Prenatal antibiotic treatment does not decrease group B streptococcus colonization at delivery

Objective:

To evaluate whether an outpatient antibiotic regimen decreased group B streptococcal (GBS) colonization to preclude the use of intrapartum antibiotics.

Methods:

A double-blind randomized controlled trial evaluating prenatal oral amoxicillin versus placebo with the primary outcome of GBS colonization at the time of labor.

Results:

Of those patients receiving both amoxicillin and a repeat culture at the time of labor, 6 of the 14 (43%) tested positive for GBS colonization. Given persistent GBS colonization of 67% (10/15) in the placebo group, treatment with amoxicillin did not significantly impact colonization at the time of delivery (P = 0.20).

Conclusion:

A regimen of outpatient amoxicillin was associated with persistent GBS colonization in 43% of women at the time of labor. Oral prenatal antibiotic prophylaxis against GBS does not sufficiently reduce colonization to preclude intrapartum intravenous antibiotics.     

Prevalence and risk factors for domestic violence against infertile women in an Iranian setting

Objective

To determine the prevalence of and risk factors for domestic violence against women with female factor infertility in an Iranian setting.

Methods

In this cross-sectional survey conducted from August 1, 2009 to January 31, 2010, 400 women with primary infertility attending Valiasr Reproductive Health Research Center in Tehran, Iran, were interviewed using the Revised Conflict Tactics Scales questionnaire (CTS₂). This instrument was developed to investigate the presence domestic violence.

Results

A total of 247 women (61.8%) reported having experienced domestic violence because of their infertility. The most common type of violence was psychological (n = 135 [33.8%]), followed by physical (n = 56 [14%]) and sexual (n = 32 [8%]), with 24 women (6%) reporting injuries. All women reported their husbands to be the perpetrators.

Conclusion

Domestic violence against infertile women is a considerable yet unreported problem. Clinicians should identify the abused women and provide them with medical care and supportive counseling.     

An ultrastructural and immunocytochemical study of a rare genetic sperm tail defect that causes infertility in humans

Objective

To characterize and describe the ontogenesis of a rare flagellar defect affecting the whole sperm population of a sterile man.

Design

Case report.

Setting

Regional referral center for male infertility in Siena, Italy.

Patient(s)

A 28-year-old man with severe asthenozoospermia.

Intervention(s)

Physical and hormonal assays, semen analysis, and testicular biopsy.

Main outcome measure(s)

Semen samples and testicular biopsies were analyzed by light and transmission electron microscopy; immunocytochemical study with anti-β-tubulin and anti-AKAP 82 antibodies was performed to detect the presence and distribution of proteins.

Result(s)

Ultrastructural analysis of ejaculated spermatozoa and testicular biopsy revealed absence of the fibrous sheath in the principal-piece region of the tail. Fibrous sheath-like structures were observed in cytoplasmic residues and residual bodies released by spermatids in the seminiferous epithelium. Other anomalies observed were supplementary axonemes and mitochondrial helix elongation. These features were confirmed by immunocytochemical staining.

Conclusion(s)

This rare sperm tail defect, characterized by absence of the fibrous sheath, presence of supplementary axonemes, and an abnormally elongated midpiece, originates in the seminiferous tubules during spermiogenesis, as detected in testicular biopsy sections. These defects occur in the whole sperm population, and therefore a genetic origin could be suggested.     

Premenstrual syndrome as reported by Brazilian women

Objective

To describe the perspectives and attitudes of Brazilian women toward premenstrual syndrome (PMS).

Methods

An exploratory study was conducted in 6 major cities: 1 in each geographic region of Brazil and 1 in the Federal District. Participants were women aged 18-40 years who consulted at public healthcare services or who were members of staff/faculty at university.

Results

Of 1053 women, 96.1% had heard of PMS; 65.4% considered that all or almost all women experienced the condition; 87.5% stated that symptoms occurred prior to menstruation; and 60.3% thought that they had PMS at the time of the interview. The emotional and physical symptoms most frequently mentioned were nervousness/anxiety (76.4%); mood swings/crying (55.7%); pain, swelling, and tenderness of the breasts (37.3%); and cramps (45.4%).

Conclusion

Premenstrual syndrome was reported by a large number of Brazilian women; actions need to be taken to provide more effectively the specific information required by both lay people and healthcare professionals.     

Curcumin disrupts uterine leiomyosarcoma cells through AKT-mTOR pathway inhibition

Objective

Uterine leiomyosarcoma generally has an unfavorable response to standard chemotherapy. The loss of PTEN which results in constitutive AKT-mTOR activation causes an increase in leiomyosarcoma formation in mice. The active ingredient derived from the herb Curcuma longa, curcumin, shows antitumor properties in a variety of cancer cell lines by altering a number of oncogenic pathways. To explore the possibility of curcumin as an alternative to standard chemotherapy, we decided to investigate curcumin's antitumor effect on uterine leiomyosarcoma cells.

Methods

Human leiomyosarcoma cell lines, SKN and SK-UT-1, were cultured for in vitro experiments. Rapamycin or curcumin was added in different doses and their effect on cell growth was detected by MTS assay. The influence of rapamycin or curcumin on AKT, mTOR, p70S6 and S6 phosphorylation and protein expression was detected by Western Blotting. The ability of rapamycin or curcumin to induce apoptosis was determined by Western blotting using cleaved-PARP specific antibody, Caspase-3 activity assay and TUNEL assay.

Results

Both rapamycin and curcumin significantly reduced SKN cell proliferation. Curcumin inhibited mTOR, p70S6 and S6 phosphorylation similar with rapamycin. Cleaved PARP, caspase-3 activity and DNA fragmentation increased proportional with curcumin concentration. At a high concentration, curcumin significantly induced apoptosis in SKN cells, but not rapamycin.

Conclusions

Curcumin inhibited uterine leiomyosarcoma cells' growth by targeting the AKT-mTOR pathway for inhibition. However, rapamycin, a specific mTOR inhibitor, did not induce apoptosis in SKN cells unlike curcumin that also has a pro-apoptotic potential in SKN cells.     

7 Methyl indole ethyl isothiocyanate causes ROS mediated apoptosis and cell cycle arrest in endometrial cancer cells

Objective

Chemotherapy options for advanced endometrial cancer are limited and newer therapeutic agents are urgently needed. This study describes the therapeutic potential of 7 Methyl-indole ethyl isothiocyanate (7Me-IEITC) in endometrial cancer cell lines.

Methods

7Me-IEITC was synthesized in our laboratory. The cell viability of 7Me-IEITC treated ECC-1 and KLE endometrial cancer cell was determined by MTS assay. Morphology and apoptosis were further confirmed by DAPI-staining and TUNEL assay. The measurement of reactive oxygen species (ROS), mitochondrial transmembrane depolarization potential (ΔΨm) and cell cycle phase was determined by FACS analysis. Expression of proteins involved in apoptosis, survival and cell-cycle progression was analyzed by Western blotting.

Results

7Me-IEITC reduced the viability of the ECC-1 and KLE cancer cell-lines (IC₅₀ ~ 2.5-10 μM) in a dose dependent fashion. 7Me-IEITC treatment caused mitochondrial transmembrane potential reduction, elevated the production of ROS, leading to activation of apoptosis in endometrial cancer KLE and ECC-1 cells. 7Me-IEITC treatment activated Bad, suppressed Bcl2 phosphorylation followed by PARP-1 deactivation and caspase 3 and 7 activation. 7Me-IEITC treatment arrested the progression of KLE cells in S-phase and caused CDC25 and cyclin-D1 downregulation. Pre-treatment with ascorbic acid abrogated 7Me-IEITC induced apoptosis in ECC-1 and KLE cells, suggesting that 7Me-IEITC mediated cytotoxicity is primarily through ROS production.

Conclusion

7Me-IEITC demonstrated promising cytotoxic effects in endometrial cancer cell line model.     

Hormonal changes and somatopsychologic manifestations in the first trimester of pregnancy and post partum

Objective

To investigate links between psychologic distress and levels of maternal hormones and cortisol during pregnancy and post partum.

Method

The study population of 308 pregnant or recently delivered women was divided into 4 equal groups, 3 representing each pregnancy trimester and the fourth one representing the first week of the postpartum period. The women were screened for psychological distress and had blood drawn to measure serum levels of estradiol, progesterone, and total cortisol on the same day.

Results

The rates of anxiety and depression were higher in the first trimester and the postpartum groups. Depression was correlated with sharp changes in estradiol and progesterone levels; anxiety was correlated with total cortisol level; and there was a correlation between depression and anxiety.

Conclusion

Sharp changes in maternal hormone levels were correlated with depression; depression was correlated with anxiety; and anxiety was correlated with elevated cortisol levels, which may adversely affect the health of mother and offspring. Measuring maternal hormones may be a diagnostic tool to evaluate psychologic stress and associated risks.     

Domestic violence against infertile women in a Turkish setting

Objective

To investigate the prevalence of domestic violence against infertile women in a Turkish setting.

Methods

A total of 122 women with primary infertility attending an obstetrics and gynecology outpatient clinic were interviewed using the Abuse Assessment Screen questionnaire to investigate their experiences of domestic violence.

Results

In total, 41 (33.6%) women had experienced domestic violence because of their infertility. Of these women, 32 (78%) had experienced domestic violence for the first time in the relationship with the current partner following diagnosis of female factor infertility. The percentage of nonabused and abused infertile women who were mostly satisfied with their sexual lives was 56.87% and 29.2%, respectively (P < 0.05).

Conclusion

Routine screening for domestic violence in infertility clinics is necessary to give affected women an opportunity to access appropriate health care and support services.     

Community-based distribution of misoprostol for treatment or prevention of postpartum hemorrhage: Cost-effectiveness, mortality, and morbidity reduction analysis

Objective

To compare the cost-effectiveness of community-based distribution of misoprostol for prevention with misoprostol for treatment of postpartum hemorrhage (PPH).

Methods

A Monte Carlo simulation depicted mortality and anemia-related morbidity attributable to PPH among 3 scenarios of 10 000 women delivering at home in rural India: (1) standard management; (2) standard management plus 800 µg of sublingual misoprostol for PPH treatment; and (3) standard management plus 600 µg of prophylactic oral misoprostol. The model included costs of drugs, birth attendant training, and transport for women who did not respond to misoprostol.

Results

Misoprostol lowered mortality by 70% and 81% in scenarios 2 and 3, respectively. Scenarios 2 and 3 raise costs by 6% and 35%, respectively. Incremental cost per disability-adjusted life year (DALY) saved is estimated at $6 and $170, respectively.

Conclusion

Both interventions were more effective at decreasing mortality and anemia than standard management. The most efficient scale-up plan would focus initially on increasing coverage with the treatment strategy ($6 per DALY).     

Kurdish pregnant women's feelings: A qualitative study

Objective

to gain a deeper understanding of how Kurdish pregnant women feel about their pregnancy.

Design

a qualitative study analysed by a grounded theory approach.

Setting

the study was conducted among women in the third trimester of their pregnancy in either their homes or the health-care centres in Sanandaj in the western part of Iran.

Participants

22 pregnant women were recruited and interviewed.

Findings

during pregnancy, women experienced a variety of feelings: ‘satisfied and happy’, ‘unpleasant’ and ‘ambivalent’.

Conclusions and implications for practice

it is important for midwives to ask pregnant women about their feelings concerning their current pregnancy, childbirth and future motherhood. If they express negative or ambivalent feelings, these should be discussed in greater detail and their causes identified. Special consideration should be given to primiparous women and multiparous women with negative experiences of previous pregnancies.     

Anti-Helicobacter pylori antibodies in cervical mucus: a new cause of infertility

Objective

The aims of our study were to determine on the one hand a correlation between the presence of anti-Helicobacter pylori (anti-H. pylori) IgG antibodies in serum and cervical mucus of women with idiopathic infertility, and on the other hand the effect of these antibodies on cervical mucus quality, in particular related to the ability of spermatozoa to penetrate it.

Study design

We analysed anti-H. pylori IgG antibodies in the serum and cervical mucus of 67 patients diagnosed with idiopathic infertility using the Quanta Lite H. pylori IgG test. The penetration of normal sperm, in 15 cervical mucus samples positive for anti-H. pylori antibodies and in 15 negative samples, was assessed using the simplified slide test.

Results

A significant positive correlation emerged between anti-H. pylori IgG antibody concentrations in the serum and in the cervical mucus (r = 0.9275; p < 0.00001). In the 15 anti-H. pylori IgG mucus-positive samples the slide test showed abnormal penetration by the spermatozoa.

Conclusions

Our study demonstrated that the presence of anti-H. pylori antibody in the cervical mucus can be involved in female infertility, interfering with sperm progression. Considering the close correlation found between serum and cervical mucus anti-H. pylori antibody titres, measuring serum antibodies could become an additional test, in particular in couples with unexplained infertility.     

The effect of semen processing on sperm DNA integrity: comparison of two techniques using the novel Toluidine Blue Assay

Objective

The first goal of this study was to determine the effect that semen processing has on sperm DNA integrity. The second goal was to assess which processing technique (modified swim-up versus density gradient centrifugation) results in a superior sample. DNA integrity was measured using a novel Toluidine Blue Assay.

Study design

Side-by-side comparison.

Materials and methods

Raw semen samples were collected from thirty-two male individuals and scored for routine semen analysis. Prior to discarding the specimens identical aliquots were divided and processed by density gradient centrifugation and a modified swim-up technique. The Toluidine Blue Assay was used to analyze raw and processed samples.

Results

Both density gradient centrifugation and the modified swim-up improved DNA quality compared to the unprocessed sample. However, the modified swim-up technique proved superior.

Conclusions

The swim-up technique generates a sperm sample with better DNA integrity. Should DNA integrity correlate with better pregnancy rates in IUI and IVF, respectively, the swim-up may be the sperm processing technique of choice for these procedures.     

Conservative management of stage IA1 squamous cell carcinoma of the cervix with positive resection margins after conization

Objective

To evaluate the efficacy of cold knife conization with electrocauterization and the feasibility of conservative management in patients with stage IA1 carcinoma of the cervix according to margin status after conization.

Methods

Medical and histopathological records of 108 patients with stage IA1 cervical carcinoma were reviewed retrospectively. Patients underwent cold knife conization with electrocauterization or conization followed by hysterectomy. Disease recurrence was defined as a histologic diagnosis of cervical intraepithelial neoplasia (CIN) 2 or higher grade lesion.

Results

Forty patients underwent conization followed by hysterectomy; of 27 women with positive margins, 14 (35%) had a residual lesion. Sixty-eight patients underwent conization without further surgical intervention. Forty patients had a negative resection margin without recurrence, while 28 had a positive resection margin: positive exocervical (n = 11), positive endocervical (n = 17). Among these, there were 7 cases of recurrence: positive exocervical (n = 1); positive endocervical (n = 6).

Conclusion

Cold knife conization with electrocauterization appears to be a safe treatment option for patients with stage IA1 cervical carcinoma if careful follow-up is guaranteed for patients with CIN 3 exocervical resection margins. However, patients with CIN 3 endocervical resection margins should be managed surgically with repeat conization or hysterectomy.     

A comparison of the accuracy of the corpuscular fragility and mean corpuscular volume tests for the alpha-thalassemia 1 and beta-thalassemia traits

Objective

To compare the accuracy of the osmotic fragility test (OFT) and mean corpuscular volume (MCV) calculation when screening for the α-thalassemia 1 and/or β-thalassemia trait.

Method

In this cross-sectional study, blood samples from 328 apparently healthy pregnant women were sent on the same day to separate laboratories for the OFT (performed using a glycerol 0.45%, phosphate-buffered, sodium chloride solution) and MCV testing (by means of a standard automated hematology analyzer). A polymerase chain reaction was also performed to positively diagnose α-thalassemia 1 carriers, and a quantitative HbA₂ test to positively diagnose β-thalassemia carriers.

Results

Sensitivity and specificity were 95.0% and 86% for the OFT; and based on the cut-off point of 78.1 fL derived from the ROC curve, they were 93% and 93.4% for MCV calculation. The latter test was found to be slightly more accurate than the OFT in predicting the presence of the α-thalassemia 1 and/or β-thalassemia trait.

Conclusion

Both tests have high screening sensitivity for the α-thalassemia 1 and/or β-thalassemia traits, and their simplicity and very low cost make them attractive as screening tests for large populations. Since MCV seems to provide fewer false-positive results, it may be the first choice wherever an automated hematology analyzer calculating MCV is available.     

Knowledge about HIV infection and acceptability of HIV testing among women delivered in Podkarpackie Province, Poland

Objective

To assess the knowledge of pregnant Polish women regarding the risk of perinatal HIV transmission, the ways to reduce this risk, and the importance of HIV testing in pregnancy, as well as their willingness to be tested for HIV.

Methods

A multicenter survey was conducted with 2123 pregnant women from Podkarpackie Province using a 4-part questionnaire.

Results

Only 15.4% of the women, mainly those with higher education, correctly assessed the risk of perinatal HIV transmission; 61.9% showed adequate knowledge of perinatal HIV transmission, mainly older, well-educated, multiparas residing in towns; and 81.1% declared a willingness to undergo HIV testing, mainly well-educated primigravidas in the 26 to 30 years age group residing in towns.

Conclusion

These pregnant women from Poland, where prenatal HIV testing is rarely done, showed a limited knowledge of perinatal HIV transmission but a high willingness to undergo HIV testing.     

Treatment of high-grade squamous intraepithelial lesions in an area of Thailand with a high incidence of cervical cancer

Objective

To audit the treatment of high-grade squamous intraepithelial lesions (HSILs) at Chiang Mai University Hospital based on 12 standard requirements of the National Health Service Cervical Screening Programme.

Methods

Records were reviewed of all women with histologically proven HSIL undergoing treatment at Chiang Mai University Hospital between January 2005 and May 2009.

Results

Four of the standard requirements were not met: not all women underwent colposcopy before definitive treatment; the rate of specimen fragmentation was high; among women with ectocervical lesions, the rate of tissue removal to a depth of greater than 7 mm was low; and among women aged over 50 years with endocervical-margin involvement, the rate of repeat excision was low.

Conclusion

This audit highlights four treatment practices that do not meet standard requirements and require detailed exploration. The development of guidelines for the treatment of cervical precancerous lesions in Thailand is challenging and merits further attention.     

Prevention of postpartum hemorrhage at home birth in Afghanistan

Objective

To test the safety, acceptability, feasibility, and effectiveness of community-based education and distribution of misoprostol for prevention of postpartum hemorrhage at home birth in Afghanistan.

Methods

A nonrandomized experimental control design in rural Afghanistan.

Results

A total of 3187 women participated: 2039 in the intervention group and 1148 in the control group. Of the 1421 women in the intervention group who took misoprostol, 100% correctly took it after birth, including 20 women with twin pregnancies. Adverse effect rates were unexpectedly lower in the intervention group than in the comparison group. Among women in the intervention group, 92% said they would use misoprostol in their next pregnancy. In the intervention area where community-based distribution of misoprostol was introduced, near-universal uterotonic coverage (92%) was achieved compared with 25% coverage in the control areas.

Conclusion

In Afghanistan, community-based education and distribution of misoprostol is safe, acceptable, feasible, and effective. This strategy should be considered for other countries where access to skilled attendance is limited.     

Characteristics of HPV prevalence among women in Liaoning province, China

Objectives

To investigate the prevalence rates of specific human papillomavirus (HPV) types infecting women in Liaoning Province, China.

Methods

Specimens from 4780 patients with cervical disease and 165 age-matched controls were tested for HPV genotypes using a chip hybridization assay.

Results

The infection rates were 35.66% for patients with cervicitis, 54.61% for those with ASCUS, 64.14% for those with CIN, 83.76% for those with cervical cancer in situ, and 83.12% for those with invasive cervical cancer. The most common HPV genotype was HPV-16, followed by HPV-58, HPV-52, HPV-33, HPV-53, and HPV-31. There were 1529 single and 731 multiple infections among the 4780 patients. Single infections with high-risk genotypes were associated with various cervical diseases. HPV-16 was present in 399 of the patients with multiple infections.

Conclusion

Compared with prevalence rates for other populations, the rates of specific HPV types infecting women are different in Liaoning Province of China.     

A qualitative study of the Australian midwives’ approaches to Listeria education as a food-related risk during pregnancy

Objective

to explore midwives’ perceptions of food-related risks and their approaches to Listeria education during pregnancy.

Design

an exploratory design within a qualitative framework.

Setting

one private and two public hospitals in New South Wales, Australia.

Participants

10 midwives providing antenatal care in the selected hospitals.

Findings

midwives had a range of approaches, from active to passive, to Listeria education. The main education provided was focused only on some of the high Listeria-risk foods with little education on safe food-handling practices. Midwives’ perception of food-related risks was a function of their limited scientific knowledge and their reliance on their experiential knowledge and their common sense. System constraints such as temporal pressure, limited availability of educational materials and low adherence to Listeria recommendations within the health system were also identified to influence midwives’ practice.

Key Conclusions

professional practice guidelines regarding food safety and Listeria education are needed, together with relevant professional training and review of hospital practices in relation to this important health issue.     

Uterine artery embolization for fibroids does not have adverse effects on ovarian reserve in regularly cycling women younger than 40 years

Objective

To evaluate the impact of uterine artery embolization (UAE) for fibroids on ovarian reserve in women younger than 40 years.

Design

Prospective study.

Setting

University-based reproductive endocrinology unit.

Patient(s)

Twenty regularly cycling women aged 33-39 years undergoing UAE for fibroids. All had cycle day 3 FSH levels <10 mIU/mL.

Intervention(s)

Measurements of serum FSH and E₂ levels and of the total ovarian volume and antral follicle number by transvaginal ultrasonography on day 3 of the menstrual cycle preceding UAE and on day 3 of the cycles occurring in months 3, 6, and 12 after UAE.

Main outcome measure(s)

Preprocedural and postprocedural hormone levels, ovarian volumes, and antral follicle numbers.

Result(s)

There were no significant changes from baseline in the mean day 3 FSH and E₂ levels, ovarian volume measurements, and antral follicle numbers measured at 3, 6, and 12 months after UAE.

Conclusion(s)

Although this study might be not sensitive enough to conclude that UAE for fibroids does not interfere with a woman's ovarian status, these data indicate that in this series of reproductive-aged women UAE did not have short- or mid-term effects on ovarian reserve as assessed by hormonal and sonographic parameters.