Comparative effects of denosumab or bisphosphonate treatment on bone mineral density and calcium metabolism in postmenopausal women.

OBJECTIVES: To clarify potential differences between denosumab (DNS) and bisphosphonates (BIS) in terms of bone density and bone metabolism, in a sample of postmenopausal women. METHODS: A total of 113 postmenopausal women aged 53-66 years were treated with either DNS or BIS for 12 months. Bone densitometry and laboratory tests were compared between baseline and follow-up. RESULTS: Femoral neck BMD increased in both treatment-arms (FN-BMD, DNS: 0.69±0.07 g/cm2 to 0.75±0.09 g/cm2; BIS: 0.69±0.06 g/cm2 to 0.71±0.07 g/cm2; p≤0.001 in both cases). Lumbar spine BMD (LS-BMD) increased significantly only in the DNS-group (0.83±0.14 g/cm2 to 0.89±0.14 g/cm2, p=0.0001). Only women under treatment with DNS had a significant increase in serum parathyroid hormone (PTH: 44.87±17.54 pg/mL to 53.27±15.77 pg/mL, p=0.04), independently of baseline vitamin D levels. DNS-administration resulted in higher increase from baseline in FN-BMD compared to BIS (DNS vs BIS: 8.7%±8.5 vs 3.8%±7.3, p=0.004). Finally, baseline 25OH vitamin D levels did not determine the extent of PTH-increase following administration of DNS- or BIS-treatment. CONCLUSIONS: Both treatments increased BMD, however, the effect of DNS on FN-BMD was superior compared to that of BIS. DNS-treatment increased serum PTH. Baseline 25OH vitamin D levels did not predict the extent of PTH increase at follow-up.

External-cause mortality among adolescents and young adults in Greece over the millennium's first decade 2000-09.

BACKGROUND: Several important socio-behavioral public health problems that either peak or start during the second decade of life contribute to young people's mortality. The aim of this study was to explore patterns, rates, trends and regional variations of external-cause (due to environmental events/circumstances) mortality among young people aged 10-24 years in Greece, over the decade 2000-09. METHODS: Data were electronically derived from the database of the Hellenic Statistical Authority to study general and specific mortality rates by major causes of death. RESULTS: Road traffic crashes (RTCs), illicit drug use and suicide accounted for 65.8, 14.7 and 4.8%, of total external-cause mortality, respectively. Mortality rates (deaths per 100 000) did not exhibit intra-country variability, were higher in young adults than in adolescents, in males than in females and decreased by 39%, from 33.6 in 2000 to 20.4 in 2009 (P < 0.001), due to declines in mortality from RTCs (from 21.3 to 14.3; P = 0.001), substance abuse (from 5.1 to 2.1; P = 0.003) and suicides (from 2.0 to 0.9; P = 0.003). CONCLUSIONS: External causes of young people's mortality were mainly psychosocial and behavioral in origin. Despite improvement over the decade, young people in Greece still have unmet health-care needs and may further benefit from a multipronged public health approach through improved youth-friendly health services.

The role of mTOR signaling pathway in premalignant and malignant cervical lesions.

PURPOSE OF THE STUDY: Aberrant activation of the Akt/mTOR/pS6 signaling pathway has been identified in various types of cancer and is under investigation in cervical cancer. The purpose of this study was to assess the expression of the phosphorylated/activated forms of Akt (upstream molecule), 4E-BP1 and pS6 (downstream molecules) in biopsy samples of cervical low grade squamous intraepithelial lesions (LSIL), high grade squamous intraepithelial lesions (HSIL), and squamous cell carcinoma (Ca) compared to normal cervical epithelium. MATERIAL AND METHODS: The study included 38 cases diagnosed as LSIL, 31 cases as HSIL, 29 cases as Ca, and eight control cases from normal cervix. Immunohistochemistry was used to assess the expression of pAkt, p4E-BP1 and pS6. RESULTS: Statistical analysis revealed significant differences between HSIL and Ca groups compared to controls regarding intensity, positivity, and total scores for all three molecules (p < 0.001). A trend for higher expression with increasing grade of dysplasia was demonstrated. CONCLUSION: These results strongly support the view that the mTOR signaling pathway is involved in cervical carcinogenesis.

IVF/ICSI frozen replacement cycles; every cycle? Opinion expressed after a systematic review of the literature.

OBJECTIVE: To determine whether in vitro fertilization (IVF), frozen replacement cycles offer better outcomes than fresh cycles in order to support, or not, a possible shift towards total replacement of fresh IVF/intracytoplasmic sperm injection (ICSI) cycles from frozen elective transfers (FETs). STUDY DESIGN: Systematic review; opinion paper. RESULTS: Initial results seem to support a shift in current practice towards frozen cycles. CONCLUSION: Initial results may support replacement all fresh IVF/ICSI cycles with FETs, as this could be a safer and equally effective strategy. However, robust evidence from randomized controlled trials is needed if this will be generally applied.

Epidemiological, clinical, and virological characteristics of women with genital warts in Greece.

This is a prospective study of the epidemiological, clinical, and virological characteristics of cases of genital warts in a Greek University Hospital. The women completed a questionnaire regarding their medical and sexual history and underwent cervical cytology, HPV DNA typing, mRNA testing, colposcopy, Chlamydia testing, and proctoscopy. Univariate and multivariate analyses were performed. The most commonly detected types were type 6 (36.1%) and 16 (24.3%). E6/E7 mRNA testing was positive in 21.5%. Concurrent cervical intraepithelial neoplasia grade 2 or worse was found in 11.1% and intra-anal warts in 10.4%. For chlamydial infection the number of sexual partners was a significant predictor. Women with warts infected with types 6 and 11 constituted only 37.5% of the total. This could have a negative effect on the efficacy of vaccination in reducing the incidence of the disease. Based on the present findings the authors recommend cytology and colposcopy for all women with genital warts.

A rare case report of squamous-cell carcinoma arising from mature cystic teratoma of ovary.

The most frequent ovarian germ cell tumors are mature cystic teratomas (MCTs), composing 10-25% of all ovarian neoplasms. MCTs have the potential of undergoing malignant transformation, typically in postmenopausal women, with a frequency of 0.17-3%, with squamous cell carcinoma being the most common malignant tumor arising from MCT. We present the rare clinical entity of a squamous cell carcinoma arising from a mature cystic teratoma in a 56-year-old premenopausal woman as well as diagnostic and therapeutic route followed.

MTHFR C677T polymorphism modifies the effect of HRT on metabolic parameters in postmenopausal women.

OBJECTIVE: To assess the interaction of the MTHFR C677T polymorphism with changes in lipid and glucose metabolism effected by oral hormone replacement therapy (HRT) in postmenopausal women. METHODS: In this open-label, prospective, interventional study, parameters of lipid and glucose metabolism, as well as homocysteine, were assessed in 97 postmenopausal women at baseline and 1 year after the initiation of HRT. Participants were stratified into three subgroups, according to the MTHFR C677T polymorphism (wild-type: CC genotype; heterozygous: CT genotype; homozygous for the mutant variable: TT genotype). RESULTS: The TT genotype was associated with an elevation of total and low density lipoprotein (LDL) cholesterol, while CT and CC genotypes were associated with a reduction of total cholesterol and LDL cholesterol after 1 year of HRT (p = 0.032 for total cholesterol and p = 0.002 for LDL cholesterol). Women with the TT genotype had higher glucose levels in contrast to women with the CC genotype who had lower glucose levels after 1 year of HRT (p = 0.011). Additionally, CC carriers under HRT had a significant elevation of apolipoprotein A1 levels (p = 0.018), contrarily to CT and TT genotypes. CONCLUSION: While HRT was associated with favorable changes in lipid and metabolic parameters in carriers of the CC genotype, this effect was not evident in carriers of the T allele. The MTHFR C677T polymorphism may modify the effect of HRT on lipid and metabolic parameters in postmenopausal women.

Gene receptor polymorphism as a risk factor for BMD deterioration in adolescent girls with anorexia nervosa.

Anorexia nervosa is a serious eating disorder that is associated with decreased bone mineral density and greater lifetime risk for fractures. This case-controlled study, analyzed single nucleotide polymorphisms of genes encoding vitamin D receptor, estrogen receptor alpha (ESR1), collagen type I and calcitonin receptor (CTR). Relationships between genotype and body mass index, cycling status and lumbar spine bone mineral density (LBMD) were determined in 40 adolescent girls with anorexia nervosa and 10 age-matched controls. The distribution of CTR-AluI genotypes differed between groups, but this polymorphism was not associated with LBMD Z-score. Distribution of ESR1-XbaI genotypes did not differ between groups, but the AA genotype was associated with decreased LBMD Z-score (≤-1) (OR = 24.79, 95% CI, 1.01-606.08). Carriers of the A allele were more likely to have decreased LBMD Z-scores compared with carriers of the G allele (OR = 4.12, 95% CI, 1.23-13.85, p = 0.022). In conclusion, our study shows that anorexic patients with wild-type genotype ESR-XbaI receptor are in greater risk for decreased BMD in relation to those with the mutated gene. Prompt recognition of these patients is crucial because early administration of the proper therapeutic treatment may contribute to the prevention of adverse sequelae on bone metabolism.

Corticotropin-releasing hormone and progesterone plasma levels association with the onset and progression of labor.

UNLABELLED: PURPOSE OF LNVESTIGATION: To examine the relationship between maternal plasma progesterone along with corticotropin- releasing hormone (CRH) plasma levels and the progression of labor. MATERIALS AND METHODS: Maternal serum CRH and progesterone were measured during the latent phase of labor, active labor, and 24 hours postpartum in women who went into spontaneous labor and delivered vaginally at term. Progesterone (P) levels in women delivered by an elective cesarean section at term were also measured as baseline. RESULTS: Mean maternal plasma P was 18% higher in the active phase than in the latent phase of labor (p < 0.01), and declined significantly by 24 hours postpartum (p < 0.001). Mean level of serum CRH was 24% higher in the active phase than in the latent phase of labor (p < 0.01), and subsequently declined significantly by 24 hours postpartum (p < 0.001). CONCLUSIONS: As labor progresses, P and CRH increase and subsequently decrease precipitously in the immediate postpartal period. P levels tend to drop in women who are in early labor compared with non-laboring full-term women.

Mediators of chronic inflammation in polycystic ovarian syndrome.

Polycystic ovarian syndrome (PCOS) is an endocrine disorder affecting 5-10% of reproductive-age women. Hyperandrogenemia, which characterizes the syndrome, stimulates the maturation of adipocytes and favors central obesity. The linking hub between obesity and other metabolic manifestations of the syndrome seems to be chronic low-grade inflammation. We discuss the most reliable current data regarding the role of inflammatory mediators in PCOS, with particular focus on the genetic mechanisms implicated. C-reactive protein levels are 96% higher in PCOS patients than in healthy controls. Patients with the -308A polymorphism of the tumor necrosis factor-α gene have elevated androgens in comparison with carriers of the -308G. Interleukin 18 (IL-18) is elevated in lean patients, with a further rise in the presence of obesity and insulin resistance. Polymorphisms of the IL-1a, IL-1b and IL-6 genes have also been associated with PCOS. Plasminogen activator inhibitor-1 levels are positively associated with the syndrome, and carriers of the 4G allele of the 4G/5G polymorphism are at risk of developing PCOS. Other mediators discussed include adhesion molecules, osteoprotegerin, asymmetric dimethylarginine, homocysteine and advanced glycation end-products. The elucidation of the pathogenetic mechanisms implicated in PCOS and their connection with low-grade inflammation may in the future offer the opportunity for the formulation of novel therapeutic strategies and individualized therapy for these patients.

Management of hematocolpos in adolescents with transverse vaginal septum.

AIM: The aim of this study was to underline the significance of premenarcheal gynecological examination in patients with transverse vaginal septum that could possibly be complicated with endometriosis. DESIGN: Retrospective study including the period between January 2008 and December 2010. SETTING: Second Department of Obstetrics and Gynecology. PATIENTS: We searched our databases regarding cases of hematocolpos caused by transverse vaginal septum. MAIN OUTCOME: Among the patients presented with hematocolpos we identified 4 cases caused by transverse vaginal septum. RESULTS: We present the management of these cases regarding diagnosis, differential diagnosis, and treatment. The mean age of the patients was 13.1 years. All patients presented in our department with hypogastric abdominal pain and hematocolpos. No problems in adrenarche or thelarche were mentioned. The U/S and MRI revealed a normal cystic in the upper part of the vagina--hematocolpos varying from 42 × 26 × 30 to 73 × 55 × 32 mm. Three of the patients had an upper transverse vaginal septum while one had a middle transverse vaginal septum. Only one patient had a concomitant anomaly of the urinary system (ectopic kidney). In our patients, after laparoscopic examination 3 out of 4 patients had findings of endometriosis (2/3 with stage I-minimal endometriosis and 1/3 with stage II-mild endometriosis). CONCLUSION: Physicians should be aware of transverse vaginal septum in the differential diagnosis of hematocolpos with abdominal pain and primary amenorrhea in the early adolescent years. Early diagnosis could be based on premenarcheal gynecological examination and could lead to correct management in order to avoid the complications of endometriosis (dysmenorrhea or infertility).

A rare case of postpartum thrombocytosis. Differential diagnosis and management.

This is a case of a 43-year-old primigravida primipara woman who presented in our Department in 36 weeks gestational age and underwent caesarean section due to preeclampsia. From her history, it was known that her pregnancy was an in vitro fertilization (IVF) result. She also received low molecular weight heparin because of thrombophilia (protein S insufficiency). We present this case of postpartum thrombocytosis and discuss the differential diagnosis of this condition through the presentation of its management.

Noncanalized horns of uterus didelphys with prolapse: a unique case in a young woman.

The authors report the unique case of a 20-year-old patient with prolapsed uterus didelphys with noncanalized horns, who complained of primary amenorrhea. Clinical examination revealed a rudimentary noncanalized cervix with a third degree prolapse and no palpable uterus. A small prolapsing remnant of a uterus didelphys with 2 noncanalized uterine horns was excised by laparotomy. Ultrastructural examination of subepithelial cervical connective tissue revealed collagen of normal structure, but of low concentration. The etiologies of both the Mullerian ducts anomalies and the genital prolapse are probably multifactorial. Low collagen concentration indicates a constitutional tissue weakness contributing to the development of genital prolapse.

Human papilloma virus molecular profile and mechanisms of cancerogenesis: a review.

Human papilloma virus (HPV) is frequently present in the genital tract. It causes various lesions at the mucosa of both sexes. It is considered as a causative factor of cervical cancer even if all women infected by HPV will not develop the disease. This article reviews aspects of HPV molecular biology and the mechanisms of cancerogenesis in HPV infected females.

Could the postoperative residual of urine predict the outcome of TVTOmidurethral sling procedure in female patients?

OBJECTIVE: To assess if the amount of postoperative postvoid residual of urine that is within the normal range (less than 100 mls) could predict the outcome of TVTO (Tension -free vaginal tape obturator) procedure. STUDY DESIGN: Second Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Greece. Patients that had been submitted to TVTO procedure between 2013 and 2017 were reviewed and outcome was assessed.The follow up assessment included cough stress test, the Patient Satisfaction Questionnaire (PSQ), the Urinary Distress Inventory-6 (UDI-6) and the Patient Global Impression of Improvement (PGI-I) questionnaire. RESULTS: The mean follow-up was 3.7 years (+1.35 years). Forty eight patients (40.3%) had only a TVTO procedure. Forty three patients (36.1%) had a TVTO procedure combined with anterior colporrhaphy. Twenty eight patients (23.6%) underwent a TVTO procedure and anterior colporrhaphy and posterior colpoperineorrhaphy. According to cough stress test 88% patients (105/119) were cured having a negative cough stress test. Using logistic regression analysis it was found that patient's age (p = 0.78), postoperative postvoid residual of urine ( = 0.24) or day of catheter removal (p = 0.22) had no statistically significant correlation with the medium term outcome of TVTO procedure. Also, regression analysis shows that patients' Body Mass Index (BMI) has negative correlation to the postoperative outcome. CONCLUSION(S): PVR < 50 mls appears to be related with successful medium term outcome after TVTO procedure. Also, patients' (BMI) has negative correlation to the postoperative outcome.

Alleviation of vulvovaginitis symptoms: can probiotics lead the treatment plan?

Disruption of vaginal microbiota equilibrium promotes infectious clinical syndromes with annoying symptoms, such as vaginal discharge, odour, irritation, pruritus, and vulvar burning. Although identifying and eradicating the pathogen involved has been the standard of care, regional microbiota restoration with probiotics has been gaining ground in recent years. This study aimed to assess the effectiveness of topical Bacillus coagulans treatment for patients exhibiting vaginal discomfort symptoms. A clinical trial was conducted on the use of a topical B. coagulans regimen among reproductive-age women (n=70) with vaginal discomfort symptoms. We assessed their symptoms using a questionnaire, measured vaginal pH, and performed vaginal swabs for microscopy and cultivation. Over the next 4 days, patients received B. coagulans vaginal douches and suppositories with appropriate antibiotic treatment being added on the fourth day based on vaginal swab results. Patients returned 16 days later to fill out in the questionnaire again. The Wilcoxon signed-ranked test was then used to assess differences in symptomatology and pH between appointments. A reduction in vaginal pH was reported between the first and second visit (P<0.001). The probiotic regimen exerted a beneficial effect in all vaginal manifestations: vulvovaginal itching, burning sensation, vaginal irritation, and vaginal discharge (P<0.001 for all symptoms). Additionally, three out of the four symptoms were alleviated to a greater extent during the first four days of exclusive probiotic use than during the second phase (P=0.007, P=0.004, and P=0.033). Our sample provided significant results regarding the benefits of B. coagulans for vaginal discomfort. We postulate that the greatest symptom improvement was achieved within the first 4 days of exclusive probiotic use, before the addition of antibiotics. This study agrees with the increasing literature on the contribution of probiotics toward vaginitis treatment.

Psychological and behavioural aspects of patients with Turner syndrome from childhood to adulthood: a review of the clinical literature.

Turner syndrome (TS) is a chromosomal abnormality, which occurs in approximately one of every 2500 female births. Short stature, infertility, additional physical abnormalities, skeletal and medical problems may be present. Genetic, hormonal, and medical problems associated with TS are likely to affect psychosexual development of female adolescent patients, and thus influence their psychological functioning, behavior patterns, social interactions and learning ability. Although TS constitutes a chronic medical condition, with possible physical, social and psychological complications in a woman's life, hormonal and estrogen replacement therapy and assisted reproduction, are treatments that can be helpful for TS patients and improve their quality of life. Authors report on a review of the research literature clinical aspects of the syndrome as well as the beneficial effect of hormonal therapy in such patients.

Human papilloma virus in adolescence.

Human papilloma virus (HPV) is one of the most widespread sexually transmitted diseases especially in adolescence. The majority of the infections are self-sustained by the immune system. However, HPV may lead to genital warts, cervical dysplasia and cervical cancer. Sexually active adolescent females should be encouraged to obtain gynecologic screening for HPV and be well informed about HPV and the risks associated with this infection. All the efforts are now focused on the vaccines that are being developed to reduce the morbidity and mortality associated with HPV infection if administered in time.

Intrauterine devices and extrauterine pregnancy. A literature review.

The incidence of ectopic pregnancy has been high over the last decades. Many risk factors are potential causes, among them IUDs use which might have a significant role. According to the current thinking, the use of IUD does not increase the risk of ectopic pregnancy. However, IUDs are more effective in protecting from intrauterine rather than ectopic pregnancy. Our review focuses on current and past IUD use, duration of its use, type of IUD and the associated risk of ectopic pregnancy. Fertility after IUD removal regarding the incidence of ectopic pregnancy is also discussed. Conflicting results regarding the association of ectopic pregnancy risk with the use of intrauterine devices exist.