Tal Lazer

Sexually transmissible infections among female sex workers: an international review with an emphasis on hard-to-access populations

BACKGROUND Women who work commercially in sex work (female sex workers [FSW]) are considered a high-risk group for sexually transmissible infections (STI), yet the level of reported pathogens varies in studies around the world. This study reviewed STI rates reported in 42 studies of FSW around the world published between 1995 and 2006 and analysed the trends and types of populations surveyed, emphasising difficult to access FSW populations. METHODS Studies were retrieved by PUBMED and other search engines and were included if two or more pathogens were studied and valid laboratory methods were reported. RESULTS The five most commonly assessed pathogens were Neisseria gonorrhea (prevalence 0.5-41.3), Chlamydia trachomatis (0.61-46.2), Treponema pallidum (syphilis; 1.5-60.5), HIV (0-76.6), and Trichomonas vaginalis (trichomoniasis; 0.11-51.0). Neisseria gonorrhea and C. trachomatis were the most commonly tested pathogens and high prevalence levels were found in diverse areas of the world. HIV was highly prevalent mostly in African countries. Although human papillomavirus infection was surveyed in few studies, prevalence rates were very high and its aetiological role in cervical cancer warrant its inclusion in future FSW monitoring. Hard-to-access FSW groups tended to have higher rates of STI. CONCLUSIONS The five most commonly detected pathogens correspond to those that are highly prevalent in the general population, however there is an urgent need to develop rapid testing diagnostics for all five pathogens to increase prevention and treatment, especially in outreach programs to the most vulnerable groups among FSW.

Early maternal feeding following caesarean delivery: a prospective randomised study

Objective. To evaluate the effect of early maternal feeding on maternal satisfaction and gastrointestinal complications on patients following simple and complicated caesarean delivery (CD). Methods. A prospective, randomised study was designed including 179 women undergoing first or repeated CD. Women who were assigned to the early feeding group received clear fluids and solid food within 8 h of surgery, in accordance with their request. The traditionally fed women received clear fluids 8–12 h after the surgery subsequent to physician examination confirming bowel sounds. Results. Some 82 women were assigned to the traditionally fed group and 97 women were assigned to the early fed group. Maternal satisfaction was significantly higher among the early fed women. No significant differences were noted between the groups regarding post‐operative complications. Conclusions. Early maternal feeding following CD is associated with higher maternal satisfaction. However, it is not associated with higher rates of post‐operative complications.

Maternal and neonatal outcome following cerebrovascular accidents during pregnancy

Objective. To assess the clinical characteristics of maternal and neonatal outcome among women with cerebrovascular accidents (CVA) during pregnancy. Methods. Our computerized database was used to identify patients with CVA during pregnancy and puerperium from January 1988 to March 2004. Their medical records were identified and reviewed. Results. There were 16 cases of CVA among 173 803 deliveries, giving a risk of almost one case per 10 000 pregnant women. Out of 16 patients, 14 (88%) had a stroke and the remaining two cases were diagnosed with venous thrombosis. Of those 14 cases, nine (64%) had ischemic strokes and five (36%) had hemorrhagic strokes. Ten of the CVAs occurred antepartum, two intrapartum and four postpartum. Hypertensive disorders were diagnosed in 75% (12/16) of the patients. Out of these 12 patients with hypertension, 9 (75%) suffered from preeclampsia. One woman had a history of chronic hypertension. Smoking was associated with 63% (10/16) of the cases. There were two maternal deaths, both in women who had hemorrhagic strokes, and both in the first half of the study (1994 and 1996). Nine out of 16 women (56%), were delivered within 48 hours of the CVA including 7 (78%) antepartum, and two (22%) intrapartum. Cesarean deliveries were performed in 11/16 women (69%) including 8/10 with CVAs occurring antepartum, 1/2 intrapartum and 2/4 postpartum. One case of neonatal mortality was identified in a patient who was delivered at 24 gestational weeks. Conclusions. (1) Hypertensive disorders and smoking were the most important factors associated with CVA during pregnancy. (2) Maternal mortality was high among patients with CVA during pregnancy. (3) Neonatal outcome was considered generally good in cases of CVA.

Sexually transmissible infections among illegal female sex workers in Israel

Due to the mobile and clandestine nature of those who enter a country illegally, female sex workers (FSWs) who are working without papers or work permits often have no access to sexual health care. This study reports on the sexually transmissible infection (STI) prevalence among a sample of 43 sex workers working illegally. Brothel workers from republics of the Former Soviet Union (FSU), working in two locales in Israel were tested for the presence of eight pathogens and the presence of pathology by Pap smear. Of these brothel workers, 48.8% had at least one positive STI result, 14% had two STIs and one woman had three STIs. There were no cases of HIV, gonorrhoea or malignancy detected; high rates of ureaplasma (26.8%) and chlamydia were found (16.7%). Four cases of hepatitis C (9%) and three cases of hepatitis B (7%) and mycoplasma (7%) were detected. There was no relationship between reported symptoms and the detection of STIs. The level of STIs is high among this population of FSWs and it is imperative to develop more accessible health services for these women.

Severe pre-eclampsia is associated with abnormal trace elements concentrations in maternal and fetal blood

Objective: The study was aimed to compare trace elements concentrations in women with and without severe pre-eclampsia (PE). Methods: A prospective case-control study was conducted comparing 43 parturients with severe PE (who received magnesium sulfate [MgSO4]) and 80 healthy parturients and their newborns, matched for gestational age and mode of delivery. Inductively coupled plasma mass spectrometry (ICPMS) was used for the determination of zinc (Zn), copper (Cu), selenium (Se) and magnesium (Mg) levels in maternal as well as arterial and venous umbilical cord serum. Results: Zn levels (µg/L) were significantly higher in fetal arterial and venous blood of the PE group (947.3 ± 42.5 vs. 543.1 ± 226, 911.1 ± 220.2 vs. 422.4 ± 145, p < 0.001; respectively). Se levels (µg/L) were significantly lower in maternal and fetal arterial and venous cord blood of the PE group (98.6 ± 24.2, 110.7 ± 19.4, 82 ± 17.8 vs. 111.6 ± 17.6, 82.1 ± 17.4 vs. 107.1 ± 25.7, p < 0.001; respectively). Cu levels (µg/L) were significantly lower in fetal arterial and venous cord blood (581.6 ± 367.4 vs. 949 ± 788.8, p = 0.022, 608.3 ± 418.1 vs. 866.9 ± 812.6, p = 0.001 respectively) but higher in maternal blood (2264.6 ± 751.7 vs. 1048 ± 851.1, p < 0.001). These differences remained significant while controlling for the mode of delivery. Mg levels were significantly higher in the PE group as compared with the control group. Conclusions: Severe PE is associated with abnormal concentrations of Zn, Cu and Se. Therefore, trace elements may have a crucial role in the pathogenesis of severe PE.

Trace elements’ concentrations in maternal and umbilical cord plasma at term gestation: a comparison between active labor and elective cesarean delivery

Objective. Trace elements are minerals required in minute quantities to maintain proper physical functioning. The role of trace elements in the process of parturition is poorly understood. This study was aimed to determine levels of trace elements’ concentration in maternal plasma and umbilical venous and arterial plasma at term during active labor vs elective cesarean delivery (CD). Study design. A prospective case–control study was conducted. Forty healthy parturients in active labor at term with their newborns were compared to 40 healthy parturients matched for maternal age, parity, and gestational age, who delivered by elective CD (before commencement of labor). Samples of maternal venous blood and umbilical cord arterial and venous blood were drawn immediately following delivery. Trace elements’ concentrations were measured using the inductively coupled plasma mass spectrometer (ICP-MS). Results. Significant higher levels of manganese (Mn) and selenium were found in maternal venous plasma during active labor vs elective CD. Magnesium (Mg) levels were significantly higher in maternal venous blood during elective CD compared to active labor. Umbilical cord artery levels of Mg, Mn, and zinc (Zn) were significantly higher in active term labor vs elective CD. Also, significant higher levels of copper and Zn were found in umbilical cord vein between active labor and elective CD. Conclusion. Trace elements’ concentrations differ significantly in fetal blood during active labor vs elective CD. Hence, trace elements may play a crucial role in the process of human parturition.

An upper limit of gonadotropin dose in patients undergoing ART should be advocated

Abstract Aim: As no upper limit of the daily dose of gonadotropins (DD GN) used for controlled ovarian hyperstimulation (COH) in patients undergoing assisted reproductive technology (ART) has been established, we aimed to evaluate the efficacy of using different DD GN in terms of live-birth achievement. Methods: Data of patients treated at a single university medical center during the same period was analyzed retrospectively. Four groups were analyzed according to the DD GN administered: group I (“high dose”):  >225– ≤ 375 IU; Group II (“Very high dose”): 376–450 IU; group III (“extremely high dose”): 451–600 IU. Normo-responders treated with DD GN ≤250 IU served as control (C). Variables included were DD GN, total GN dose/cycle, age, FSH, BMI, gravidity, parity, cycle number, IVF/ICSI, infertility diagnosis treatment protocol and outcome parameters. Results: The analysis of 1394 treatment cycles of 943 patients indicated that DD and total dose of GN correlated negatively with the number of oocytes, implantation, clinical pregnancy and live-birth rate (25.9%, 14.6%, 11.4% and 4.7% in groups C, I, II and III, respectively) The logistic regression analysis indicated that the adjusted odds ratios for LBR correlated inversely with the DD administered – independently from age, baseline FSH, BMI and previous failed cycles. Conclusions: Increasing the daily dose of GN to doses higher than 450 IU or a total dose of 3000 IU/cycle is at least questionable if not harmful.

Should high BMI be a reason for IVF treatment denial

Abstract Our aim was to examine the influence of BMI on the live-birth rate following IVF/ICSI and evaluate its specific contribution among other factors thus enabling accurate reproductive policy development. All patients that underwent IVF/ICSI at our center during January 2012–July 2015 were included in this retrospective study. A total of 1654 ICSI cycles were divided into four groups according to the patient’s BMI (kg/m2): group I (normal weight): <25 (943 cycles); group II (overweight): 25–30 (403 cycles); group III (obese): 30–35 (212 cycles); group IV (morbid obesity): >35 (96 cycles). Comparing the four groups of BMI, mean age and number of previous ART cycles was significantly lower in group I compared to groups II, III and IV. Length of treatment was significantly shorter in group I compared to groups II, III and IV. Ovarian response to COH was comparable in terms of mean estradiol and progesterone levels on the day of hCG administration mean number of oocytes retrieved, fertilized and number of embryos transferred. Endometrial thickness was significantly lower in group IV. Outcome measures, such as implantation rate, clinical pregnancy rate (CPR) per cycle and per ET, as well as live-birth rates did not differ significantly between the groups, although in group IV LBR per cycle and per ET was lower. Multivariate logistic regression stepwise analysis found a significant correlation between age and BMI but did not find correlation between BMI and clinical pregnancy (p = 0.436) or LB (p = 0.206). The results of our relatively large retrospective study did not demonstrate a significant impact of BMI on the ART cycle outcome. Therefore, BMI should not be a basis for IVF treatment denial.

Does progesterone to oocyte index have a predictive value for IVF outcome? A retrospective cohort and review of the literature

Abstract The potential adverse effect of Serum progesterone (SP) elevation on the day of hCG administration is a matter of continued debate. Our study aimed to evaluate the relative value of progesterone to a number of aspirated oocytes ratio (POI) to predict clinical pregnancy (CP) and live birth (LB) in fresh IVF cycles and to review the relevant literature. A retrospective analysis of GnRH Antagonist IVF-ET cycles. POI was calculated by dividing the SP on the day of hCG by the number of aspirated mature oocytes. A multivariate logistic regression analysis was performed to evaluate the predictive value of POI for CP and LB. Cycle outcome parameters included clinical pregnancy, live-birth and miscarriage. A total of 2,693 IVF/ICSI cycles were analyzed. POI was inversely associated with CP adjusted OR 0.063 (95% CI 0.016–0.249, p < .001) and with LB adjusted OR 0.036 (95% CI 0.007–0.199, p < .001). For prediction of LB, the area under the curve (AUC) was 0.68 (95% CI 0.64–0.71, p < .001) for the POI model. POI above the 90th percentile with a value of 0.36 ng/mL/oocyte results in CP and LB rates of 8.0 and 5.9%, respectively. POI is a simple index for the prediction of IVF-ET cycle outcomes, it can advocate a limit above which embryo transfer should be reconsidered.