Mircea Onofriescu

HPV prevalence and type distribution in women with or without cervical lesions in the Northeast region of Romania

BackgroundCervical cancer is a major public health problem worldwide. While Romania has the highest incidence of cervical cancer in Europe, the prevalence of HPV has not been evaluated. We report the first data on HPV prevalence and type distribution in Northeast Romania.MethodsHPV prevalence and genotype distribution was investigated in 514 consecutively women with or without cervical lesions in Northeast Romania. Genotyping was performed with Linear Array Genotyping/Roche kit.ResultsIn our study group, 192/514 (37.4%) patients were positive for HPV (infected with single and with multiple HPV types). Most frequent types were: 16 (10.5%), 53 (5.44%), 51 (5.05%), 52 (4.08%) 18 (2.91%) and 31 (2.73%).ConclusionsInfection with high risk types of HPV is common in Northeast Romania. Enhanced and systematic screening for cervical cancer is needed. Our results call for the implementation of a National HPV vaccine program in Romania.

Factors Affecting the Feasibility of Routine First-Trimester Fetal Echocardiography

The purpose of our study was to assess the factors that may improve the feasibility of routine fetal echocardiography at the time of the first‐trimester scan.

The Need for Cervical Cancer Control in HIV-Positive and HIV-Negative Women from Romania by Primary Prevention and by Early Detection Using Clinically Validated HPV/DNA Tests

Background In Romania, a country with no organized national surveillance program regarding cervical cancer, the early diagnosis of HPV (Human Papilloma Virus) infections is a major requirement, especially in HIV-infected women. The objective of this study was to determine the HPV prevalence and type distribution in young HIV-positive women and to assess the difference in the risk factors for developing cervical cancer compared to those of HIV-negative women. Method We conducted one cross-sectional cohort study from June 2013–September 2014, including 1,032 women: 992 HIV- women who were 36.5 years old (limits: 17 ÷ 84) and 40 HIV + women who were 22.9 years old (limits: 17 ÷ 30) with iatrogenic HIV infected. We detected HPV types with the Linear Array HPV Genotyping test (Roche, Romania). Results DNA/HPV was detected in 18/40 (45%) of the HIV+ patients and in 350/992 (35.2%) of the HIV- patients (OR = 1.5, 95%CI 0.76÷2.96). After age adjustment, the overall HPV prevalence was 51.6% in HIV+ versus 63.2% in HIV- women aged under 25, and 22.2% in HPV+ versus 47.2% in HIV- women aged 25–34. We detect HIV being a risk factor for acquiring multiple HPV type infections (OR = 2.30, 95% CI 0.88÷5.97). The eight most common HPV types (high-risk, and low-risk) for women below age 30, HIV+ / - were: HPV 16, 18, 31, 51, 58, 68, and 6 and 82 respectively. To assess the risk factors of HIV-positive women for acquiring HPV infection, we analyzed the CD4/μL, ARN/HIV copies/μL, the age group, the number of sexual partners, smoking, and the type of HPV infection (single versus multiple infections). We found that the number of sexual partners and smoking are statistically significant risk factors. Conclusion Even though there are no significant differences regarding the prevalence of HPV infection in HIV + versus HIV – patients, multiple infections were more frequent in the first group. In our study group young HIV-infected patients under HAART therapy, high number of sexual partners (more than 3) and smoking were detected to be risk factors. Future organized screening for HPV infection using sensitive and specific methods are necessary at the national level in Romania.

Ovarian stimulation outcome in infertile women with endometriosis undergoing IVF

Objectives: The aim of our study was to assess the influence of ovarian endometriosis on the outcome of controlled ovarian stimulation (COS) in IVF patients with normal functional ovarian reserve. Material and methods: This was a retrospective case-control study of patients undergoing IVF/ICSI treatment between January 2013 and September 2014, aged ≤40 years and a good ovarian reserve, characterized by antral follicle count ≥7, anti-mullerian hormone levels ≥0.8 ng/ml and day 3 serum FSH values ≤12mUI/ml. The study group (1) consisted of 28 patients with ovarian endometriosis. The control group (2) included 57 patients with laparoscopically diagnosed tubal-factor infertility, without endometriosis. These groups were analyzed for the number of stimulation days, the total amount of gonadotropins used for COS, number of total or M2 oocytes and ovarian sensitivity index (OSI). Results: The mean stimulation days, in groups 1 and 2, was 9.2±1.5 and 9.3±1.6, respectively. The mean number of retrieved oocytes in groups 1 and 2 was 10.5±4.7 and 9.0±4.5, respectively. The average number of metaphase II oocytes, in groups 1 and 2, was 8.8±4.71 and 8.2±4.1, respectively. The average of the total amount of gonadotropins used for stimulation, and the OSI were similar for both groups. We found no statistically significant differences in terms of the number of stimulation days, number of oocytes retrieved, total dose of FSH used and the OSI, between the two groups. Conclusions: The simple presence of ovarian endometriosis does not seem to affect the outcome of the exogenous gonadotropin stimulation, when the ovarian functional reserve is not significantly impaired.

Safety Indices during Fetal Echocardiography at the Time of First-Trimester Scan Are Machine Dependent

The aim of our study was to evaluate the thermal index (TI) and mechanical index (MI), during the assessment of the fetal heart at the time of first-trimester scan, with different ultrasound machines. This was part of an observational study conducted in patients undergoing routine first-trimester screening. Cases were examined with Voluson E8 or 730Pro scanners using 2–8 MHz transabdominal probes. TI and MI were retrieved from the saved displays while in gray mode, color flow mapping and pulsed-wave (PW) Doppler examinations of the fetal heart and also from the ductus venosus (DV) assessment. We evaluated 552 fetal cardiac examinations, 303 (55%) performed with Voluson E8 and 249 (45%) with Voluson 730Pro ultrasound machines. The gray-scale exam of the heart and the PW Doppler DV assessment had TI values significantly lower for the Voluson E8 group (median, 0.04 vs. 0.2 and 0.1 vs. 0.2, respectively). The MI values from gray-scale and color flow mapping of the heart were significantly lower (median, 0.6 vs, 1.2 and 0.7 vs. 1) and for PW Doppler exam of the tricuspid flow were significantly higher (median 0.4 vs. 0.2) in the Voluson E8 group. The TI values from Doppler examinations of the heart, either color flow or PW imaging and MI values from DV assessment were not significantly different between the two groups. A different (newer) generation of ultrasound equipment provides lower or at least the same safety indices for most of the first-trimester heart examinations.

Multicentric collaborative database in obstetrics and gynecology. Interdisciplinary Multicentric Working Group on Antenatal Research

Notwithstanding the type of study that is planned (retrospective or prospective), a multicentric and interdisciplinary approach assures a much better progress of the data collection than a single center approach does. We present herein the potential applicability of the system adapted by us in the national projects budgeted by the Romanian Academy of Medical Sciences. In our research we use an adapted version of Astraia - a database for women’s health data management. The database allows the documentation of main medical data about pregnant women, birth and neonates. The database was adapted to allow documentation of information about the biological samples collected and stored from patients. Queries were edited to allow identification and recognition of samples in the database. Our previous research recommends our platform for use in the following projects of the Romanian Academy of Medical Sciences: National Registry of Malformations and New Strategies in Health Prevention Measures.

Isolated laryngeal atresia, prenatal diagnosis and pathology. Case report

Congenital high airway obstruction syndrome (CHAOS) is a rare disorder defined as any fetal abnormality that obstructs the larynx or trachea. Most cases are sporadic with an unknown incidence. We report a case that was diagnosed prenatally at 21 gestational weeks, which showed a typical CHAOS pattern with expanded hyperechogenic lungs, inverted diaphragms, dilated trachea and ascites. There were no other fetal abnormalities and the karyotype was normal (46xy). The parents opted to have an elective termination of pregnancy. Pathological examination confirmed the diagnosis, showing infraglottic atresia (type II) and complete trachea obstruction. The disease is incompatible with life, and antenatal ultrasound diagnosis is advisable. However, few cases have been reported which managed with neonatal interventions such as ex-utero intrapartum treatment.