoadjuvant approach. A series of 29 early cervical cancer patients was also included in the analysis. METHODS: Eighty-two LACC patients with documented clinical response to neoadjuvant treatment and 29 early stage cases underwent radical surgery. The operative technique consisted of a type II-V radical hysterectomy and systematic pelvic lymphadenectomy (median number of lymph nodes removed 46; range 5-140). Sixty-four cases were submitted to para-aortic lymphadenectomy up to the level of the inferior mesenteric artery (median number of lymph nodes removed 13; range 1-37). RESULTS: Two subgroups of lymph nodes were defined: lower pelvic lymph nodes (LPN), including obturator and external iliac nodes, and upper pelvic nodes (UPN) including common iliac, presacral, and internal iliac nodes. Metastatic UPN involvement showed a strict association with LPN involvement: in LACC cases, 6 of 7 (86%) positive UPN cases had tumor disease at the LPN level. The single positive UPN case with negative LPN was intraoperatively identified by palpation and frozen section. Similarly, in early cervical cancer patients, 100% of positive UPN cases showed metastatic involvement at the LPN level. Sixty-three of 70 (90%) LACC patients with negative histological parametrium had negative LPN. Among 12 cases with metastatic involvement of parametrium, 5 cases (41.7%) had positive LPN. In early stage cervical cancer, 23 of 27 (85%) cases with negative parametrium showed no lymph nodal involvement. Intraoperative palpation of the parametrium could identify all cases with parametrial involvement not predicted by LPN status. CONCLUSIONS: These data offer the basis for tailoring the extent of radical surgery in LACC patients, through the selection of those lymph node stations likely to provide reliable information on the pathological status of UPN and parametrium.     

Does oocyte cryopreservation have a future in Hungary?

The Committee of Human Reproduction established by the Hungarian Ministry of Health is currently working on a proposition that has the intention to ban oocyte cryopreservation in Hungary temporarily. According to the notion of the committee, oocyte cryopreservation and the utilization of frozen oocytes entail enormous risks for future generations. They argue that the safety of the method is unproven. Consequently, their standpoint maintains that cryopreservation invariably remains a grave risk factor with regards to the genetic material of the oocyte by significantly increasing the risk to the offspring. Therefore,the Committee is requesting additional animal experiments to clarify the probability of permanent lesions to the spindle and alterations to the genetic material. According to their point of view, the suspension of the method is further justified since the efficiency of the procedure has yet not reached the level required for clinical adaptation. With the proposed forthcoming step,this commentary takes the opportunity to make critical comments and clarify necessary questions.     

Is there a place for inhibition of cervical ripening in the management of preterm labour?

Although premature cervical ripening is one of the two major pathophysiological processes occurring in preterm labour, research has mostly focused on the development of tocolytic agents. Our goal in this study was to review the recent progress made in the understanding of cervical ripening physiology and to explore the molecules that could be targeted for the development of new pharmacological compounds capable of inhibiting this process and to further improve the management of preterm labour.     

Prevention of cervical cancer in Africa: a daunting task?

Africa has a high estimated incidence of cervical cancer, thus requiring the development of an effective prevention strategy. Cytology-based screening is beyond the capacity of many African countries, hence the need for alternatives. Visual inspection of the cervix after application of 3-5% acetic acid (VIA) is a promising screening test, with similar sensitivity to that of cytology but lower specificity. The same accounts for other VIA methods using magnification devices, visual inspection after the application of Lugol's iodine, or human papilloma virus (HPV) DNA testing, all proposed alternatives to cervical cancer prevention screening tests. Vaccination against HPV is the most promising strategy for the prevention of cervical cancer, but a wider variety of HPV types than currently being investigated must be considered for the development of the multivalent vaccine preparations required in Africa. Other considerations in developing an effective prevention programme include full public sector investment and achieving acceptability of a vaccine against a sexually transmitted infection targeted for adolescents. Unfortunately, however, if HPV vaccines are developed the initial impact of prophylactic vaccines will be delayed for many years. Alternative strategies should, therefore, be promoted in parallel. There are several approaches to cervical cancer prevention and their evaluation should be comprehensive and coordinated to achieve short and long-term public health benefits in different programme settings.     

Placental biopsy by frozen section: does it have a role in evaluation of fetal well-being?

AIM: To assess the effectiveness of post-partum placental biopsy and frozen section evaluation in diagnosing pregnancy disorders. STUDY DESIGN: Between January and July 1998, biopsies were carried out on 100 newly delivered placentas. Biopsies were carried out using a 14-gauge needle, and frozen section evaluations were reviewed. These were compared to the standard evaluation of histological evaluation of the whole placenta sections. Specimens were evaluated by standard placental pathologic criteria. RESULTS: Villous oedema which is associated with antenatal hypoxia was observed with a sensitivity of 78%, and specificity of 97%, yielding a positive predictive value of 84% in frozen section compared to standard placental evaluation. No statistical difference was observed in the evaluation of dysmaturity, intravillous fibrin agglutination and chronic villitis between frozen sectioning and whole placenta sections. Increased syncytial knots were detected with a sensitivity of 45% and specificity of 98%. CONCLUSION: Placental biopsy by frozen sectioning might be a useful and quick method of evaluation for placental pathology. Theoretically, fetal status could be more precisely evaluated by combining prenatal placental biopsy by permanent section with conservative ante-partum well-being tests.     

Local hormone therapy for genitourinary syndrome of menopause in breast cancer patients: is it safe?

The genitourinary syndrome of menopause (GSM) is a frequent complaint among breast cancer (BC) survivors that lead to an important affection of their quality of life (QoL). Lifestyle measures such as smoking cessation or regular sexual activity are usually insufficient to significantly improve GMS and although therapies such as lubricants and polycarbophil moisturized gels are considered first-line therapies to alleviate symptoms of vulvovaginal atrophy, these non-hormonal options are not able to reverse atrophy once it occurs. Instead, this complaint is corrected by local estrogens. The estrogen vaginal treatment usually used to treat GSM, is an issue of concern in this group due to the possible negative effect over the BC outcomes. On the other hand, the worsening of QoL in these patients due to symptoms related to GSM can lead to discontinuation of hormone adjuvant therapies and therefore must be addressed properly.

The goal of this review is to contribute to health care professionals to make an informed decision to care for their BC patients.