Lucian Boiculese

The value of serological markers in the diagnosis and prognosis of endometriosis: a prospective case-control study

OBJECTIVE We analyzed selected well-known and less well-known serum markers that have been proposed for diagnosis and severity assessment of endometriosis, in a case-control study. STUDY DESIGN This prospective study was carried out in a Clinical Department of Gynecology in Iasi, Romania. Study participants included endometriosis patients, and controls in whom laparoscopy had excluded endometriosis. Each case and control was investigated for serum levels of CA125, TNF, IL-1, IL-6 and IL-8. The data were correlated with clinical symptoms and revised American Fertility Society (rAFS) score and stage, and interpreted by Mann-Whitney U-test and ANOVA regression analysis. RESULTS Over the course of 1 year, 24 cases of endometriosis and 24 controls of matched age were selected. The rAFS stages were: stage I, 12.5%; stage II, 16.7%; stage III, 58.3%; and stage IV, 12.5%. CA125 levels were over the cut-off of 35 IU/l in 54% of patients (versus 8% of controls), averaging 67.5 (CI95: ±17.5). The sensitivity and specificity were 54% and 91%, respectively, with a p value of <0.001 (statistically significant). For IL-6, 71% of cases and 87% of controls were above the cut-off of 2 pg/ml, with an average of 11.83 ± 7. The sensitivity and specificity were 71% and 12%, respectively, but the difference was not statistically significant, p = 0.071. Other tested serum markers had no discrimination value. A correlation with severity of endometriosis was seen for CA125 (p = 0.03) but not for IL-6, by ANOVA. CONCLUSION CA125 correlated with endometriosis screening and severity, indicating its superiority as a marker for further, larger studies.

Comparison of the pain experienced by infertile women undergoing hysterosalpingo contrast sonography or radiographic hysterosalpingography

To evaluate the pain and cause of pain experienced by women undergoing hysterosalpingography (HSG) and contrast hysterosalpingo sonography (HyCoSy) with air in a saline solution for the assessment of uterine and tubal patency.

Natural course of nonmalignant partial portal vein thrombosis in cirrhotic patients

Background/Aim: Portal vein thrombosis (PVT) has a high incidence in patients with liver cirrhosis and determines a poor prognosis of hepatic disease. The aim of our study was to define the natural course of partial PVT in cirrhotic patients, including survival and decompensation rates. Patients and Methods: We performed a prospective, cohort study, in a tertiary referral center. There were 22 cirrhotic patients with partial nonmalignant PVT, without anticoagulant treatment, who were followed-up between January 2011 and October 2013. All patients were evaluated by Doppler abdominal ultrasound and computed tomography. Kaplan–Meier method was used to determine the difference in clinical events between the study subgroups. Results: After a mean follow-up period of 20.22 months, partial PVT improved in 5 (22.73%), was stable in 11 (50%), and worsened in 6 (27.27%) patients. Hepatic decompensation rate at 6 and 18 months was higher in patients with worsened PVT than in those with stable/improved PVT (50% vs. 25%, P < 0.0001 and 100% vs. 56.25%, P < 0.0001, respectively). The survival rate at 6 months was 66.66% in worsened PVT group vs. 81.25% (P = 0.005) in stable/improved group, and 16.66% vs. 81.25% (P < 0.0001) at 18 months, respectively. Multivariate analysis showed that Model of End-Life Disease was the independent predictor of hepatic decompensation [hazard ratio (HR) 1.42; 95% confidence interval (CI): 1.08−1.87, P = 0.012] and survival (HR 1.76; 95% CI: 1.06−2.92, P = 0.028). Conclusions: Nonmalignant partial PVT remained stable/improved in over half of cirrhotic patients and aggravated in more than one fourth in whom it negatively influenced the survival and decompensation rates.

Levonorgestrel releasing-intrauterine system for the treatment of menorrhagia and/or frequent irregular uterine bleeding associated with uterine leiomyoma

ABSTRACT Objective To evaluate the effectiveness of the levonorgestrel releasing-intrauterine system (LNG-IUS) in the treatment of menorrhagia and/or frequent irregular uterine bleeding in women with uterine myomas. Study design Prospective study whereby 102 women with intramural myomas (in a few cases associated with submucous or subserous myomas), suffering from menorrhagia and/or frequent irregular uterine bleeding, were evaluated by means of the Pictorial Blood Assessment Chart (PBAC; Higham score) and ultrasound, three, six and 12 months after insertion of a LNG-IUS. Results The PBAC score dropped (from a mean value of 231.7 to 17.6 at 12 months). The duration of menstrual bleeding diminished significantly (p < 0.001). Uterine volume decreased from a mean of 145 cm³ to 129 cm³ at 12 months (p = 0.01). Changes in the volume of the myomas were not statistically significant (p = 0.23). Satisfaction rate was good in 91 cases (89%), fair in four cases (4%), and poor in seven cases (7%). During the one-year period of follow-up, 11 cases of expulsion or removal of the LNG-IUS were recorded. Conclusion The LNG-IUS is effective in controlling heavy menorrhagia and/or frequent irregular uterine bleeding related to the presence of myomas, but has no significant effect on the size of the tumours.

Proton pump inhibitors therapy and risk of Clostridium difficile infection: Systematic review and meta-analysis

AIM To perform a systematic review and meta-analysis on proton pump inhibitors (PPIs) therapy and the risk of Clostridium difficile infection (CDI). METHODS We conducted a systematic search of MEDLINE/PubMed and seven other databases through January 1990 to March 2017 for published studies that evaluated the association between PPIs and CDI. Adult case-control and cohort studies providing information on the association between PPI therapy and the development of CDI were included. Pooled odds ratios (ORs) estimates with 95% confidence intervals (CIs) were calculated using the random effect. Heterogeneity was assessed by I2 test and Cochran’s Q statistic. Potential publication bias was evaluated via funnel plot, and quality of studies by the Newcastle-Otawa Quality Assessment Scale (NOS). RESULTS Fifty-six studies (40 case-control and 16 cohort) involving 356683 patients met the inclusion criteria and were analyzed. Both the overall pooled estimates and subgroup analyses showed increased risk for CDI despite substantial statistical heterogeneity among studies. Meta-analysis of all studies combined showed a significant association between PPI users and the risk of CDI (pooled OR = 1.99, CI: 1.73-2.30, P < 0.001) as compared with non-users. The association remained significant in subgroup analyses: by design-case-control (OR = 2.00, CI: 1.68-2.38, P < 0.0001), and cohort (OR = 1.98, CI: 1.51-2.59, P < 0.0001); adjusted (OR = 1.95, CI: 1.67-2.27, P < 0.0001) and unadjusted (OR = 2.02, CI: 1.41-2.91, P < 0.0001); unicenter (OR = 2.18, CI: 1.72-2.75, P < 0.0001) and multicenter (OR = 1.82, CI: 1.51-2.19, P < 0.0001); age ≥ 65 years (OR = 1.93, CI: 1.40-2.68, P < 0.0001) and < 65 years (OR = 2.06, CI: 1.11-3.81, P < 0.01). No significant differences were found in subgroup analyses (test for heterogeneity): P = 0.93 for case-control vs cohort, P = 0.85 for adjusted vs unadjusted, P = 0.24 for unicenter vs multicenter, P = 0.86 for age ≥ 65 years and < 65 years. There was significant heterogeneity across studies (I2 = 85.4%, P < 0.001) as well as evidence of publication bias (funnel plot asymmetry test, P = 0.002). CONCLUSION This meta-analysis provides further evidence that PPI use is associated with an increased risk for development of CDI. Further high-quality, prospective studies are needed to assess whether this association is causal.

Pregnancy during Adolescence and Associated Risks: An 8-Year Hospital-Based Cohort Study (2007–2014) in Romania, the Country with the Highest Rate of Teenage Pregnancy in Europe

Aim. To determine pregnancy and delivery outcomes among teenagers. Materials and Methods. An 8-year retrospective comparative hospital-based cohort study is analysing singleton pregnancy comorbidities and delivery parameters of a teenage group under the age of 20 compared with a young adult group 20–24 years of age in a university hospital. Results. Teenage is a risk factor for preterm birth <37 weeks (1.21 [1.08–1.35]), foetal growth restriction (1.34 [1.21–1.48]), episiotomy (1.27 [1.21–1.34]), uterine revision (1.15 [1.06–1.25]), APGAR <7 at 1 min (2.42 [1.21–1.67]), cephalopelvic disproportion (1.26 [1.07–1.48]), and postpartum haemorrhage (1.42 [1.25–1.62]); however, caesarean delivery occurs less frequently in teenagers than in adults (0.75 [0.70–0.80]). The following comorbidities are risk factors for teenage pregnancy (risk ratio [CI 95%]): anaemia (1.13 [1.10–1.17]), low urinary tract infection (1.10 [1.03–1.18]), pediculosis (2.42 [1.90–3.00]), anogenital condyloma (1.50 [1.04–2.17]), and trichomoniasis (1.74 [1.12–2.68]). The risks for hepatitis B and hepatitis C, premature rupture of membranes, and placenta praevia were lower compared with those in the young adult group, respectively, 0.43 (0.26–0.71), 0.90 (0.85–0.96), and 0.29 (0.20–0.41), while the risk for gestational diabetes and preeclampsia were the same in both groups. Conclusion. Considering the high risks for teenage pregnancy, this information should be provided to pregnant adolescent women and their caregivers.

Correlation Between Chlamydia trachomatis IgG and Pelvic Adherence Syndrome

Chlamydia trachomatis genital tract infections are prevalent worldwide (Stamm 2008), with 92 million new chlamydia cases occured every year: 3–4 million new cases occur every year in the US, 5 million in Western Europe, and 16 million in Sub-Saharan Africa (World Health Organization 2001; Weinstock et al., 2004). Chlamydia prevalence has been reported to range from 3%–7% among asymptomatic populations in men, and in women range from 3.0% in the general population to 9.5% among university students (World Health Organization 2001; Stamm 2008; Patel et al.,. 2008; Forhan et al., 2009; Imai et al., 2010; Satterwhite et al., 2010).

Recurrent respiratory tract infections in children

Respiratory tract infections are one of the major complaints in preschool children. The aim of this study was to highlight the particularities of recurrent respiratory tract infections manifested by ETN and pulmonary infections in children. Materials and methods: The authors performed a retrospective study of 148 patients aged between 2 months and 5 years old, hospitalized with the recurrent respiratory infections. We assessed the risk factor of RRI in children. In the control group were included 40 pediatric patients with abdominal pain sindrome without respiratory infections. Results: The most common clinical forms of RRI in our study included: acute otitis media − 58.31% of cases and/or recurrent pneumonia − 51.16 % of cases, chronic adenoiditis − 60.46% of cases. The authors observed a significant association between RRI and breastfeeding (p=0.0035), school-aged siblings (p=0.0013), immunodeficiencys (p=0.002), recurrent use of antibiotics (p≪0.001), early socialization (in day-care centers) (p=0.0316). In conclusion, the risk factors identified in the study group responsible for RRI were: the duration under 4 months of natural food, the presence of older siblings in the family attending the community, comorbidities (immunodeficiency, malnutrition, iron deficiency anemia, rickets) antibiotics, and early socialization.

Prevention of cardiovascular risk factors in childhood obesity

Childhood overweight and obesity are related to cardiovascular risk (CVR) factors (hypertension, type 2 diabetes mellitus, abnormal lipid profiles and increased risk of adult obesity and high morbidity and mortality rates. Methods: We performed a retrospective study of 78 overweight and obese children, hospitalized in a Pediatric Clinic from Saint Mary Hospital Iasi, 42 girls and 37 boys. The nutritional status was evaluating using BMI (body mass index) and BMI percentiles (overweight was defined as a BMI within the 85th to 95th percentile and obesity > 95th percentile). The cardiovascular risk parameters were defined by age and sex. Results: From the study group, 58% of children were obese (67% of boys and 50% of girls). Elevation of triglycerides was found in 28.2% of the patients and decreased HDL-cholesterol was present only in 2 patients. Medium and high cardiovascular risk was found in 14.1%, respectively 4% of children. Regression analysis of cholesterol showed a significant correlation with the values of systolic blood pressure. Among overweight children (37% of children), medium cardiovascular risk was found in 9% children. Conclusions: Identification and treatment of CVR factors in childhood is important in order to reduce or prevent premature cardiovascular diseases in adults.