Role of Molecular Biomarkers in Endometriosis-Related Infertility: A Narrative Review of the Literature.

Endometriosis is a chronic benign inflammatory disease that affects women of reproductive age. The clinical presentations of endometriosis include dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. There is a well-established association between endometriosis and infertility. Therefore, there is a need for an early diagnosis of endometriosis-related infertility. In this study, we aim to identify the role of biomarkers as predictive factors of the presence of the disease and its severity and their correlation with the pregnancy outcome. We performed an electronic database search of all published studies in PubMed and EMBASE from January 2018 to May 2023. Numerous innovative biomarkers identified in cases of endometriosis and infertility have been studied over the past years, including micro-RNAs, BCL6 endometrial expression, cytotoxic T-lymphocyte antigen 4, human leukocyte antigen G, programmed cell death protein 1, programmed cell death ligand 1 immune checkpoint molecules, plasma fibronectin-fibrin complexes, homeobox A10 gene, systemic inflammatory response markers, uterine natural killer cells, and the eutopic endometrium proteome. Considerable research has been done to identify diagnostic biomarkers for the early detection and prevention of endometriosis-associated infertility. However, none of these biomarkers displayed enough diagnostic accuracy to be used in daily clinical practice. Future research is valuable to establish them as reliable diagnostic tools.

Pregnancy physical activity questionnaire: Translation and cross-cultural adaptation of a Greek version.

OBJECTIVE: The aim of this study was to translate and adapt the Pregnancy Physical Activity Questionnaire (PPAQ) into Greek culture. STUDY DESIGN: The procedure followed to translate the PPAQ included the stages: forward translation, synthesis, backward translation and an expert committee review. Members of the research team discussed ambiguities, discordances and equivalence at each stage. Then, the pre-final Greek version of the PPAQ was pre-tested on 46 pregnant women; a quantitative and qualitative analysis was conducted. RESULTS: Few modifications were done to the original PPAQ, in order to ensure cultural adaptation and clinical implementation. Appropriate changes to the international metric units were done. In addition, two items have been modified to achieve relevance with Greek culture. Two items were merged into one and three items were splitted, which maintained their initial meaning. Those changes were made to match the energy expenditure compendium update for physical activities. Participants at the pre-test had a mean age of 34,23 years, response time to the questionnaire varied between 5 and 10 min and there were no missing data. No difficulties or misunderstandings were reported by the participants during pre-testing. Thus, the research team agreed on the pre-final PPAQ Greek version. CONCLUSION: The final PPAQ Greek version indicated transcultural equivalence to the original PPAQ in English. It is also a unique questionnaire for assessing physical activity in Greek pregnant women and will be a useful tool in clinical routine.

Awareness Regarding Human Papilloma Virus Among Health Professionals and Will to Accept Vaccination: A Systematic Review.

Human Papilloma Virus (HPV) infection is the most common sexually transmitted disease and the leading cause of cervical cancer. The undeniable causal link between HPV and cervical cancer led to the creation of HPV prophylactic vaccines. Health professionals are key in counseling parents about their children's immunization, as they are considered valid and reliable sources of information. The systematic review aimed to determine doctors' and nurses' knowledge of HPV, their awareness of the vaccine, and their willingness to accept vaccination. Systematic studies were conducted from 2015 to January 2022 in Medline/PubMed and Google Scholar online databases. The systematic review included 10 good-quality cross-sectional studies and a total of 6700 participants who were administered self-administered questionnaires or personal interviews. From the analysis of most of the studies, it is demonstrated that health professionals have a satisfactory level of knowledge about HPV infection and its effects on human health, even if their knowledge gap in essential details regarding the virus and HPV vaccination is apparent. It was found that various factors regarding health professionals, such as their specialty, gender, working environment, weekly working hours, and the interval since their last HPV training, contribute to forming their knowledge level about HPV and vaccination. In addition, most studies show that most healthcare professionals knew about the existence of HPV vaccines but did not know many details about how their work and their potential benefits. In conclusion, the provision of counseling by health professionals is currently estimated to be the strongest predictor of target group compliance with the HPV vaccine. Consequently, it is essentially considered to investigate the HPV-related knowledge level among health workers and to intensively reeducate them regarding the HPV infection risks and the necessity of HPV vaccination to improve their awareness and strengthen their attitude in favor of vaccination against cervical cancer.

Rupture of Ectopic Ovarian Pregnancy Accompanied by Massive Intra-abdominal Bleeding and Disorder of the Coagulation Mechanism: A Rare and Life-Threatening Obstetric Complication.

The rupture of ectopic ovarian pregnancy accompanied by massive intra-abdominal bleeding is a rare obstetric complication, occurs predominantly in the first trimester of pregnancy, and can be dangerous and life-threatening for the pregnant woman. Our case describes a 37yr old woman with a history of 4 lower segment Cesarian sections (LSCS) (Caesarean sections) and multiple surgical abortions, presenting at the ER with acute abdomen symptoms. The patient's hemodynamic status was unstable. The positive urine pregnancy test combined with the clinical and ultrasound findings established the diagnosis of the ruptured ectopic pregnancy, and immediate surgical treatment was decided. During surgery, a large amount of blood was found in the peritoneal cavity, resulting from a rupture of the right ovary and accompanied by hemorrhagic infiltration of adjacent tissues, without participation in the damage of the ipsilateral fallopian tube. It was deemed necessary to remove the ipsilateral adnexa and whole blood transfusion. The patient was discharged from our department on the fourth postoperative day. The price of beta-chorionic gonadotropic hormone was on a downward trend. Three weeks later, the level of beta-chorionic gonadotropic hormone was zero. In the present paper, a brief review is attempted regarding the diagnostic and therapeutic approach for patients with ruptured ectopic ovarian pregnancy after describing the case.

Primary Fallopian Tube Carcinoma: An Extremely Rare Gynecological Cancer Misdiagnosed Intraoperatively as Benign Ovarian Neoplasm: A Case Report.

Primary fallopian tube carcinoma is very rare. Diagnosis is challenging. The description of our case concerns an asymptomatic 71-year-old patient who came for a routine gynecological examination. Imaging of the pelvis revealed the presence of a two-chambered cystic formation in the anatomical position of the right ovary. It was decided to investigate the disease by laparotomy. Examination of the frozen section from the site of the cystic lesion was negative for malignancy. An abdominal total hysterectomy was performed with bilateral salpingo-oophorectomy. Serous carcinoma of the fallopian tube was diagnosed postoperatively by histological examination of the surgical preparation. Immediately after surgery, the patient's health was good.The patient was referred to an oncology center and was monitored. Chemotherapy based on platinum and taxane was recommended. Six months after the operation the patient is in good health. The possibility of a second surgery to treat fallopian tube cancer with pelvic lymph node dissectionis under discussion and is expected to be decided by oncologists and gynecologists-oncologists. In this article, after describing the case report, a brief review of this rare entity disease's diagnostic and therapeutic approach is attempted.

Surgical Treatment of Ovarian Pregnancy.

The description of this case concerns the early diagnosis and the surgical treatment of a patient diagnosed with an ectopic ovarian pregnancy. A gravida 2, para 0 woman with a history of termination of pregnancy in the second trimester, was referred to the outpatients of the Gynecologic Department of the General Hospital of Trikala, reporting vaginal bleeding, accompanied by a deep, mild pain in the abdomen for a few days. The urine pregnancy test was positive. The transvaginal ultrasound in combination with the ß-chorionic gonadotropin level was indicative of an ectopic pregnancy, and the surgical treatment of the patient was decided. Intraoperatively, the presence of an ovarian ectopic pregnancy was detected, and a wedge resection of the affected ovary was performed. The patient was discharged from our clinic on the third postoperative day, with instructions for weekly follow-up of the ß-chorionic gonadotropin level until it returns to normal values.