Giuliana Giunta

Influence of lactoferrin in preventing preterm delivery: a pilot study.

Lactoferrin (Lf) is an approximately 80-kDa iron-binding glycoprotein, belonging to the transferrin family, with well-known bacteriostatic and bactericidal properties. It is produced and stored in specific (secondary) neutrophil granules and released during neutrophil activation and degranulation. Nowadays, Lf has a well-known therapeutic indication for combating iron deficiency anemia (IDA) in pregnant women. Studies suggest that Lf plays an important role against cervicovaginal infections by decreasing cytokines levels, such as interleukin (IL)-6, in cervicovaginal fluid. The aim of this preliminary trial was to evaluate the effectiveness of Lf in preventing preterm delivery caused by cervical infections and ripening. From November 2009 to August 2010, 21 pregnant women (26-32 weeks pregnant), aged between 22 and 36 years, suffering from IDA, at risk of preterm delivery, were prospectively enrolled in the study. One group (N=14) received 100 mg of recombinant human lactoferrin (bLf) [corrected] (lattoferrina; AG-pharma) twice a day before meals, for one month. The other group (N=7) received 520 mg of ferrous sulfate (Ferro-Grad; Abbott Laboratories, USA) once a day. The patients underwent transvaginal ultrasound to evaluate cervical length and funneling, and vaginal swabs were used to detect infections and cervicovaginal fluid sample collection to determine IL-6 levels. The results showed a correlation between the oral administration of 200 mg of bLf [corrected] with both the normalization of vaginal flora (vaginal infection disappearance) and the decrease in IL-6 cervicovaginal fluid levels in women at risk of preterm delivery.

Bacterial biota of women with bacterial vaginosis treated with lactoferrin: an open prospective randomized trial

ABSTRACT Background: Bacterial vaginosis is the most frequent condition associated to the vaginal microbiota imbalance, affecting about the 40–50% of women in the world. Even if antibiotics are effcetive for bacterial vaginosis treatment a long-term recurrence rates, higher than 70%, is recorded. Lactoferrin is an iron-binding glycoprotein with bacteriostatic and bactericidal properties. It owns the ability to protect the host against infection, by binding and regulating the iron needed for the bacterial proliferation. Objective: The present study was an open prospective randomized trial (registration no. SHI-EVE-2014.01) aimed at characterizing the bacterial biota of women affected by bacterial vaginosis (BV) and assessing the effects of two different lactoferrin concentrations (100 mg and 200 mg vaginal pessaries) on the composition and dynamics of the vaginal bacterial biota. Design: Sixty women with BV were recruited and randomized into two groups to receive lactoferrin pessaries for 10 days. Clinical evaluation was based on Amsel criteria and Nugent scores. Culture-dependent methods and Ion Torrent PGM sequencing of the 16S rRNA gene were applied to study in depth the overall structure of the vaginal bacterial biota and its dynamics during the treatment. Results: Vaginal lactoferrin administration modified the vaginal microbiota composition in patients with BV. During treatment, both 100 mg and 200 mg lactoferrin vaginal pessaries significantly decreased the occurrence of bacteria associated with BV, such as Gardnerella, Prevotella, and Lachnospira, and increased the occurrence of Lactobacillus species. The bacterial biota balance was maintained up to 2 weeks after treatment only in women treated with 200 mg lactoferrin pessaries. Conclusions: This study indicates that lactoferrin could be proposed as an alternative therapeutic approach for BV. Our data showed, for the first time, the dominance of Lactobacillus helveticus species during and after vaginal lactoferrin treatment.

Effects of Urinary Incontinence Subtypes on Women's Sexual Function and Quality of Life

OBJECTIVE To evaluate the effects of different subtypes of urinary incontinence (UI) on sexual function and quality of life (QoL). MATERIALS AND METHODS Ninety-three women with UI were enrolled in the observational study. By the urodynamic findings, 32 women (34.5 %) were diagnosed with stress urinary incontinence (SUI), 35 (37.6%) with urgency urinary incontinence (UUI), and 26 (27.9%) with mixed urinary incontinence (MUI). The Short Form-36 questionnaire was used to investigate the QoL, and the Female Sexual Function Index and Female Sexual Distress Scale questionnaires were used to study sexual function and sexual distress, respectively. RESULTS Low mean total Female Sexual Function Index scores and high mean Female Sexual Distress Scale total scores were obtained for each group. However, women with MUI showed a significantly higher impairment of female sexual function (P <.05) compared with others. Women with MUI and UUI had more orgasmic disorder than those with SUI, and women with MUI and SUI had mainly lower sexual desire than those with UUI. QoL was worse in women of all groups, particularly in those with UUI and MUI. CONCLUSION UI, whatever its nature, has a significant impact on sexual function; notwithstanding, the subgroups of UI, namely SUI, UUI, and MUI, may have their sexual function affected in different ways. All subtypes of UI can have severe consequences on perception of QoL, but when compared, a significantly high impairment of QoL was observed in the MUI and the UUI groups.

Neurovegetative disorders of perimenopausal women treated with docosahexaenoic acid (DHA, 625 mg)

Abstract The study evaluated the effect of DHA 625 mg in women who experience menopausal symptoms, on sexuality and quality of life (QoL), and on the auditory brainstem response (ABR). Forty-two perimenopausal women were enrolled. The Kupperman Index (KI) was used to evaluate menopause symptoms. The Short Form-36 (SF-36), Female Sexual Function Index (FSFI), and the Female Sexual Distress Scale (FSDS) were used to assess QoL, sexual function, and sexual distress, respectively. Auditory evoked potentials to measure the ABR. The study had one follow-up at 6 months. The women reported an improvement in the KI total score (p < .001). Moreover, women reported QoL improvements in all the psychological categories (p < .001), but not in physical categories (p = NS). FSFI and FSDS total scores increased (p < .01) and the FSDS score decreased (p < .01), mainly due to arousal (p < .03) and lubrication (p < .05) sexual aspects. The ABR wave latencies were lower than the baseline values (p < .05). DHA could be effective in modulating some perimenopausal symptoms in women and, consequently could contribute to improve their QoL and sexual life. Finally, DHA seems to have a direct activity on the neuronal conduction time into the audiological system.

35-Week twin delivery after embryo reduction at 11 weeks and subsequent expulsion of a dead foetus at 20

Giuliana Giunta , Michele Fichera, Salvatore Caruso , Beatrice La Rosa, Martina Ferrara, Ambra Iuculano, Giovanni Monni and Antonio Cianci Department of General Surgery and Medical Surgical Specialties, Obstetrics and Gynecology Unit, Policlinico G. Rodolico, University of Catania, Catania, Italy; Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Microcitemico Pediatric Hospital, Cagliari, Italy

Does vaginal estriol make urodynamic changes in women with overactive bladder syndrome and genitourinary syndrome of menopause

OBJECTIVES OAB is a common finding in postmenopausal women. Hypoestrogenism is the root cause of many signs and symptoms of Genitourinary Syndrome of Menopause (vaginal dryness, atrophy, dyspareunia, urinary disorders, etc.). As such the aim of this study was to evaluate the urodynamic effects of ultralowdose estriol vaginal gel formulation to treat women with Genitourinary Syndrome of Menopause and Overactive Bladder Syndrome. STUDY DESIGN This open-labeled, single center, prospective study involved 37 women with OAB recruited in our Urogynecological Unit between January and July 2016. They received estriol 50 mcg/g vaginal gel, one applicator-dose per day for 3 weeks followed by one dose twice a week for 12 weeks. Objective and subjective parameters were evaluated before and after treatment through the urodynamic examination, Overactive Bladder symptom score and Short Form Health Survey-36 questionnaires. RESULTS Vaginal atrophy symptoms and signs as well as the overactive bladder subjective symptom parameter improved significantly. Urodynamic evaluation showed significant improvement in first desire to void and maximum cystometric capacity after estriol usage. Patients who had detrusor overactivity did not show any improvement for this parameter after treatment. The voiding function parameters did not significantly change. Short form-36 showed a better quality of life after treatment especially for the emotional role, as well as mental and general health. CONCLUSIONS A local ultra-low dose concentration of estriol could be effective in women with vaginal atrophy and Overactive Bladder Syndrome for improving both subjective symptoms and urodynamic parameters of storage function not affecting voiding function.

Ectopic pregnancy after right annessiectomy and left tubal ligation: case report

Objective. We report an unusual case of ectopic pregnancy in a woman with right annessiectomy and left tubal ligation. Case report. A 35-year old woman underwent laparotomy right annessiectomy and left tubal ligations, because of a mature cystic teratoma attached to the right annex. She arrived in emergency three years later with lower abdominal pain, amenorrhea and a positive level of beta hCG (Beta subunit of human chorionic gonadotropin). An urgent videolaparoscopy was performed, with a left salpingectomy with the removal of the ectopic pregnancy in the distal remain tube. The pathologic report confirmed the diagnosis of ectopic pregnancy. The patient’s postoperative recovery was normal. Conclusion. The analysis of the literature/published data shows that the partial salpingectomy increases the risk of ectopic pregnancy, so total salpingectomy is the preferred option over partial salpingectomy, in order to reduce the risk of recurrent ectopic pregnancy.