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Medicina (Kaunas, Lithuania) Jul 2023: The purpose of this study was to describe and evaluate the bleeding that occurs during the first weeks of gestation and its implications throughout pregnancy....
: The purpose of this study was to describe and evaluate the bleeding that occurs during the first weeks of gestation and its implications throughout pregnancy. Secondarily, we assessed the associated complications in order to identify potential risk factors that could be used to select women at higher risk of adverse outcomes that could benefit from an early diagnosis and improved monitoring. : We made a selection of all the women who consulted in the Emergency Department of the Hospital QuirónSalud in Malaga on 2015 presenting with first trimester metrorrhagia. We refer to first trimester metrorrhagia as that which occurs until week 12 + 6. Once these pregnant women were identified, we studied several variables not related to the gestation and some others associated with it and its natural course. : The average age of the patients assessed was 34.1. Associated gestational complications were metrorrhagia in the second trimester (6.3%), threatened preterm labor (7.4%), preeclampsia (2.5%), gestational diabetes (7.4%), late abortion (1.2%), and early postpartum hemorrhage (1.8%). We sought associations to assess possible risk factors, establishing an increased maternal age as an aggravating factor for the development of complications. We also studied gestational complications, finding a higher prevalence of them in older women, such as prematurity (33.11 vs. 34.48 years), gestational diabetes (33.11 vs. 36.06 years), and preeclampsia (33.25 vs. 35 years). : Maternal age is a risk factor for first-trimester spontaneous miscarriage and for the development of complications of pregnancy. It is crucial to perform a correct screening of different pathologies throughout the pregnancy to anticipate potential complications.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Aged; Metrorrhagia; Retrospective Studies; Diabetes, Gestational; Pre-Eclampsia; Pregnancy Trimester, First; Follow-Up Studies
PubMed: 37629660
DOI: 10.3390/medicina59081370 -
Journal of Minimally Invasive Gynecology Jul 2023This study aimed to evaluate the learning curve of vaginal natural orifice transuminal endoscopic surgery (vNOTES) hysterectomy in expert minimal invasive and vaginal...
STUDY OBJECTIVE
This study aimed to evaluate the learning curve of vaginal natural orifice transuminal endoscopic surgery (vNOTES) hysterectomy in expert minimal invasive and vaginal surgery team.
DESIGN
This is a cohort study on a retrospective analysis.
SETTING
Department of Obstetrics and Gynecology of Cannizzaro Hospital in Catania Italy.
PATIENTS
First 50 women underwent vNOTES hysterectomy between February 2021 and February 2022.
INTERVENTION
vNOTES hysterectomy performed by a team with optimal skills in laparoscopic and vaginal surgery.
MEASUREMENT AND MAIN RESULTS
Primary outcome was surgical time. Secondary outcomes were intraoperative and postoperative complications, length of hospitalization, and first 24-hour postoperative pain. All patients underwent hysterectomy for benign indications: 27 fibromatosis, 13 metrorrhagia, and 10 precancerous. Concomitant procedures have been bilateral adnexectomy in 35 cases and bilateral salpingectomy in 15 cases. The median age was 51 years (range, 42-64). Median body mass index was 26 kg/m (range, 21-42). The median operative time was 75 minutes (range, 40-110). The median hospital stay was 2 days (range, 1-4). There was 1 intraoperative adverse event (bladder lesion) and 1 postoperative grade 3 complication (hemoperitoneum). The median visual analog scale score for pain assessment during the first 24 hours after surgery was 3 (range, 1-6). The experience in our surgical center with the first 25 vNOTES hysterectomies showed an accumulation of initial experience in the first 5 cases with stable operating time and a gradual reduction of mean operating time in the subsequent 17 surgeries. The learning curve plotted by cumulative sum analysis shows 3 phases: phase 1 of competence (cases 1-5), phase 2 of proficiency (cases 6-26), and phase 3 of mastering the procedure (after the 31st case) with the management of more complex cases.
CONCLUSION
vNOTES hysterectomy is a feasible and reproducible approach for benign indications with a short learning curve and low rate of perioperative complications. For a team skilled in minimally invasive surgery, 5 cases are required to rich competence and 25 to rich proficiency in vNOTES hysterectomy. Mastering phase, with the introduction of more complex cases, should be addressed after 30 surgeries.
Topics: Pregnancy; Female; Humans; Middle Aged; Retrospective Studies; Cohort Studies; Learning Curve; Hysterectomy, Vaginal; Hysterectomy; Natural Orifice Endoscopic Surgery; Laparoscopy; Postoperative Complications; Vagina
PubMed: 36966920
DOI: 10.1016/j.jmig.2023.03.013 -
Journal of Ethnopharmacology Oct 2024Celosia cristata L. (C. cristata) is a widely used herb in China and has been used as a medicine for more than 1000 years. The herb has been clinically employed to treat... (Review)
Review
Celosia cristata L.: A review of its traditional uses, phytochemistry, pharmacology, toxicology, and quality control, along with network pharmacological analysis of its components and targets.
ETHNOPHARMACOLOGICAL RELEVANCE
Celosia cristata L. (C. cristata) is a widely used herb in China and has been used as a medicine for more than 1000 years. The herb has been clinically employed to treat various types of bleeding disorders including metrorrhagia, metrostaxis, and leukorrheal diseases, gastrointestinal infections.
AIM OF THE STUDY
This review provides a comprehensive analysis of C. cristata, encompassing its botany, traditional applications, phytochemistry, pharmacology, safety, and quality control. Additionally, it delves into the prevailing challenges and limitations with contemporary research concerning C. cristata, thus furnishing valuable insights for future investigations in this domain.
MATERIALS AND METHODS
Research data were gathered from authoritative sources including the Pharmacopoeia of China, the Flora of China, as well as various internet databases such as Web of Science, CAS CiFinder, PubMed, Science Direct, and CNKI, along with numerous ancient classics on Chinese herbal medicine.
RESULTS
Clinical applications of C. cristata demonstrate its efficacy in treating dysfunctional uterine bleeding, vaginitis, and pelvic inflammatory disease. Presently, seventy-seven compounds have been isolated, including flavonoids, triterpenoids, steroids, organic acids, phenylpropanoids, and alkaloids, with flavonoids and triterpenoids emerging as the primary bioactive constituents. Pharmacological studies reveal its diverse biological activities, such as haemostatic, antitrichomonal, antibacterial, antiviral, analgesic, immunoregulatory, anti-inflammatory, anticancer, hepatoprotective, and antioxidant effects. Leveraging network pharmacology, researchers have embarked on preliminary inquiries into the interplay among chemical constituents, molecular targets and pathological conditions.
CONCLUSIONS
C. cristata shows significant potential for use in hemostasis, anti-inflammatory, and antimicrobial treatments. Modern research has revealed its diverse chemical composition and pharmacological activities, making it highly valuable for further study. At the same time, it is necessary to find the characteristic components of C. cristata and establish better quality control standards to better explore its therapeutic potential.
Topics: Humans; Animals; Quality Control; Phytochemicals; Ethnopharmacology; Drugs, Chinese Herbal; Network Pharmacology; Medicine, Chinese Traditional; Phytotherapy
PubMed: 38740106
DOI: 10.1016/j.jep.2024.118325 -
Reproductive Biomedicine Online Aug 2023Is there association between the presence of a uterine niche and the presence of symptoms?
RESEARCH QUESTION
Is there association between the presence of a uterine niche and the presence of symptoms?
DESIGN
This cross-sectional study was conducted at a single tertiary medical centre. All women who underwent Caesarean section from January 2017 to June 2020 were invited to the gynaecological clinics, and requested to complete a questionnaire regarding symptoms related to the presence of a niche (heavy menstrual bleeding, intermenstrual spotting, pelvic pain, infertility). Transvaginal two-dimensional ultrasonography was performed to assess the uterus and uterine scar characteristics. The primary outcome was defined as the presence of a uterine niche, evaluated by length, depth, residual myometrial thickness (RMT) and ratio between the residual myometrial thickness (RMT) and adjacent myometrial thickness (AMT).
RESULTS
Of 524 women who were eligible and scheduled for evaluation, 282 (54%) completed the follow-up; 173 (61.3%) were symptomatic and 109 (38.6%) asymptomatic. Niche measurements, including RMT/AMT ratio, were comparable between the groups. In a sub-analysis of each symptom, heavy menstrual bleeding and intermenstrual spotting were associated with reduced RMT (P = 0.02 and P = 0.04, respectively) compared with women with normal menstrual bleeding. An RMT less than 2.5 mm was significantly more prevalent in women reporting heavy menstrual bleeding (11 [25.6%] versus 27 [11.3%]; P = 0.01] and new infertility (7 [16.3%] versus 6 [2.5%]; P = 0.001]. In logistic regression analysis, infertility was the only symptom associated with an RMT less than 2.5 mm (B = 1.9; P = 0.002).
CONCLUSIONS
A reduced RMT was found to be associated with heavy menstrual bleeding and intermenstrual spotting, while values below 2.5 mm were also associated with infertility.
Topics: Female; Pregnancy; Humans; Cesarean Section; Cicatrix; Menorrhagia; Cross-Sectional Studies; Uterus; Metrorrhagia; Infertility; Ultrasonography
PubMed: 37277298
DOI: 10.1016/j.rbmo.2023.04.012 -
Cureus Apr 2024Introduction Menstrual changes after COVID-19 vaccination suggest a secondary connection to the immune response to vaccination rather than a specific component of the...
Introduction Menstrual changes after COVID-19 vaccination suggest a secondary connection to the immune response to vaccination rather than a specific component of the vaccine. The evaluation of these alterations in women with the same and multiple vaccination schedules will provide valuable information. Methods An observational, cross-sectional study was carried out; data were collected through a survey of 164 vaccinated women at the American British Cowdray (ABC) Santa Fe Medical Center Hospital in Mexico City. The survey was validated by the Delphi method. Results The survey was applied from March 2023 to February 2024. Post-vaccination menstrual alterations occurred in 48.1%; the most frequent alteration was menorrhagia in 20.7% and pain accompanied by menstruation in 27.4%. Fifty-seven percent had a history of previous COVID-19 infection. There were no significant associations between changes in menstrual bleeding after vaccination, history of COVID-19 infection, and age group (p>0.9). However, women who received multiple doses of vaccines had a higher risk of suffering abnormalities in bleeding by 36.6%. Conclusion The incidence of menstrual disorders in this study post COVID-19 vaccination was 49%. Menstrual alterations in patients who received multiple doses and a single regimen were similar at 47% and 48%, where there is no statistical significance. The greatest number of menstrual alterations was seen in the first dose at 36%, probably due to the immunity they acquired after the different types of vaccination. Vaccination is a very effective way to prevent the severity of COVID-19 infection; it has an impact on menstrual bleeding in terms of menorrhagia and metrorrhagia. Vaccination against COVID-19 is associated with small changes in the menstrual cycle, without statistical significance. Women receiving the first dose of the vaccine had changes in the amount of bleeding specifically the amount.
PubMed: 38654961
DOI: 10.7759/cureus.58783 -
Radiology Case Reports Mar 2024Uterine scar pregnancy is a rare form of ectopic pregnancy that is life-threatening and functionally compromising due to complications such as hemorrhage or early...
Uterine scar pregnancy is a rare form of ectopic pregnancy that is life-threatening and functionally compromising due to complications such as hemorrhage or early uterine rupture. We report the case of a 41-year-old patient admitted for metrorrhagia at 13 weeks' amenorrhea. Transvaginal ultrasound allowed early diagnosis of pregnancy on uterine scar and MRI-guided therapeutic management indicating hysterectomy. This study and literature review aims to highlight the importance of imaging features in the diagnosis and management of this rare condition, knowledge of which may improve prognosis.
PubMed: 38229603
DOI: 10.1016/j.radcr.2023.11.064 -
Chemistry & Biodiversity May 2024Nelumbo nucifera Gaertn is a recognised herbal plant in ancient medical sciences. Each portion of the plant leaf, flower, seed and rhizome is utilised for nutritional... (Review)
Review
Nelumbo nucifera Gaertn is a recognised herbal plant in ancient medical sciences. Each portion of the plant leaf, flower, seed and rhizome is utilised for nutritional and medicinal purposes. The chemical compositions like phenol, alkaloids, glycoside, terpenoids and steroids have been isolated. The plant contains various nutritional values like lipids, proteins, amino acids, minerals, carbohydrates, and fatty acids. Traditional medicine confirms that the phytochemicals of plants give significant benefits to the treatment of various diseases such as leukoderma, smallpox, dysentery, haematemesis, coughing, haemorrhage, metrorrhagia, haematuria, fever, hyperlipidaemia, cholera, hepatopathy and hyperdipsia. To verify the traditional claims, researchers have conducted scientific biological in vivo and in vitro screenings, which have exhibited that the plant keeps various notable pharmacological activities such as anticancer, hepatoprotective, antioxidant, antiviral, hypolipidemic, anti-obesity, antipyretic, hypoglycaemic, antifungal, anti-inflammatory and antibacterial activities. This review, summaries the nutritional composition, chemical constituents and biological activities substantiated by the researchers done in vivo and in vitro.
Topics: Nelumbo; Humans; Plant Extracts; Animals; Antioxidants; Phytochemicals
PubMed: 38327030
DOI: 10.1002/cbdv.202301493 -
Journal of Clinical Medicine May 2024Peritoneal sclerosis (PS) and its most severe form, encapsulating PS (EPS), are rare entities that can occur in various procedures (liver transplantation,...
Peritoneal sclerosis (PS) and its most severe form, encapsulating PS (EPS), are rare entities that can occur in various procedures (liver transplantation, intraperitoneal chemotherapy) or secondary to medications (beta-blockers); however, PS or EPS typically occur in patients undergoing peritoneal dialysis as a form of renal function substitution. Medical or surgical treatments can be applied, but morbidity and mortality have high rates. This condition typically presents clinically as an intestinal obstruction caused by the inclusion of the intestinal loops in the peritoneal fibrous membrane. : Herein, we present data from a single tertiary surgery center that has dedicated teams for patients receiving dialysis. Over 12 years, we analyzed a group of 63 patients admitted for catheter replacement/removal or for acute surgical pathology. In five cases (7.9%), we diagnosed EPS. Two patients with EPS presented with atypical abdominal pathologies requiring emergency surgery: one case of hemoperitoneum caused by a ruptured ovarian cyst and one case of uterine fibroids and metrorrhagia. : The definitive diagnoses were established intraoperatively and by analyzing the morpho-pathological changes in the peritoneum. The possible intraoperative challenges included laborious dissection, difficulties in restoring the correct anatomical landmarks, an increased duration of the surgical intervention and a high rate of incidents and accidents. : The aim of the present study was to emphasize the possibility of other surgical pathologies overlapping with EPS, increasing the complexity of the surgical intervention.
PubMed: 38792461
DOI: 10.3390/jcm13102921 -
Journal of Obstetrics and Gynaecology... Apr 2024Abnormal uterine bleeding is a common problem mainly encountered in reproductive age group and post-menopausal women. Hysteroscopy is a safe, simple, well tolerated and...
BACKGROUND
Abnormal uterine bleeding is a common problem mainly encountered in reproductive age group and post-menopausal women. Hysteroscopy is a safe, simple, well tolerated and reliable procedure for the diagnosis of AUB across all age groups. The aim of the study is to determine the association of hysteroscopy and histopathologic examination (HPE) findings in abnormal uterine bleeding. The secondary objective of the study are to enumerate the hysteroscopy findings in patients with AUB and to evaluate the pattern of AUB.
MATERIALS AND METHODS
Observational cross-sectional study among 60 women in reproductive and post-menopausal age group presenting with features/symptoms suggestive of abnormal uterine bleeding were studied. All patients reporting in the outpatient department (OPD) and who are eligible to participate were included in the study, after obtaining written informed consent. Detailed history, Clinical examination, Ultrasound pelvis and endometrial thickness assessment is done. Hysteroscopic findings were compared against histopathological findings.
RESULTS
The various patterns of bleeding documented in our study population were menorrhagia, metrorrhagia, menometrorrhagia, polymenorrhea, and post-menopausal bleeding. Out of these patterns, the commonest was menorrhagia at 50.0% and post-menopausal bleeding at 26.67%. In our study population, the various hysteroscopy findings were strawberry, tongue-shaped projections, pebble stones, polypoidal patterns, and cerebroid patterns. Out of these, the most common was a polypoidal pattern, strawberry pattern, and tongue-shaped projections with 45%, 31.67%, and 26.7%, respectively. The most common histopathology finding was secretory and proliferative constituting 35% and 26.67%, respectively. Carcinoma endometrium constitutes about 6.67% of the study population. The sensitivity, specificity, PPV, and NPV of strawberry appearance in hysteroscopy in comparison with secretory changes in histopathology were 52.38%, 79.49%, 57.89%, and 75.61%, respectively. The sensitivity, specificity, PPV, and NPV of tongue-shaped projections appearance in hysteroscopy in comparison with HPE findings was 60%, 76.36%, 18.75%, and 95.45%, respectively. The sensitivity, specificity, PPV, and NPV of polypoidal pattern in hysteroscopy in comparison with Endometrial hyperplasia in histopathology was 66.67%, 56.14%, 7.41%, and 96.97%, respectively. The sensitivity, specificity, PPV, and NPV of cerebroid appearance in hysteroscopy in comparison with carcinoma endometrium in histopathology were 75.0%, 100%, 100%, and 98.25%, respectively. This correlation of cerebroid pattern with carcinoma endometrium was highly significant. Among all correlations, the highly reliable was in Carcinoma endometrium followed by endometrial polyps.
CONCLUSION
Hysteroscopy has high sensitivity and specificity in diagnosing intrauterine pathology especially endometrial cancer followed by endometrial polyps. Among the various patterns of abnormal uterine bleeding, menorrhagia was the most common. A combination of hysteroscopy and endometrial sampling was found to increase diagnostic accuracy in patients with abnormal uterine bleeding and will effectively guide us in planning the appropriate management for these patients.
PubMed: 38707886
DOI: 10.1007/s13224-023-01888-z -
Chemistry & Biodiversity Aug 2023The abnormal uterine bleeding (AUB) is complex and usually leads to severe anemia. Melastomadodecandrum (MD) is clinically used for the treatment of metrorrhagia...
Combined Metabolite Analysis and Network Pharmacology to Elucidate the Mechanisms of Therapeutic Effect of Melastoma dodecandrum Ellagitannins on Abnormal Uterine Bleeding.
The abnormal uterine bleeding (AUB) is complex and usually leads to severe anemia. Melastomadodecandrum (MD) is clinically used for the treatment of metrorrhagia bleeding. The MD ellagitannins (MD-ETs) had been evidenced being effective at hemorrhage, and exerts biological activities upon their metabolites including ellagic acid and urolithins. In this study, the blood-permeated metabolites from theMD-ETs were analyzed using LC-MS approach, and 19 metabolites including ellagic acid and urolithin A derivatives were identified. Furthermore, a network pharmacology analysis including the target prediction analysis, AUB target analysis, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were conducted to reveal the relationships between "metabolites-targets-pathways", which was further verified by molecular docking analysis. The results showed that methyl ellagic acid, urolithin A and isourolithin A produced from MD-ETs can be absorbed into the blood, and might act on the core targets of VEGFA, SRC, MTOR, EGFR and CCND1. And the hemostatic effects were exerted through PI3K-Akt, endocrine resistance and Rap 1 signaling pathways. These results implied the potential effective constituents and action mechanism of MD-ETs in the therapy of AUB, which will promote the application of MD-ETs as natural agent for the treatment of gynecological bleeding diseases.
Topics: Female; Humans; Hydrolyzable Tannins; Ellagic Acid; Molecular Docking Simulation; Network Pharmacology; Phosphatidylinositol 3-Kinases; Uterine Hemorrhage; Drugs, Chinese Herbal
PubMed: 37358391
DOI: 10.1002/cbdv.202300646