Amparo García-Tejedor

HIV detection in amniotic fluid samples: Amniocentesis can be performed in HIV pregnant women?

OBJECTIVES To assess amniotic fluid (AF) HIV contamination as a marker of intrauterine HIV infection and to evaluate amniocentesis as a risk factor for vertical HIV transmission when the mother was under antiretroviral treatment. STUDY DESIGN Three hundred and sixty-six HIV pregnant women were included in the study. AF was obtained from three groups of patients: (a) genetic amniocentesis before 1997 (n=11); (b) amniocentesis a few days before the delivery day (n=18); and (c) AF collected on delivery (n=38). An univariate study was conducted to analyze amniocentesis as a risk factor of HIV transmission (groups a and b). Groups b and c were recruited after 1997; these patients were under combined antiretroviral treatment, they were studied to relate AF HIV contamination with fetal infection and maternal blood viral load at delivery (n=56). RESULTS From 1984 to 1996, before antiretroviral therapy use in HIV pregnant women, transmission rate was 17%. In the group of patients who underwent genetic amniocentesis (group a) it was 30% (3/10) versus 16.2% (40/247) for patients without amniocentesis. Between 1997 and 2000 transmission rate was 3%. In group b it was 0% (0/18) when amniocentesis was done versus 3.7% (3/81) if no amniocentesis was done (no statistical differences). AF virus was undetectable in all samples (n=56) and no newborn infection was observed after the follow up. CONCLUSIONS Amniotic fluid virus load was undetectable when maternal antiretroviral therapy was used, even if the virus was detectable in maternal blood samples. This finding raises the possibility to perform amniocentesis, when it is indicated, to provide the mother with an adequate antiretroviral treatment.

Intrapartum fetal invasive procedures and perinatal transmission of HIV

OBJECTIVE To study the effect of intrapartum use of fetal invasive procedures (scalp electrodes or scalp pH sampling) on perinatal transmission rate of HIV. STUDY DESIGN We compared the perinatal transmission of 57 HIV pregnancies in which invasive procedures (IP) were performed with a control group of 214 pregnancies without IP. We controlled for potentially risk factors (maternal CD4 level, gestational age, antiretroviral therapy use, duration of rupture of membranes (ROM), length of labor and mode of delivery) by stratification and logistic regression. RESULTS Transmission rate in the group with IP was 26.3% (15/57) versus 13.6% (29/214) in the control group, relative risk (RR) 1.9, 95% CI (1.1-3.4). By logistic regression we observed three significant factors involved in transmission of HIV: low maternal CD4 level (odds ratio (OR)=3.3, 95% CI=1.2-9.4), duration of ROM (OR=2.9, 95% CI=1.1-7.9) and IP use (OR=3.5, CI 95%=1.2-9.6). Interaction between duration of ROM and IP are also significant (OR=5.1, CI 95%=1.5-17.5). CONCLUSIONS Intrapartum use of fetal scalp electrodes or fetal scalp pH sampling increases the perinatal transmission of HIV and should therefore be avoided in HIV patients.

Influence of highly active antiretroviral treatment (HAART) on risk factors for vertical HIV transmission.

Objective. To analyze the influence of highly active antiretroviral treatment (HAART) on risk factors for perinatal transmission of human immunodeficiency virus (HIV). Design. A prospective cohort study was performed between HIV pregnant women under HAART therapy and without treatment. Setting. The maternity hospital ‘La Fe’ in Valencia, Spain. Population or sample. Five hundred HIV‐positive pregnant women. Method. Known maternal and obstetrical perinatal risk factors were analyzed by univariate and multivariate methods (logistic regression). The influence of HAART on the risk factors was evaluated independently to determine whether there was a modulation in perinatal HIV transmission. Main outcome measures. Known perinatal risk factors were found not to have any significant influence on perinatal HIV transmission in women under HAART therapy. Results. Vertical transmission risk decreased significantly from 18.2% without treatment to 8.6% with mono/dual therapy and 0.6% with HAART. A CD4+ cell count below 500 cell/μl, intrapartum use of invasive procedures, rupture of membranes >six hours, labor length >five hours, and birthweight were the significant risk factors associated to vertical HIV transmission and elective cesarean section. Antiretroviral treatment administered during delivery was a protective factor in HIV pregnant women before HAART therapy. Conclusions. HAART therapy reduces the influence of the perinatal risk factors on vertical HIV transmission.

Risk factors for vertical transmission of hepatitis C virus: a single center experience with 710 HCV-infected mothers

OBJECTIVE The aim of this study was to analyze the risk factors on the perinatal transmission of hepatitis C virus (HCV). STUDY DESIGN A retrospective cohort study with 711 infants born to 710 HCV-infected mothers was conducted at the Hospital La Fe, in Valencia, Spain, from 1986 to 2011. As potential risk factors for transmission we analyzed: maternal age, mode of acquisition of HCV infection, HIV co-infection, antiretroviral treatment against HIV, CD4 cell count, HIV and HCV viral load, liver enzyme levels during pregnancy, smoking habit, gestational age, intrapartum invasive procedures, length of rupture of membranes, length of labor, mode of delivery, episiotomy, birth weight, newborn gender and type of feeding. RESULTS Overall perinatal HCV transmission rate was 2.4%. The significant risk factors related with HCV transmission were maternal virus load >615copies/mL (OR 9.3 [95% CI 1.11-78.72]), intrapartum invasive procedures (OR 10.1 [95% CI 2.6-39.02]) and episiotomy (OR 4.2 [95% CI 1.2-14.16]). HIV co-infection and newborn female were near significance (p=0.081 and 0.075, respectively). CONCLUSIONS Invasive procedures as fetal scalp blood sampling or internal electrode and episiotomy increase vertical transmission of HCV, especially in patients with positive HCV RNA virus load at delivery.

Perioperative cesarean delivery morbidity among HIV-infected women under highly active antiretroviral treatment: a case-control study

OBJECTIVE To compare post-cesarean complications between HIV-infected women on highly active antiretroviral therapy (HAART) and a matched group of non-HIV-infected women, and to evaluate predisposing risk factors for these complications in the HIV group. STUDY DESIGN We performed a retrospective study of 160 HIV-infected women and 320 non-infected women who underwent cesarean section in a single reference center from 1997 to 2007. All HIV patients were under high active antiretroviral therapy (HAART). The women were assessed for a large number of major and minor postoperative complications. Selected risk factors for perioperative morbidity were analyzed in the HIV-positive group and data were analyzed using logistic regression. RESULT(S) Overall postoperative complications did not differ significantly between the two groups (26.9% in HIV patients vs. 22.8% in controls; OR = 1.24; 95% confidence interval [CI] = 0.8-1.92). Anemia was the most frequent morbidity observed, affecting 17.5% of HIV-positive women and 11.8% of controls. Major complications were associated with a CD4+ cell count of < 500 cell/ml (OR = 3.28, 95% CI = 1.04-10.31) and prematurity < 34 weeks (OR = 9.76, 95% CI = 1.99-47.71). CONCLUSION(S) Post-cesarean complications were not significantly increased in HIV-infected women on HAART compared to non-HIV-infected women. Prematurity and low CD4+ cell count were risk factors for major complications.

Ethanol sclerotherapy of ovarian endometrioma: a safe and effective minimal invasive procedure. Preliminary results

OBJECTIVE To study if ultrasound-guided aspiration with ethanol sclerosis is a safe and effective treatment for endometriomas. STUDY DESIGN We conducted a prospective study of 25 women with 27 endometriomas (two bilateral) measuring 4-10cm in diameter with no suspected malignancy, who underwent ultrasound-guided aspiration and ethanol sclerosis between August 2010 and July 2014. Patients were followed up by ultrasound at 6, 12, 24, and 36 months to identify rates of complication and recurrence. Clinical characteristics of the patients (age, history of infertility, previous surgery, and abdominal pain), the cysts (location, diameter, and volume) and the procedure (duration and complications) were recorded. Kaplan-Meier survival curves were used to analyze the recurrence rates by SPSS statistical software. RESULTS The recurrence rate after sclerosis was 12%. The mean length of follow-up was 17 (SD 9.9) months. Although no major procedure-related complications were recorded, minor complications included three cases of low abdominal pain during the procedure (10.7%) and two cases of abdominal ethanol extravasation (7.1%). CONCLUSION Ultrasound-guided aspiration and ethanol sclerotherapy are a safe and effective treatment for endometriomas measuring 4-10cm in diameter with no evidence of malignancy. This conservative treatment could possibly achieve a symptomatic cure while preserving healthy ovarian tissue, thereby improving fertility outcomes and avoiding early menopause.

Ultrasound-Guided Aspiration of Adnexal Cysts With a Low Risk of Malignancy Is It a Recommendable Option?

The purpose of this study was to establish the viability of ultrasound (US)‐guided adnexal cyst aspiration and identify a target group in which this procedure would be advisable.

The Shift From Sentinel Lymph Node Biopsy Performed Either Before or After Neoadjuvant Systemic Therapy in the Clinical Negative Nodes of Breast Cancer Patients. Results, and the Advantages and Disadvantages of Both Procedures

Micro‐Abstract The clinical consequence of performing sentinel lymph node biopsy (SLNB) before or after neoadjuvant therapy (NAT) in breast cancer patients remains under study. Therefore, we present a comparison between both approaches. The lymphadenectomy rate is reduced by threefold when the SLNB is assessed after NAT with no increase in early recurrences; consequently, it seems that this approach has more advantages for the patients than before NAT. Background: In patients with breast cancer who are candidates for neoadjuvant therapy (NAT), the timing of when to perform sentinel lymph node biopsy (SLNB) remains under discussion. The aim of this study was to compare the advantages and disadvantages of SLNB performed before and after NAT. Patients and Methods: One hundred seventy‐two patients, T1c to T3 and N0 (clinically and according to ultrasound) candidates for NAT were included. We compared the outcomes of 2 groups: (1) 122 patients of whom SLNB was performed before NAT (pre‐NAT) from December 2006 to April 2014; and (2) 50 patients with SLNB performed after NAT (post‐NAT) from May 2014 to July 2016. Results: Both groups were homogeneous in baseline patient characteristics. The SLNB was positive in 50 patients [41.7%] (33 macrometastases [66%] and 17 micrometastases [34%]) versus 6 patients [12%] (5 macrometastases [83.3%] and 1 micrometastases [16.7%]) in pre‐ and post‐NAT groups, respectively. The lymphadenectomy was performed in 34 patients [28.3%] versus 4 patients [8%], with an odds ratio of 3.48 (95% confidence interval, 1.3‐9.3). The recurrences in the pre‐NAT group after a median follow‐up of 62 months were 12 systemic, 2 local and systemic, and none axillary. In the post‐NAT group were no recurrences after a median follow‐up of 16 months. Finally, SLNB after NAT reduces the delay in starting NAT from 24 to 14 days (medians; P < .001) and the identification of the SLNB was in 122 patients [100%] versus 49 patients [98%]. Conclusion: SLNB performed after NAT significantly reduces the rate of lymphadenectomies without any increase in recurrences at early follow‐up. Furthermore, it allows systemic treatment to be started earlier without interfering in the SLNB identification rate.

Ultrasound-Guided Aspiration With and Without Ethanol Sclerotherapy in the Management of Simple Adnexal Cysts: A Single-Center Experience.

STUDY OBJECTIVES To compare the efficacy of ultrasound-guided aspiration versus aspiration with ethanol sclerotherapy in the management of simple adnexal cysts measuring 3 to 10 cm, and to explore the risk factors for recurrence associated with each approach. DESIGN A prospective follow-up of patients after cyst aspiration with and without ethanol sclerotherapy in simple adnexal cysts in a single-center trial (Canadian Task Force classification II-1). SETTING Bellvitge Teaching Hospital, Barcelona, Spain. PATIENTS Cyst aspiration and ethanol sclerotherapy were performed in 66 and 75 patients, respectively, between 2002 and 2014. Women enrolled before March 2009 underwent simple aspiration (group 1), and those enrolled after March 2009 underwent ethanol sclerotherapy (group 2). INTERVENTIONS Ultrasound-guided fine-needle aspiration with and without ethanol sclerotherapy. MEASUREMENTS AND MAIN RESULTS Potential risk factors for recurrence-age, menopausal status, symptoms, cyst diameter, laterality, aspirated volume, simple US-guided aspiration or alcohol sclerotherapy, and complications-were analyzed by logistic regression. The recurrence rates were analyzed by the Kaplan-Meier and Mantel-Haenszel methods. The overall recurrence rates were 72.7% (48 of 66) in group 1 and 22.7% (17 of 75) in group 2 (p < .0001). Risk factors significantly associated with recurrence were simple aspiration without ethanol sclerotherapy (odds ratio [OR], 19.7; 95% confidence interval [CI], 6.756-57.714), postmenopausal status (OR, 9.3; 95% CI, 1.720-50.956), and cyst size (OR, 1.04; 95% CI, 1.005-1.093). CONCLUSION Based on the lower recurrence rate, ethanol sclerotherapy was more efficacious than simple aspiration in the management of simple adnexal cysts measuring <10 cm.

Analysis of the ectoenzymes ADA, ALP, ENPP1, and ENPP3, in the contents of ovarian endometriomas as candidate biomarkers of endometriosis.

The diagnosis of endometriosis, a prevalent chronic disease with a strong inflammatory component, is usually delayed due to the lack of noninvasive diagnostic tests. Purinergic signaling, a key cell pathway, is altered in many inflammatory disorders. The aim of the present work was to evaluate the levels of adenosine deaminase (ADA), alkaline phosphatase (ALP), ecto‐nucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1), and ENPP3, elements of purinergic signaling, as biomarker candidates for endometriosis.