Maternal obesity predict isolated birth defects in live births in Eastern Province of Saudi Arabia

Objective: There is no research on the predictors of birth defects in Al Ahsa Governorate in the Eastern Province of Saudi Arabia. The aim of this research was to detect the predictors of isolated structural birth defects in live births. Methods: We conducted this study from April 2006 to 2010. Live births with isolated birth defects represented our sample for this retrospective case control study. Univariate analysis was done for all possible risk factors. Logistic regression analysis was done for all predictors in relation to different birth defects. Results: Out of 37168 live births, isolated structural birth defects were found in 318 cases. Obesity ( body mass index > 30) was a significant predictor for increased nervous system anomalies ( odds ratio (OR): 7.83, CI: 3.9–15.4), facial defects (OR: 5.92, CI: 2.8–12.4), genitourinary anomalies (OR: 4.6 CI: 1.9–11.1), and cardiac malformations (OR: 2.7 CI: 1.3–5.7). Consanguinity increased the risk for cardiac malformations (OR: 3.32, CI: 1.54–7.17). Low socio-economic status increased the risk for nervous system anomalies (OR: 2.09, CI: 1.18–3.7), facial defects (OR: 2.33, CI: 1.25–4.33) and musculoskeletal anomalies (OR: 2.3, CI: 1.29–4.09). Conclusion: Maternal obesity represented the most common predictor for certain categories of isolated structural birth defects including nervous system, facial, genitourinary and cardiac.     

Gender differences in perception of psychosocial distress and coping mechanisms among infertile men and women in Saudi Arabia

The objective of the study was to evaluate the differences in psychosocial distress and coping mechanisms among infertile men and women in Saudi Arabia (SA). We performed a cross-sectional study of infertile patients (206 women and 200 men) attending infertility clinics in three referral hospitals in Riyadh, SA. A semi-structured questionnaire was developed to assess socio-demographic, clinical and psychosocial variables. Infertility-related psychosocial pressures were reported in 79 (39.7%) male and 97 (47.3%) female participants (p?=?0.123). Males suffered more from intrusive questions and pressure to conceive, remarry or get divorced, while females were stressed more from psychological and emotional exhaustion, marital discord, attitudes of mothers-in-law or society, and persistent desire by the husband to have children. To cope with infertility, females engaged more in religious activities (p < 0.001) and spoke more to someone regarding their problems (p < 0.001). To solve their infertility problems, 50% tried to find solutions via the internet, and 38.5% of males and 51% of females reported using alternative medicines (p = 0.012). The patients with infertility in SA face multiple psychosocial stressors related to their infertility, and cope differently based on the gender and culture-specific knowledge of infertility. The female participants were significantly more affected from psychosocial stressors and the persistent desire by their spouse to have children.     

Gynecological tuberculosis in the west of Scotland.

Between 1st January 1950 and 15th June 1978, 638 women with proved tuberculosis of the genital tract were investigated. 7 different drug programmes were used to treat 581 patients. Apart from the most recent regimens employing ethambutol and rifampicin, the best results were obtained with a combination of streptomycin, PAS and isoniazid for 18 mth or 2 yr. Today the treatment of choice is a combination of rifampicin, ethambutol and isoniazid for 1 yr. Surgery should be employed where drug treatment has failed. It is essential that women with tuberculosis of the pelvic organs should be followed up indefinitely after drug treatment.     

Hemangiopericytoma of the uterus vs. hemangiopericytoma-like endometrial stromal sarcoma: a histopathological approach to differential diagnosis

A case of uterine hemangiopericytoma is reported and compared to a case of endometrial stromal sarcoma of low-grade malignancy (also termed endolymphatic stromal myosis). Their clinical features are quite similar, whereas their morphological appearances are fairly unalike. The actual existence of the uterine hemangiopericytoma is emphasized, although the very nature of this tumour is still disputed by some authors. Light-microscopy findings supplemented by special stains allow a definite diagnosis even without ultrastructural study. Histological criteria for differentiating hemangiopericytoma of the uterus from uterine mesenchymal neoplasms with a pericytomatous-like pattern are discussed.     

Metastasis to a uterine leiomyoma originating from lung cancer: A case report

The uterus is an uncommon site of metastasis especially from a primary lung adenocarcinoma. More frequently, extragenital primary tumours, including lung cancer, metastasize to the ovaries. In the literature, lung cancer metastasizing to the uterus is rare and has been reported to involve the endometrium and uterine serosa. Here, we report an unusual case of a 58-year-old woman who had a history of lung adenocarcinoma with subsequent metastasis to a single uterine fibroid only. The patient was known to have a long history of asymptomatic fibroids. In 2008, she was diagnosed with lung adenocarcinoma which was treated with primary surgery and adjuvant chemotherapy. Four years later, a routine abdominal computerised tomography scan showed an enlargement of the fibroid and she underwent a hysterectomy and bilateral salpingo-oophorectomy. Pathology reported a lung adenocarcinoma metastatic to the uterine leiomyoma with a similar morphology to the original pulmonary malignancy and this was confirmed with immunohistochemical staining. She had no evidence of metastatic disease elsewhere. The final diagnosis was metastasis of a primary lung adenocarcinoma confined to a uterine leiomyoma. Our patient also fulfilled the criteria for a phenomenon called tumour-to-tumour metastasis in this case a primary malignancy having metastasized to a benign tumour. In conclusion, metastasis of a primary lung cancer to the female reproductive tract has been documented, but clinicians should also be aware that metastasis to benign gynaecological tumours such as fibroids can also occur, especially in the setting of tumour-to-tumour metastasis. In addition, the clinical history and use of immunohistochemistry are invaluable in reaching a diagnosis.     

宫腔镜子宫纵隔切开术治疗纵隔子宫

诊断纵隔子宫的金标准仍然是宫腔镜联合腹腔镜手术。文章阐述宫腔镜子宫纵隔切开术的手术技巧,回顾分析190例纵隔子宫患者术后的妊娠结局。宫腔镜下子宫纵隔切开术可减少流产率,提高活产率。宫腔镜下子宫纵隔矫形手术安全,并发症少,可明显改善纵隔子宫合并不良孕产史患者的妊娠结局。     

Trends in incidence rates of cervical and endometrial cancer

During the period 1950–1965 there was a rising trend in the incidence rate of cervical cancer and endometrial cancer in Rotterdam. This was statistically not significant for cervical cancer, but statistically significant for endometrial cancer. The ratio of cervical to endometrial cancer did not show a statistically significant decrease. The increase in the incidence rate of cervical and endometrial cancer was caused by an increase in the number of older women of Rotterdam.     

Prevalence and genotypes' distribution of human papillomavirus in invasive cervical cancer in Saudi Arabia

Objective

Data concerning HPV infection in cervical cancer are globally lacking in Saudi Arabia. Therefore, the aim of this study was to assess HPV prevalence and genotypes' distribution in invasive cervical cancer in our patients to provide baseline information for screening and prevention.

Methods

The study included 100 paraffin-embedded cervical tumors. HPV genotyping was performed using the Linear Array kit (Roche Diagnostic) that enables the concomitant detection of 37 mucosal HPVs including 13 most common high-risk viruses.

Results

Eighty-nine specimens were HPV-positive. Eleven different HPV genotypes were detected, 8 high risk (16, 18, 31, 39, 45, 51, 59, 73) and 3 low risk (6, 64, 70). Ten patients had double infections involving mainly HPV-16 and 18. The most common genotypes were 16 (65.2%), 31 (7.9%), 45 (6.7%), 18 (3.4%), and 73 (2.3%). However, by considering double infections, HPV-18 became the second most common genotype (10.1%). The patients' median age was significantly lower (P = 0.028) in HPV-16/18 infected group compared to other genotypes (44, range 32-76 vs. 49, range 38-67).

Conclusions

Eighty-nine percent of cervical cancers in Saudi Arabia were associated with HPV infection, and 78.7% (70/89) of HPV-positive tumors were infected with HPV-16/18, which caused the cancer to appear 5 years earlier than the combined HPV-negative and other HPV genotypes (P = 0.013).     

Metastatic extragenital neoplasms to the uterus: a clinicopathologic study of four cases

Abstract.   Giordano G, Gnetti L, Ricci R, Merisio C, Melpignano M. Metastatic extragenital neoplasms to the uterus: a clinicopathologic study of four cases. Int J Gynecol Cancer 2006; 16(Suppl. 1):433–438 .
The aim of this study was to elucidate the clinicopathologic features, the differential diagnostic problems, and the prognostic consequences of patients with metastatic extragenital malignancies to uterus. The patients with metastatic extragenital malignancies to the uterus were evaluated. We considered the metastases in non–genital tract organs at diagnosis of primary neoplasm, the distribution of the metastases in the uterus, and the presence of concomitant metastases in other genital and non–genital tract organs. There were four cases of metastatic extragenital malignancies to the uterus. The breast was the most frequent primary site (two cases: 50%). The other two primary tumors were adenocarcinoma of the cecum and malignant melanoma of the skin. The diagnosis was facilitated by clinical history, revealing the previous primary neoplasm, and by specific immunohistochemical study. Almost all the patients died from disseminated disease. Thus, the prognosis of metastatic extragenital malignancies to the uterus alone or simultaneously to the uterus and other organs of the genital tract is poor. Thus, the metastases to the uterus and to other organs of the genital tract can be considered a preterminal event.     

Ovarian cancer: changes in patterns at diagnosis and relative survival over the last three decades

OBJECTIVE: The purpose of this study was to examine patterns of diagnosis and relative survival in women who had a diagnosis of primary invasive epithelial ovarian cancer (EOC) from 1973 to 1997, with follow-up through the end of 1999. STUDY DESIGN: From the population-based Surveillance, Epidemiology and End Results (SEER) Program, 32,845 women diagnosed between 1973 and 1997 were used for analysis. The study population was divided in three cohorts based on year of diagnosis and the cohorts were compared with respect to variables of interest by using chi(2) tests and relative survival analysis by the life table method. RESULTS: There was an increase in the proportions of minorities diagnosed with EOC, of women 60 years or older at diagnosis, and of women undergoing surgery over time. Survival continuously improved over time, although older patients (60 years or older) and African Americans continued to have the poorest survival. CONCLUSION: Over time, relative survival of women who had primary invasive EOC diagnosed improved.     

Rising incidence of vulval cancer in North East Scotland 1974–94: a population based study

Incidence trends for vulval cancer between 1974 and 1994 within a geographically static population are reported. The age standardized incidence rate for combined vulval tumor types is increasing ( P = 0.014). A similar trend for squamous cell carcinoma of the vulva was observed which may be important, but this did not reach statistical significance. A subgroup analysis of age at diagnosis, tumor stage, smoking history and parity for the two time periods 1974–83 and 1984–94 failed to identify changes which might identify an underlying cause for this rise. Careful scrutiny of pathology records detected significant cancer registry underascertainment. Further population based studies in other geographic areas would be useful to confirm this rise and to examine further trends in squamous cell carcinoma incidence.     

Attachment Insecurity and Sexual and Relational Experiences in Saudi Arabian Women: The Role of Perceived Partner Responsiveness and Sexual Assertiveness

BackgroundAttachment and intimacy play an important role in shaping sexual and relational experiences. Yet, their interrelation has rarely been investigated in the context of sexual problems and never been tested in Saudi Arabian women.AimThe present study examined the interrelations of attachment orientation and sexual function, distress, satisfaction, and relational satisfaction in a sample of Saudi Arabian women and explored whether this link can be explained by 2 important aspects of (sexual) intimacy, namely perceived partner responsiveness (PPR) and sexual assertiveness.MethodThis is a cross-sectional, observational study in a sample of 50 heterosexual women with sexual problems and 50 control women without problems, who completed an Arabic version of questionnaires on attachment orientation, sexual assertiveness, PPR, relationship satisfaction, sexual satisfaction, sexual distress, and sexual function.ResultsWe found that both attachment anxiety and sexual refusal showed a significant association with the level of sexual function, sexual distress, and sexual satisfaction (P < .01) in the clinical group. No mediating effects of sexual refusal were found. In the control group, sexual function, sexual distress, and sexual satisfaction were predicted by attachment avoidance (P < .01). Level of sexual function was also predicted by sexual initiation (P < .05). PPR fully mediated the association between attachment anxiety and relational satisfaction in the clinical group (P < .01), while in the control group the link between attachment avoidance and relational satisfaction was only partially mediated by PPR (P < .01).Strengths & LimitationsThis study offers unique information on relational and sexual functioning in a culture in which sexual expression and intimate behavior are restricted, particularly in women.Clinical ImplicationsPerceiving the partner as being more responsive is an important target of intervention to increase satisfaction with the relationship.ConclusionsOur results suggest that attachment anxiety and low sexual assertiveness, as indicated by lower tendencies to refuse sex when not desired, play a significant role in predicting negative sexual experiences in women who cope with sexual difficulties.Attaky A, Kok G, Dewitte M. Attachment Insecurity and Sexual and Relational Experiences in Saudi Arabian Women: The Role of Perceived Partner Responsiveness and Sexual Assertiveness. J Sex Med 2020;17:1383–1394.     

Gardnerella vaginalis in the urinary tract: incidence and significance in a hospital population

The significance of Gardnerella vaginalis in urine was studied by comparing urine culture results, urinalysis data, and clinical findings. Over a two-year period, G vaginalis was reported in 2.3% of all urine cultures. Of 72 patients with pure cultures (greater than 10(4) cfu/mL), 43 patients (59.7%) were found to have G vaginalis urinary tract infections. Furthermore, four of the infected patients had pyelonephritis. Symptoms associated with G vaginalis urinary tract infections varied, and pyuria was detected in only 58% of the cases. Conditions associated with G vaginalis urinary tract infection included a history of recurrent urinary tract infections and/or instrumentation and upper urinary tract disease.     

DNA-ploidy and HPV infection in epithelial lesions of the lower female genital tract

DNA content was related to the type of human papillomaviruses (HPV) in a series of 87 lesions of the lower female genital tract. Nineteen condylomas, 32 biopsies with slight dysplasia, 19 with moderate dysplasia and 17 with severe dysplasia-carcinoma in situ were studied. HPV status was assessed by in situ hybrization (ISH) with biotinylated probes (HPV 6/11, 16/18, 31/35/51) and the polymerase chain reaction (PCR) (HPV 16,18). DNA ploidy was measured by Feulgen DNA cytophotometry. Positivity for HPV by ISH and PCR was obtained in 48% and 59% of the biopsies, respectively. Seventy-eight per cent of the lesions were diploid or tetraploid and the remaining 22% were aneuploid. The percentage of aneuploid DNA increased with the severity of the lesions. By comparing DNA-ploidy and HPV types by ISH, diploid DNA was more frequently found in HPV 6/11 positive lesions (93%) than in HPV 16/18 positive (81%) or HPV 31/35/51 positive (57%). PCR was more sensitive for detecting HPV in aneuploid dysplastic lesions than ISH, probably indicating the HPV copies are scarce in such lesions. In summary, the results indicate some relationship between aneuploidy and HPV types 16/18 and 31/35/51, which supports an oncogenic potential of these subtypes of HPV.     

Prevalence of HSV-2 antibody in a Melbourne antenatal population attending a tertiary obstetric hospital

Objective: To determine the herpes simplex virus 2 (HSV-2) seroprevalence rate in a Melbourne antenatal cohort.
Design: Prospective collection of serum and questionnaires in 1371 women attending an outpatient antenatal clinic.
Setting: A tertiary obstetric hospital in metropolitan Melbourne.
Participants: Women aged 18 years or older attending an antenatal clinic appointment.
Main outcome measure: Seroprevalence rate of HSV-2 using an ELISA-based- type-specific serological assay.
Results: The overall HSV-2 seroprevalence rate in women was 13.6%. Only 0.4% of assays were equivocal and required confirmation by Western blot analysis. By multivariate analysis, HSV-2 seroprevalence was found to be associated with increasing age (odds ratio (OR) 4.63; confidence interval (CI) 1.86, 11.52 for age greater than 40 years), increasing number of sexual partners (OR 4.07, CI 2.13, 7.7 for five or more) and a past history of genital herpes in the index case (OR 5.48, CI 2.77, 10.87) or in a current or previous partner (OR 8.29, CI 4.15 to 16.56).
Conclusions: HSV-2 seroprevalence rates in Melbourne are comparable to other similar populations in Australia. Routine antenatal screening for HSV-2 is probably not warranted but targeted screening based on numbers of sexual partners or a history of genital herpes in partners may be justified.     

Co-expression of p53 by epithelial and stromal elements in carcinosarcoma of the female genital tract: an immunohistochemical study of 19 cases

Carcinosarcoma is an aggressive neoplasm of the female genital tract, which comprises 1–2% of malignancies of the uterine corpus. Because of the broad range of differentiation exhibited by these tumors, the precise nature of the relationship between epithelial and stromal components in this unique tumor remain unclear. Previous studies have demonstrated that mutation and consequent overexpression of the tumor suppressor gene p53 occurs frequently in carcinosarcoma and is conserved from primary to metastastic sites. We examined p53 accumulation in formalin-fixed, paraffin-embedded archival sections in 19 cases previously shown to have mutations in the p53 gene and performed semi-quantitative analysis of the intensity of staining and relative density of positive cells and stromal and glandular elements. There was a high level of concordance of immunohistochemical staining for the p53 oncoprotein between glandular and stromal elements. These results further suggest a clonal origin for the diverse elements of carcinosarcoma.     

Female circumcision (female genital mutilation): a problem for brachytherapy in cervical cancer

Female circumcision is a traditional practice common in African countries. It involves partial or total removal of external female genitalia. It has led to many complications, in particular, the scarring of the external genitalia. The consequence is a very narrow introitus making the intracavitary brachytherapy treatment component difficult when these women develop cancer of cervix. We present two such cases from our institution. Our aim is to make the radiation and gynecological oncologists, both in developed and developing countries, aware of this practice and the problems they can encounter in the management of such cases. Intracavitary brachytherapy is an important component in the potentially curative role of radiation therapy for cervical cancer. Every effort should be made to ensure that the sequelae of genital mutilation does not deprive these women of the same standard of care as the general population.