Brucellosis in pregnancy: case reports with different outcomes in an endemic region.

Different outcomes of brucellosis in pregnancy regarding the fetus/neonate and the mother are described. Medical records of five pregnant women with brucellosis were retrospectively analyzed. Patients were treated in several departments of infectious diseases in the Republic of Macedonia between 1995 and 2009. The diagnosis of brucellosis was based on clinical findings compatible with the disease supported by detection of specific antibodies. Pregnancy outcomes in patients were as follows: spontaneous abortion, intrauterine fetal death, premature delivery in two cases (one with twin pregnancy) and term delivery. One of the women experienced relapse. Follow-up results of neonates showed no infection and their normal growth and development. Brucellosis, especially if acquired in early pregnancy, can have an impact on pregnancy outcome. In endemic regions, in pregnant women with persisting fever and unspecific manifestations one should always have in mind brucellosis. In these areas, cases with unexplained spontaneous abortion, intrauterine fetal death and premature delivery should also be investigated for brucellosis.

Comparison Between HPV DNA Testing and HPV E6/E7 MRNA Testing in Women with Squamous Cell Abnormalities of the Uterine Cervix.

INTRODUCTION: The aim of the study was to compare the results of two human papillomavirus (HPV) diagnostic techniques: human papillomavirus deoxyribonucleic acid (HPV DNA) testing and human papillomavirus E6/E7 messenger ribonucleic acid (HPV E6/E7 mRNA) testing in women with squamous cell abnormalities of the uterine cervix. MATERIAL AND METHODS: Comparative prospective study, conducted in the period from January 2016 to June 2017 of 128 sexually active women, age groups of 20 to 59 years (40.50 ± 10.85) with squamous cell abnormalities on the cervical cytology. All patients were subject to: HPV DNA testing, HPV E6/E7 mRNA testing and colposcopic cervical biopsy with endocervical curettage for histopathologycal analysis. HPV DNA testing was done using multiplex polymerase chain reaction (PCR) and reverse hybridization methods. HPV E6/E7 mRNA testing was done using real-time PCR method. RESULTS: Data analysis showed an association between the results of HPV DNA testing and HPV E6/E7 mRNA testing (p˂0.0001). The concordance between the results of both tests was moderate (55.47%). The results show that HPV E6/E7 mRNA testing had a higer specificity 88.89% and positive predictive value (PPV) 93.59% for HSIL + invasive squamous cell carcinoma compared to HPV DNA testing that had specificity of 55.56% and PPV 84.61%, respectively. CONCLUSION: The results of our study suggested that HPV E6/E7 mRNA testing is more specific and has a higher positive predictive value than HPV DNA testing and that viral oncoproteins E6 and E7 are superior biomarkers for the detection of high-risk HPV-associated squamous intraepithelial lesions of the uterine cervix.

Impact of socio-demographic factors on the delayed diagnosis and advanced stage presentation of patients with invasive cervical cancer in Macedonia.

AIM: The study aims to establish certain socio-demographic factors associated with delayed presentation (i.e. advanced stage at diagnosis) in patients with invasive cervical cancer in Macedonia. MATERIALS AND METHODS: The cross-sectional study was conducted with patients already diagnosed and treated for invasive cancer of the uterine cervix who came in for their regular annual check-up at the University Radiotherapy and Oncology Clinic, Medical Faculty, Ss. Cyril and Methodius University in Skopje, Macedonia. The data were collected by interviewing the participants using a standardized questionnaire. RESULTS: A total of 115 patients were recruited in the study. Eight of them were excluded from further analysis due to incomplete data. Close to 72% of the patients analysed presented with advanced stage disease, while 28.04% of the patients were diagnosed with early stage disease. The univariate analysis and Chi-square statistics showed that the patients had a higher probability of being diagnosed with advanced stage disease if they had a low monthly income (p = 0.01), had lower degrees of education (p < 0.001), had an unsatisfactory level of genital hygiene (p < 0.001) and had no family history of invasive cervical cancer in first degree female relatives (p = 0.003). DISCUSSION: The results from the study could be utilized to identify the population at risk which should be targeted for implementation of specialized educational programmes for familiarizing the population with the nature of the disease which in turn would increase the level of consciousness as a step towards implementing a national screening programme.

Computed tomography or magnetic resonance imaging - our experiences in determining preoperative TNM staging of bladder cancer.

UNLABELLED: Bladder cancer is the ninth most common cancer diagnosis worldwide. Early detection of bladder cancer is important, since up to 47% of bladder cancer-related deaths might be avoided. AIM: To show our experience in determining the staging of bladder cancer with multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), making comparison of stage accuracy with contrast enhanced MDCT, conventional MR imaging and dynamic contrast-enhanced MR imaging on the one hand and pathoistological diagnoses after transurethral resection of the non-muscle invasive bladder cancers or radical cystectomy for patients with muscle-invasive bladder cancers. MATERIALS AND METHODS: Ninety patients with histologically proved bladder cancer were prospectively examined with MDCT, conventional and dynamic MR imaging before tumour resection. RESULTS: Staging was correct in 55.6% with CT, 56.7% with conventional MRI and in 86.7% with dynamic MRI, which was highly significant compared with CT and conventional MRI. Overestimation for superficial tumors was high with CT (31.25%) and conventional MR imaging (25%), but was significantly reduced with dynamic MR imaging (8.3%). The percentages of underestimation in surgically proved invasive tumours (pT2- pT4) were lowest with dynamic MR imaging. CONCLUSION: CT and MR imaging are less accurate in the evaluation of the depth of mural invasion and for both techniques overstaging is the most frequent error. Dynamic contrast-enhanced MRI with 87% of accuracy, 8.3% overestimation for superficial tumours and lowest underestimation for invasive tumours, make this imaging considerably more accurate.