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International Urogynecology Journal Dec 2020Er:YAG laser is frequently used in dermatology and gynecology. Clinical studies document high satisfaction rates; however, hard data on the effects at the structural and... (Review)
Review
INTRODUCTION AND HYPOTHESIS
Er:YAG laser is frequently used in dermatology and gynecology. Clinical studies document high satisfaction rates; however, hard data on the effects at the structural and molecular levels are limited. The aim of this systematic review was to summarize current knowledge about the objective effects of non-ablative Er:YAG laser on the skin and vaginal wall.
METHODS
We searched MEDLINE, Embase, Cochrane, and the Web of Science. Studies investigating objectively measured effects of non-ablative Er:YAG laser on the skin or vaginal wall were included. Studies of any design were included. Owing to the lack of methodological uniformity, no meta-analysis could be performed and therefore results are presented as a narrative review.
RESULTS
We identified in vitro or ex vivo studies on human cells or tissues, studies in rats, and clinical studies. Most studies were on the skin (n = 11); the rest were on the vagina (n = 4). The quality of studies is limited and the settings of the laser were very diverse. Although the methods used were not comparable, there were demonstrable effects in all studies. Immediately after application the increase in superficial temperature, partial preservation of epithelium and subepithelial extracellular matrix coagulation were documented. Later, an increase in epithelial thickness, inflammatory response, fibroblast proliferation, an increase in the amount of collagen, and vascularization were described.
CONCLUSIONS
Er:YAG laser energy may induce changes in the deeper skin or vaginal wall, without causing unwanted epithelial ablation. Laser energy initiates a process of cell activation, production of extracellular matrix, and tissue remodeling.
Topics: Animals; Female; Laser Therapy; Lasers, Solid-State; Rats; Skin; Vagina
PubMed: 32780174
DOI: 10.1007/s00192-020-04452-9 -
International Journal of Molecular... Aug 2022In healthy women, the cervicovaginal microbiota is characterized by the predominance of spp., whereas the overgrowth of anaerobic bacteria leads to dysbiosis, known to... (Meta-Analysis)
Meta-Analysis Review
In healthy women, the cervicovaginal microbiota is characterized by the predominance of spp., whereas the overgrowth of anaerobic bacteria leads to dysbiosis, known to increase the risk of acquiring genital infections like . In the last decade, a growing body of research has investigated the composition of the cervicovaginal microbiota associated with chlamydial infection via 16s rDNA sequencing, with contrasting results. A systematic review and a meta-analysis, performed on the alpha-diversity indices, were conducted to summarize the scientific evidence on the cervicovaginal microbiota composition in infection. Databases PubMed, Scopus and Web of Science were searched with the following strategy: "Chlamydia trachomatis" AND "micro*". The diversity indices considered for the meta-analysis were Operational Taxonomic Unit (OTU) number, Chao1, phylogenetic diversity whole tree, Shannon's, Pielou's and Simpson's diversity indexes. The search yielded 425 abstracts for initial review, of which 16 met the inclusion criteria. The results suggested that the cervicovaginal microbiota in -positive women was characterized by dominance, or by a diverse mix of facultative or strict anaerobes. The meta-analysis, instead, did not show any difference in the microbial biodiversity between -positive and healthy women. Additional research is clearly required to deepen our knowledge on the interplay between the resident microflora and in the genital microenvironment.
Topics: Chlamydia Infections; Chlamydia trachomatis; Female; Humans; Microbiota; Phylogeny; RNA, Ribosomal, 16S; Vagina
PubMed: 36076948
DOI: 10.3390/ijms23179554 -
Journal of Epidemiology and Global... Jun 2024Latina women experience disproportionately higher rates of HPV infection, persistence, and progression to cervical dysplasia and cancer compared to other racial-ethnic...
BACKGROUND
Latina women experience disproportionately higher rates of HPV infection, persistence, and progression to cervical dysplasia and cancer compared to other racial-ethnic groups. This systematic review explores the relationship between the cervicovaginal microbiome and human papillomavirus infection, cervical dysplasia, and cervical cancer in Latinas.
METHODS
The review abides by the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, EMBASE, and Scopus databases were searched from January 2000 through November 11, 2022. The review included observational studies reporting on the cervicovaginal microbiota in premenopausal Latina women with human papillomavirus infection, cervical dysplasia, and cervical cancer.
RESULTS
Twenty-five articles were eligible for final inclusion (N = 131,183). Forty-two unique bacteria were reported in the cervicovaginal microbiome of Latinas. Seven bacteria: Lactobacillus crispatus, Lactobacillus iners, Chlamydia trachomatis, Prevotella spp., Prevotella amnii, Fusobacterium spp. and Sneathia spp. were enriched across multiple stages of cervical carcinogenesis in Latinas. Therefore, the total number of reported bacteria includes four bacteria associated with the healthy state, 16 bacteria enriched in human papillomavirus outcomes, 24 unique bacteria associated with abnormal cytology/dysplasia, and five bacteria associated with cervical cancer. Furthermore, three studies reported significantly higher alpha and beta diversity in Latinas with cervical dysplasia and cancer compared to controls. Lactobacillus depletion and an increased abundance of L. iners in Latinas compared to non-Latinas, regardless of human papillomavirus status or lesions, were observed.
CONCLUSIONS
The identification of 42 unique bacteria and their enrichment in cervical carcinogenesis can guide future cervicovaginal microbiome research to better inform cervical cancer prevention strategies in Latinas.
Topics: Humans; Female; Papillomavirus Infections; Uterine Cervical Neoplasms; Hispanic or Latino; Vagina; Microbiota; Uterine Cervical Dysplasia; Carcinogenesis
PubMed: 38407720
DOI: 10.1007/s44197-024-00201-z -
Zoonoses and Public Health Dec 2014Q fever in humans and coxiellosis in livestock are both caused by Coxiella burnetii. The public health importance of vaccination against C. burnetii shedding from sheep... (Meta-Analysis)
Meta-Analysis Review
A systematic review and meta-analysis of phase I inactivated vaccines to reduce shedding of Coxiella burnetii from sheep and goats from routes of public health importance.
Q fever in humans and coxiellosis in livestock are both caused by Coxiella burnetii. The public health importance of vaccination against C. burnetii shedding from sheep and goats was evaluated using systematic review and meta-analysis to provide evidence for policy direction to prevent potential zoonotic spread. Publications reporting shedding of C. burnetii in vaginal and uterine secretions, milk, placenta and faeces were included. A single observational (one goat) and seven experimental (four goat and three sheep) vaccine studies were included in the review. No relevant publications on other interventions were identified. Random effects meta-analyses were performed for the risk of shedding in individuals in the control and vaccinated groups and for the mean difference in the level of bacterial shedding in sheep and goats stratified by age and previous exposure status. Limited data were available for further analytic evaluation. From the pooled analysis, an inactivated phase I vaccine significantly reduced the risk of shedding from uterine (RR = 0.10; 95%CI 0.05-0.20) secretions in previously sensitized goats. Individual studies reported significant risk reduction in milk (RR = 0.03; 95%CI 0.01-0.26), vaginal secretions (RR = 0.40; 95%CI 0.22-0.75) and faeces (RR = 0.79; 95%CI 0.63-0.97) from naïve goats. The pooled mean levels of bacteria shed from placental [mean difference (MD = -5.24 Log10 ; 95%CI -6.75 to -3.7)] and vaginal (MD = -1.78 Log10 ; 95%CI -2.19 to -1.38) routes were significantly decreased in vaccinated naïve goats compared with controls. Shedding through all other routes from vaccinated goats was not significantly different than shedding from control goats. No effect of vaccination was found on the risk of shedding or the mean level of shedding in vaccinated sheep compared with control sheep. Our conclusions are based on a limited amount of data with variable risk of systematic error.
Topics: Animals; Bacterial Shedding; Bacterial Vaccines; Coxiella burnetii; Feces; Female; Goat Diseases; Goats; Humans; Milk; Pregnancy; Public Health; Q Fever; Sheep; Sheep Diseases; Vaccination; Vaccines, Inactivated; Vagina; Zoonoses
PubMed: 24251777
DOI: 10.1111/zph.12086 -
Archives of Gynecology and Obstetrics Feb 2021The aim of the present study was to determine the prevalence of E. coli and extended-spectrum β-lactamase-producing (ESBL) E. coli in pregnant women in a systematic... (Meta-Analysis)
Meta-Analysis
PROPOSE
The aim of the present study was to determine the prevalence of E. coli and extended-spectrum β-lactamase-producing (ESBL) E. coli in pregnant women in a systematic review and meta-analysis study.
METHODS
We searched important databases, including Medline (PubMed), Embase, Scopus, Web of sciences, Cochrane library, Ovid, and CINHAL to retrieve all articles reporting the prevalence of ESBL E. coli in pregnant women that published from January 1990 to June 2020.
RESULTS
The pooled prevalence of E. coli in pregnant women with and without symptoms of UTI after combining 82 studies with a sample size of 33,118 was 29% (29%; %95 CI 23, 36%). The prevalence based on urine, Feacal, and vagina samples was 26% (% 95 CI 19-34%), 77% (% 95 CI 22-98%), and 32% (% 95 CI 17-48%), respectively. Also, 19 studies with a sample size of 9,200 reported ESBL E. coli prevalence in pregnant women. After combining the results of these studies, the pooled prevalence of ESBL E. coli in pregnant women was 34% (34%; %95 CI 24, 43%). The pooled prevalence of E. coli in pregnant women with HIV was 9%(9%; %95 CI 7, 11%).
CONCLUSION
According to the results of this study, the prevalence of E. coli and ESBL E. coli is high in pregnant women. Also, the overuse of antibiotics was higher in European and Asian pregnant women than other continents.
Topics: Adult; Anti-Bacterial Agents; Escherichia coli; Escherichia coli Infections; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Pregnant Women; Prevalence; beta-Lactamases
PubMed: 33386957
DOI: 10.1007/s00404-020-05903-w -
International Urogynecology Journal Dec 2017The treatment of post-hysterectomy vaginal vault prolapse (VVP) has been investigated in several randomized clinical trials (RCTs), but a systematic review of the topic... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION AND HYPOTHESIS
The treatment of post-hysterectomy vaginal vault prolapse (VVP) has been investigated in several randomized clinical trials (RCTs), but a systematic review of the topic is still lacking. The aim of this study is to compare the effectiveness of treatments for VVP.
METHODS
We performed a systematic review and meta-analysis of the literature on the treatment of VVP found in PubMed and Embase. Reference lists of identified relevant articles were checked for additional articles. A network plot was constructed to illustrate the geometry of the network of the treatments included. Only RCTs reporting on the treatment of VVP were eligible, conditional on a minimum of 30 participants with VVP and a follow-up of at least 6 months.
RESULTS
Nine RCTs reporting 846 women (ranging from 95 to 168 women) met the inclusion criteria. All surgical techniques were associated with good subjective results, and without differences between the compared technique, with the exception of the comparison of vaginal mesh (VM) vs laparoscopic sacrocolpopexy (LSC). LSC is associated with a higher satisfaction rate. The anatomical results of the sacrocolpopexy (laparoscopic, robotic [RSC]. and abdominal [ASC]) are the best (62-91%), followed by the VM. However, the ranges of the anatomical outcome of VM were wide (43-97%). The poorest results are described for the sacrospinal fixation (SSF; 35-81%), which also correlates with the higher reoperation rate for pelvic organ prolapse (POP; 5-9%). The highest percentage of complications were reported after ASC (2-19%), VM (6-29%), and RSC (54%). Mesh exposure was seen most often after VM (8-21%). The rate of reoperations carried out because of complications, recurrence prolapse, and incontinence of VM was 13-22%. Overall, sacrocolpopexy reported the best results at follow-up, with an outlier of one trial reporting the highest reoperation rate for POP (11%). The results of the RSC are too small to make any conclusion, but LSC seems to be preferable to ASC.
CONCLUSIONS
A comparison of techniques was difficult because of heterogeneity; therefore, a network meta-analysis was not possible. All techniques have proved to be effective. The reported differences between the techniques were negligible. Therefore, a standard treatment for VVP could not be given according to this review.
Topics: Female; Gynecologic Surgical Procedures; Humans; Hysterectomy; Laparoscopy; Pelvic Organ Prolapse; Postoperative Complications; Sacrum; Surgical Mesh; Treatment Outcome; Vagina
PubMed: 29038834
DOI: 10.1007/s00192-017-3493-2 -
Colorectal Disease : the Official... Sep 2017To assess the outcomes of recto-vaginal reinforcement procedures in adults with chronic constipation. (Review)
Review
AIM
To assess the outcomes of recto-vaginal reinforcement procedures in adults with chronic constipation.
METHOD
Standardised methods and reporting of benefits and harms were used for all CapaCiTY reviews that closely adhered to PRISMA 2016 guidance. Main conclusions were presented as summary evidence statements with a summative Oxford Centre for Evidence-Based Medicine (2009) level.
RESULTS
Forty-three articles were identified, providing data on outcomes in 3346 patients. Average length of procedures ranged between 20 and 169 min, and length of stay between 1 and 15 days. Complications typically occurred after 7-17% of procedures (range 0-61%). Post-operative bleeding was uncommon (0-4%) as well as haematoma or sepsis (0-2%). Fistulation did not occur in most studies. Two procedure-related deaths were observed for 3209 patients. Although inconsistent, 78% of patients reported a satisfactory or good outcome, with 30-50% experiencing reduced symptoms of straining, incomplete emptying or reduced vaginal digitation. About 17% of patients developed anatomical recurrence. Considering measures of harm and global satisfaction rating scales, there was insufficient evidence to prefer one type of procedure over another. There was no evidence to support better outcomes based on selection of patients with a particular size or grade of rectocoele.
CONCLUSION
Evidence supporting recto-vaginal reinforcement procedures is currently derived from observational studies and comparisons, with only one high quality study. Large trials are needed to inform future clinical decision making.
Topics: Chronic Disease; Constipation; Female; Humans; Length of Stay; Operative Time; Patient Satisfaction; Patient Selection; Postoperative Complications; Practice Guidelines as Topic; Rectocele; Rectum; Recurrence; Treatment Outcome; Vagina
PubMed: 28960924
DOI: 10.1111/codi.13781 -
Gynecologic Oncology May 2014The purpose of this study is to summarize the data on the incidence, clinical behavior and overall survival of patients with glassy cell cervical carcinoma (GCCC). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The purpose of this study is to summarize the data on the incidence, clinical behavior and overall survival of patients with glassy cell cervical carcinoma (GCCC).
METHODS
Twenty-four case series and fifteen case reports identified by searching PubMed database qualified for inclusion in this study. The published cases were combined with data from a retrospective chart review of patients with GCCC in two major teaching hospitals in Brooklyn, NY.
RESULTS
A total of 292 cases were collected through our literature and chart review. Median age at diagnosis was 45 years old (range 12-87 years of age). GCCC incidence ranges from 0.2 to 9.3% of all cervical cancers and 2 to 30.2% of cervical adenocarcinomas. The stage distribution is similar to squamous cell carcinoma with 79% of the patients being diagnosed with Stage I or II disease. Most common sites of recurrence for Stage I patients are the vagina and pelvis. In Stage II patients locoregional and distant metastases are equally common. Recurrence rate was higher among patients treated only with surgery (32.7%), as compared to patients treated with surgery followed by radiation (11%) or patients treated with radiation only (10%). Median overall survival (OS) was 25 months (95% CI 8.4-41.6). Overall 5-year survival for all stages is lower when compared to all cervical cancers (54.8% vs 75%). There was no interaction between race and OS (p=0.66).
CONCLUSION
GCCC is a rare histologic type of cervical cancer that presents at a younger age, is associated with high risk for distant failure and carries worse prognosis as compared to the squamous cell type. Radiation therapy is associated with decreased risk of recurrence.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Carcinoma, Adenosquamous; Child; Combined Modality Therapy; Female; Humans; Hysterectomy; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Radiotherapy; Retrospective Studies; Uterine Cervical Neoplasms; Young Adult
PubMed: 24503463
DOI: 10.1016/j.ygyno.2014.01.048 -
Systematic Reviews Mar 2015Recognition that ascending infection leads to preterm birth has led to a number of studies that have evaluated the treatment of vaginal infections in pregnancy to reduce... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recognition that ascending infection leads to preterm birth has led to a number of studies that have evaluated the treatment of vaginal infections in pregnancy to reduce preterm birth rates. However, the role of candidiasis is relatively unexplored. Our aim was to undertake a systematic review and meta-analysis to assess whether treatment of pregnant women with vulvovaginal candidiasis reduces preterm birth rates and other adverse birth outcomes.
METHODS
We undertook a systematic review and meta-analysis of published randomised controlled trials (RCTs) in which pregnant women were treated for vulvovaginal candidiasis (compared to placebo or no treatment) and where preterm birth was reported as an outcome. Trials were identified by searching the Cochrane Central Register of Controlled Trials, Medline and Embase databases to January 2014. Trial eligibility and outcomes were pre-specified. Two reviewers independently assessed the studies against the agreed criteria and extracted relevant data using a standard data extraction form. Meta-analysis was used to calculate pooled rate ratios (RR) and 95% confidence intervals (CI) using a fixed-effects model.
RESULTS
There were two eligible RCTs both among women with asymptomatic candidiasis, with a total of 685 women randomised. Both trials compared treatment with usual care (no screening for, or treatment of, asymptomatic candidiasis). Data from one trial involved a post-hoc subgroup analysis (n = 586) of a larger trial of treatment of 4,429 women with asymptomatic infections in pregnancy and the other was a pilot study (n = 99). There was a significant reduction in spontaneous preterm births in treated compared with untreated women (meta-analysis RR = 0.36, 95% CI = 0.17 to 0.75). Other outcomes were reported by one or neither trial.
CONCLUSIONS
This systematic review found two trials comparing the treatment of asymptomatic vaginal candidiasis in pregnancy for the outcome of preterm birth. Although the effect estimate suggests that treatment of asymptomatic candidiasis may reduce the risk of preterm birth, the result needs to be interpreted with caution as the primary driver for the pooled estimate comes from a post-hoc (unplanned) subgroup analysis. A prospective trial with sufficient power to answer the clinical question 'does treatment of asymptomatic candidiasis in early pregnancy prevent preterm birth' is warranted.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42014009241.
Topics: Adult; Candida; Candidiasis; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Premature Birth; Vagina
PubMed: 25874659
DOI: 10.1186/s13643-015-0018-2 -
Archives of Gynecology and Obstetrics Mar 2015To estimate the accuracy of pelvic magnetic resonance imaging (MRI) in the diagnosis of deeply infiltrating endometriosis (DIE). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To estimate the accuracy of pelvic magnetic resonance imaging (MRI) in the diagnosis of deeply infiltrating endometriosis (DIE).
METHODS
A comprehensive search of the Medline, Pubmed, Lilacs, Scopus, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Biomed Central, and ISI Web of Science databases was conducted from January 1990 to December 2013. The medical subject headings (MeSHs) and text words "deep endometriosis", "deeply infiltrating endometriosis", "DIE", "magnetic resonance", and "MRI" were searched. Studies that compared the parameters of pelvic MRIs with those of paraffin-embedded sections for the diagnosis of DIE were included.
RESULTS
Twenty studies were analyzed, which included 1,819 women. Pooled sensitivity and specificity were calculated across eight subgroups: for all sites, these were 0.83 and 0.90, respectively; for the bladder, 0.64 and 0.98, respectively; for the intestine, 0.84 and 0.97, respectively; for the pouch of Douglas, 0.89 and 0.94, respectively; for the rectosigmoid, 0.83 and 0.88, respectively; for the rectovaginal, 0.77 and 0.95, respectively; for the uterosacral ligaments, 0.85 and 0.80, respectively; and for the vagina and the posterior vaginal fornix, 0.82 and 0.82, respectively.
CONCLUSION
In summary, pelvic MRI is a useful preoperative test for predicting the diagnosis of multiple sites of deep infiltrating endometriosis.
Topics: Abdominal Cavity; Adnexa Uteri; Endometriosis; Female; Humans; Magnetic Resonance Imaging; Pelvis; Predictive Value of Tests; Preoperative Care; Sensitivity and Specificity; Vagina
PubMed: 25288268
DOI: 10.1007/s00404-014-3470-7