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Clinical Breast Cancer Dec 2023Vulvo-vaginal atrophy (VVA) or genitourinary syndrome of menopause (GSM) is a common condition among breast cancer (BC) patients, especially those undergoing... (Meta-Analysis)
Meta-Analysis Review
Vulvo-vaginal atrophy (VVA) or genitourinary syndrome of menopause (GSM) is a common condition among breast cancer (BC) patients, especially those undergoing antiestrogen therapy. Despite being an option in refractory cases, the safety of hormonal treatment remains uncertain in this population. The aim of this study was to review the safety and serum estrogen levels of hormonal therapy in patients with BC history presenting with VVA symptoms. Pubmed, Embase, and Cochrane were searched for studies comparing different hormonal treatment options for VVA in breast cancer survivors. Statistical analysis was performed using a random effects model and heterogeneity using Cochran's Q-statistic and the I2 index. We included 17 studies, of which 5 were randomized controlled trials (RCTs). Treatment modalities included in this study were topical vaginal estradiol and estriol preparations, vaginally applied testosterone, DHEA, and ospemifene. We found that, among patients treated with the estriol and estradiol preparations, there was an average increase of 7.67 pg/mL (SMD 7.67 pg/mL; 95% CI -1.00, 16.35; p < .001). Analysis of the testosterone group found temporary peaks of serum estradiol levels, but 1 study showed persistent elevation above normal postmenopausal levels. One study with prasterone revealed no elevation of serum estradiol concentration. One study with ospemifene demonstrated no increase in the risk of BC recurrence. In conclusion, among treatments available for BC survivors, low-dose vaginal estrogen showed the smallest changes in serum estradiol levels and had the most evidence, but safety remains unclear, especially for patients on aromatase inhibitors. Alternative treatments such as ospemifene need more data supporting safety and efficacy. These results suggest that concerns related to cancer recurrence should keep aiming for the lowest possible concentration.
Topics: Female; Humans; Breast Neoplasms; Cancer Survivors; Neoplasm Recurrence, Local; Vaginal Diseases; Vagina; Estradiol; Survivors; Testosterone; Estrogens; Atrophy; Estriol
PubMed: 37806915
DOI: 10.1016/j.clbc.2023.08.003 -
International Journal of Gynecological... Sep 2017Worldwide, 1,470,900 women are diagnosed yearly with a gynecological malignancy (21,000 in the UK). Some patients treated with pelvic radiotherapy develop chronic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIM
Worldwide, 1,470,900 women are diagnosed yearly with a gynecological malignancy (21,000 in the UK). Some patients treated with pelvic radiotherapy develop chronic changes in their bowel function. This systematic review summarizes current research on the impact of cancer treatment on the gut and vaginal microbiome in women with a gynecological malignancy.
METHODS
The Preferred reporting Items for Systematic Reviews and Meta-analyses guidelines for systematic reviews were used to ensure transparent and complete reporting. Quantitative studies exploring the gut or vaginal microbiome in this patient cohort were included. Animal studies were excluded. There were no language restrictions.
RESULTS
No studies examined the possible effects of surgery or chemotherapy for gynecological cancers on the gut or vaginal microbiome.Three prospective cohort studies were identified using sequencing of changes in the gut microbiome reporting on a total of 23 women treated for gynecological cancer. All studies included patients treated with radiotherapy with a dosage ranging from 43.0 to 54.0 Gy. Two studies assessed gastrointestinal toxicity formally; 8 women (57%) developed grade 2 or 3 diarrhea during radiotherapy. The outcomes suggest a correlation between changes in the intestinal microbiome and receiving radiotherapy and showed a decrease in abundance and diversity of the intestinal bacterial species. Before radiotherapy, those who developed diarrhea had an increased abundance of Bacteroides, Dialister, and Veillonella (P < 0.01), and a decreased abundance of Clostridium XI and XVIII, Faecalibacterium, Oscillibacter, Parabacteroides, Prevotella, and unclassified bacteria (P < 0.05).
CONCLUSION
The limited evidence to date implies that larger studies including both the vaginal and gut microbiome in women treated for a gynecological malignancy are warranted to explore the impact of cancer treatments on the microbiome and its relation to developing long-term gastrointestinal toxicity. This may lead to new avenues to stratify those at risk and explore personalized treatment options and prevention of gastrointestinal consequences of cancer treatments.
Topics: Cohort Studies; Female; Gastrointestinal Microbiome; Genital Neoplasms, Female; Humans; Prospective Studies; Vagina
PubMed: 28590950
DOI: 10.1097/IGC.0000000000000999 -
Journal of Lower Genital Tract Disease Jan 2023Small cell carcinoma of the vagina (SmCCV) is an extremely rare disease. Evidence-based data and specific guidelines are lacking. We conducted the first systematic...
OBJECTIVES
Small cell carcinoma of the vagina (SmCCV) is an extremely rare disease. Evidence-based data and specific guidelines are lacking. We conducted the first systematic review of case reports to provide the most overall picture of SmCCV.
MATERIALS AND METHODS
Literature search in PubMed and Scopus was performed using the terms "small cell carcinoma" and "vagina." English-language case reports of primary SmCCV up to January 2022 were included.
RESULTS
Twenty-nine articles describing 44 cases met our inclusion criteria. We report a new case of our hospital. The global median overall survival (mOS) was 12.00 months (95% CI = 9.31-14.69). The mOS was not reached for stage I, and it was 12.00, 12.00, 9.00, and 8.00 months for stages II, III, IVA, and IVB, respectively (statistically significant differences between stage I and stages II, III, or IVA [log rank p = .003-.017]). Thirty-five cases received local treatments (77.8%). The mOS of patients treated with surgery ± complementary chemotherapy, radiotherapy ± complementary chemotherapy, chemoradiation ± complementary chemotherapy, and surgery + radiotherapy ± complementary chemotherapy were 11.00, 12.00, 17.00, and 29.00 months, respectively. The use of adjuvant or neoadjuvant chemotherapy (64.5%, mostly platinum + etoposide) showed longer mOS (77.00 vs 15.00 months). Four of 5 tested cases presented human papillomavirus infection, 3 of them presenting type 18.
CONCLUSIONS
Small cell carcinoma of the vagina shows dismal prognosis. Multimodal local management plus complementary chemotherapy seems to achieve better outcomes. Human papillomavirus could be related to the development of SmCCV. A diagnostic-therapeutic algorithm is proposed.
Topics: Female; Humans; Algorithms; Carcinoma; Neoadjuvant Therapy; Neoplasm Staging; Prognosis; Vagina
PubMed: 36282979
DOI: 10.1097/LGT.0000000000000712 -
International Journal of Gynaecology... Mar 2016Robot-assisted laparoscopic sacrocolpopexy (RALSC) has spread rapidly without the availability of comprehensive and systematically recorded outcome data. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Robot-assisted laparoscopic sacrocolpopexy (RALSC) has spread rapidly without the availability of comprehensive and systematically recorded outcome data.
OBJECTIVE
To systematically review and compare the outcomes of laparoscopic sacrocolpopexy (LSC) and RALSC.
SEARCH STRATEGY
PubMed and Scopus were searched for reports published from 2000 to 2014, using the search terms "robotic sacrocolpopexy," "laparoscopic sacrocolpopexy," and "sacral colpopexy."
SELECTION CRITERIA
Studies were included if they directly compared the outcomes of RALSC and LSC, the sample size in each group was more than 15, the follow-up duration was longer than 3 months, and the report was in English.
DATA COLLECTION AND ANALYSIS
The studies' characteristics, quality, and outcomes were recorded. Random-/fixed-effects models were used to combine data.
MAIN RESULTS
Data on 264 RALSC and 267 LSC procedures were collected from seven studies. The mean operative time was longer in the RALSC group (245.9 minutes vs 205.9 minutes; P<0.001). The estimated blood loss in the two groups was similar (114.4 mL vs 160.1 mL; P=0.36). The differences in incidence of intraoperative/postoperative complications were also similar (P=0.85 vs P=0.92). The costs of RALSC were significantly higher than were those of LSC series in each of three studies (P<0.01 for all).
CONCLUSIONS
The clinical outcomes of prolapse surgery are similar with RALSC and LSC, but RALSC is less efficient in terms of cost and time.
Topics: Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Length of Stay; Operative Time; Patient Satisfaction; Pelvic Organ Prolapse; Postoperative Complications; Randomized Controlled Trials as Topic; Robotic Surgical Procedures; Surgical Mesh; Treatment Outcome; Vagina
PubMed: 26797199
DOI: 10.1016/j.ijgo.2015.08.008 -
Iranian Journal of Public Health May 2021Group B streptococcus or streptococcus Agalactia is a gram positive beta hemolytic bacteria which is the main factor in neonatal infections. This study aimed at... (Review)
Review
BACKGROUND
Group B streptococcus or streptococcus Agalactia is a gram positive beta hemolytic bacteria which is the main factor in neonatal infections. This study aimed at determining the prevalence of GBS in world and clarifying the rate of this infection in Islamic and non-Islamic countries.
METHODS
We performed a systematic search by using different databases including Medline, Scopus, Science Direct, Psycho-Info ProQuest and Web of Science published up to Feb 2019. We undertook meta-analysis to obtain the pooled estimate of prevalence of GBS colonization in Islamic and non-Islamic countries.
RESULTS
Among 3324 papers searched, we identified 245 full texts of prevalence of GBS in pregnancy; 131 were included in final analysis. The estimated mean prevalence of maternal GBS colonization was 15.5% (CI:95% (14.2-17)) worldwide; which was 14% (CI:95% (11-16.8)) in Islamic and 16.3% (CI:95% (14.6-18.1)) in non-Islamic countries and was statistically significant. Moreover, with regards to sampling area, prevalence of GBS colonization was 11.1 in vagina and 18.1 in vagina-rectum.
CONCLUSION
Frequent washing of perineum based on religious instructions in Islamic countries can diminish the rate of GBS colonization in pregnant women.
PubMed: 34183947
DOI: 10.18502/ijph.v50i5.6106 -
Journal of Assisted Reproduction and... Nov 2023The aim of the study was to synthesize disparate studies to investigate potential impact of microbial presence in FF of infertile women on IVF outcomes. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The aim of the study was to synthesize disparate studies to investigate potential impact of microbial presence in FF of infertile women on IVF outcomes.
METHODS
Following preliminary searches to find medical subject heading (MeSH) terms plus free terms, a systematic search was performed in the PubMed, Cochrane Library, Embase, Web of Science, and Clinicaltrials.gov databases from January 10, 2022, to July 5, 2023. Data collected for each study were analyzed using RevMan 5.4 software available on the Cochrane website.
RESULTS
After correcting for contamination from the vagina, the FFs of 289 women were detected positively by microbial culture and identification, ELISA, and IPA. The pregnancy rate of the FF-positive group was significantly lower than the FF-negative group (19.7% vs. 32.2%) and (OR: 0.57, 95% CI: 0.28-1.14, P=0.11; I=56%) while the fertilization rate was almost equal (60.0% vs. 62.0%) and (OR: 1.03, 95% CI: 0.88-1.20, P=0.72; I=0%). Evidence quality was very low.
CONCLUSIONS
The different species of microorganisms in FF of infertile women may have different effects on IVF outcomes. The Lactobacillus spp. may have a positive effect, while other microorganisms may have the opposite effect.
Topics: Pregnancy; Humans; Female; Follicular Fluid; Infertility, Female; Fertilization in Vitro; Pregnancy Rate; Vagina
PubMed: 37688752
DOI: 10.1007/s10815-023-02912-x -
Intravaginal practices, vaginal infections and HIV acquisition: systematic review and meta-analysis.PloS One Feb 2010Intravaginal practices are commonly used by women to manage their vaginal health and sexual life. These practices could, however, affect intravaginal mucosal integrity.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Intravaginal practices are commonly used by women to manage their vaginal health and sexual life. These practices could, however, affect intravaginal mucosal integrity. The objectives of this study were to examine evidence for associations between: intravaginal practices and acquisition of HIV infection; intravaginal practices and vaginal infections; and vaginal infections and HIV acquisition.
METHODOLOGY/PRINCIPAL FINDINGS
We conducted a systematic review of prospective longitudinal studies, searching 15 electronic databases of journals and abstracts from two international conferences to 31(st) January 2008. Relevant articles were selected and data extracted in duplicate. Results were examined visually in forest plots and combined using random effects meta-analysis where appropriate. Of 2120 unique references we included 22 publications from 15 different studies in sub-Saharan Africa and the USA. Seven publications from five studies examined a range of intravaginal practices and HIV infection. No specific vaginal practices showed a protective effect against HIV or vaginal infections. Insertion of products for sex was associated with HIV in unadjusted analyses; only one study gave an adjusted estimate, which showed no association (hazard ratio 1.09, 95% confidence interval, CI 0.71, 1.67). HIV incidence was higher in women reporting intravaginal cleansing but confidence intervals were wide and heterogeneity high (adjusted hazard ratio 1.88, 95%CI 0.53, 6.69, I(2) 83.2%). HIV incidence was higher in women with bacterial vaginosis (adjusted effect 1.57, 95%CI 1.26, 1.94, I(2) 19.0%) and Trichomonas vaginalis (adjusted effect 1.64, 95%CI 1.28, 2.09, I(2) 0.0%).
CONCLUSIONS/SIGNIFICANCE
A pathway linking intravaginal cleaning practices with vaginal infections that increase susceptibility to HIV infection is plausible but conclusive evidence is lacking. Intravaginal practices do not appear to protect women from vaginal infections or HIV and some might be harmful.
Topics: Africa South of the Sahara; Female; HIV Infections; Humans; Infections; Models, Biological; United States; Vagina; Vaginal Douching; Vaginosis, Bacterial
PubMed: 20161749
DOI: 10.1371/journal.pone.0009119 -
European Journal of Obstetrics,... Aug 2007This systematic review aims to identify reviews of fetal fibronectin and transvaginal cervical length for predicting preterm birth, so that these could be appraised and... (Review)
Review
This systematic review aims to identify reviews of fetal fibronectin and transvaginal cervical length for predicting preterm birth, so that these could be appraised and the findings from good quality reviews highlighted. Reviews, rather than individual studies, are the basis for this systematic review because of the proliferation of reviews and the benefits of a single, consistent appraisal and assessment of evidence from these reviews, rather than further attempts to find and appraise the many individual studies in the literature. Potentially eligible reviews were sought primarily through searches of the electronic databases MEDLINE (1966-2005), EMBASE (1980-2005), CINHAL (1982-2005), Science Citation Index (1970-2005) and The Cochrane Library (Issue 3, 2005). Our systematic review consists of a description of the two factors that might be predictive of preterm birth and for which at least one relevant review was found. The scope and quality of the identified review(s) are described, and their conclusions and the strength of these conclusions discussed. Ten reviews were identified, of which seven were included in this systematic review of reviews. The quality of each review is assessed within the following domains; the extent of searching undertaken, description of study selection and inclusion criteria, comparability of included studies, assessment of publication bias, assessment of heterogeneity and conduct of sensitivity analyses. The reviews we identified show that cervicovaginal fetal fibronectin and transvaginal sonographic cervical length measurements are clinically useful factors in predicting preterm birth. Consideration might be given to the use of both the measurement of cervicovaginal fetal fibronectin and transvaginal sonographic assessment of cervical length to identify women at increased risk of preterm birth and, potentially, to improve the outcome for these women and their babies.
Topics: Female; Fibronectins; Humans; Pregnancy; Premature Birth; Prognosis; Review Literature as Topic; Ultrasonography; Vagina
PubMed: 17452071
DOI: 10.1016/j.ejogrb.2007.03.005 -
Urology Sep 2022We reviewed neovaginal colonization and inflammatory patterns, and factors that may impact this. A systematic review of the neovaginal microbiome was conducted in... (Review)
Review
We reviewed neovaginal colonization and inflammatory patterns, and factors that may impact this. A systematic review of the neovaginal microbiome was conducted in concordance with PRISMA guidelines through October 2021. Thirteen articles were included, totaling 458 patients. Neovaginal constructions were most commonly performed with penile and scrotal skin grafts, sigmoid segments, and peritoneal grafts. The neovaginal microflora identified were generally polymicrobial and shared similarities with the native tissue. Nine studies identified Lactobacillus: 5 of 6 for penile skin, 1 of 3 for sigmoid, 1 of 1 for peritoneum, and 2 of 3 for other graft types, suggesting that the neovagina may support Lactobacillus either innately, via rectal migration or oral probiotic supplementation. A polymicrobial, bacterial vaginosis-like environment was found in 9 studies. Inflammatory markers were also described: 2 of 6 for penile skin, 2 of 3 for sigmoid, 0 of 1 for peritoneum, and 1 of 3 for other graft types. Scant data were available on the impact of postsurgical duration, oral hormones, dilating, sexual practices, or douching on the neovaginal microbiome. Understanding and optimizing the polymicrobial neovaginal microenvironment may improve surgical outcomes, specifically inflammatory, pain, and infectious. Future research should focus on standardizing testing, classification systems, and treating neovaginal dysbiosis.
Topics: Female; Hormones; Humans; Male; Microbiota; Penis; Sex Reassignment Surgery; Vagina
PubMed: 35276200
DOI: 10.1016/j.urology.2022.02.021 -
Archives of Gynecology and Obstetrics Sep 2022Despite the vaginal mucosa is able to respond to allergenic stimuli, vaginal allergic responses have been under investigated in clinical practice. Thus, we aimed to... (Review)
Review
PURPOSE
Despite the vaginal mucosa is able to respond to allergenic stimuli, vaginal allergic responses have been under investigated in clinical practice. Thus, we aimed to identify the most frequent etiological agents responsible for vulvovaginal allergies, the prevalent signs/symptoms, and the diagnostic tests applied in this clinical condition.
METHODS
Literature search was performed on PubMed, Scopus, Scielo, Web of Science, and EMBASE. The study protocol was registered on PROSPERO (CRD42020167238). Studies were divided in two groups depending on allergen exposure route. Due to a significant number of studies correlating allergy to Candida infection, subgroup analysis was included.
RESULTS
In direct exposure cases, Human Seminal Plasma was the most prevalent allergen, sensitizing 73% of affected women. These women presented localized swelling and burning as prevalent symptoms, affecting 42/68 and 36/68 women, respectively. Cutaneous Prick tests were applied in 58/68 women, either alone or combined with IgE measurements. Regarding cases of indirect/unidentified exposure, house dust mites was the most prevalent allergen (54%), followed by pollen (44%). Predominant symptoms were vulvar pruritus and burning, affecting 67/98 and 52/98 women. Skin prick test was the most prevalent diagnostic method used among different studies. Hypersensitivity toward Candida antigen was present in only half (163/323) of women presenting concomitant allergy and Candida infection.
CONCLUSION
From the two types of allergen exposure that can cause vulvovaginal allergic responses, direct contact of the antigen with the vulva and/or vagina was the most prevalent. Still, allergens can also sensitize the vaginal mucosa secondarily to other exposure route, specifically aeroallergens.
Topics: Allergens; Candidiasis; Female; Humans; Hypersensitivity; Skin Tests; Vulvovaginitis
PubMed: 34825938
DOI: 10.1007/s00404-021-06332-z