[The effect of anogenital warts on life quality of affected patients].

INTRODUCTION: Anogenital warts represent a clinical manifestation of the infection of the lower female genital tract, human papilloma viruses types 6 and 11. They belong to the group of sexually transmitted diseases and then may be localized either on the female or male genitalia. The aim of the study was to show the effect of anogenital warts on life quality of the affected patients. MATERIAL AND METHODS: The study was conducted on 200 female patients using the standardized questionnaire filled in by patients under the researcher's supervision immediately before laser wart removal. Each question out of 15 could be answered by one of the suggested answers: always, almost always, sometimes, rarely and never. The answer "always" was worth one point, "almost always" two points, "sometimes" three points, "rarely" four points and never "five" points. Life quality was categorized as bad, tolerable, good, very good and excellent. The lower number of points in the questionnaire indicated the worse life quality and the higher number of points demonstrated a better life quality. RESULTS: The study results showed that the highest number of subjects was in the third and fourth decade of life. The presence of anogenital warts had an effect on life quality in most patients. 5% of subjects assessed their life quality as bad, 16% as tolerable, 45% as good and 23% as very good. Only in 11% of patients the presence of anogenital warts did not have any effect on life quality (chi2 = 121.680, p < 0.001). CONCLUSION: The presence of anogenital warts has a significant effect on life quality of affected patients, indicating the significance of their early detection and treatment.

[The significance of the ovarian arteriolar vasodilatation in pathogenesis of the ovarian hyperstimulation syndrome].

Ovarian hyperstimulation syndrome is a complication of the ovulation stimulation, most commonly by gonadotrophins. It frequently occurs in patients included in in vitro fertilization program. The exact mechanism of development of this syndrome has not been elucidated yet. The basic pathogenic mechanism of development of this syndrome is vasodilation of the ovarian blood vessels. Dilated ovarian blood vessels become permeable. Permeability of dilated ovarian blood vessels is more increased by released ovarian mediators. Due to increased permeability of the blood vessels, there is leakage of the intravascular fluid into the extravascular areas resulting in hypovolemia, edema and ascites. Hypovolemia leads to renal perfusion decrease. Increased salt and water reabsorption occurs in the renal tubules so oliguria develops. Decreased arterial blood volume results in stimulation of the renin-angiotensin-aldosterone system, the sympathetic nervous system as well as the antidiuretic hormone. The activation of the sympathetic nervous system via beta adrenergic receptors stimulates renin release and aldosterone secretion. Renin stimulates release of angiotensin I which transforms into angiotensin II. Angiotensin II increases the pressure and stimulates aldosterone secretion. In patients with this syndrome, there is an elevated plasma endothelin and natriuretic peptide level. Endothelin is an important vasoconstrictor. It increases secretion of renin, aldosterone, catecholamines, antidiuretic hormone, and atrial natriuretic peptide, and enhances the vasoconstrictive effect of norepinephrine and angiotensin II. The platelet number increase together with the elevated factor of blood coagulation and hyperviscosity in a severe form of this syndrome may result in development of intravascular thrombosis. The treatment consists of maintenance of circulatory function, i.e. the increase of effective arterial blood volume by applying the plasma volume expanders.

Evaluation of ribavirin efficacy and tolerance in subjects with chronic hepatitis C virus infection.

BACKGROUND: Reports by hepatologists indicated that anti-HCV antibodies might be detected in 71% to 84% of cases of post-transfusion hepatitis and in up to 50% of cases of sporadic non-A non-B hepatitis. Anti-HCV antibodies were detected in 0.05-1% of blood donors with normal alanine transaminase (ALT) levels and negative anti-HBc screening. Anti-HCV antibodies were found in 67% of patients with a history of intravenous drug abuse or autoimmune hepatitis, and in 10-30% of patients with hepatocellular carcinoma. This indicated that hepatitis C virus was a major cause of the acute and chronic hepatitis throughout the world. METHODS: This was a multicenteric, international, double-blind, randomized, placebo-controlled study. After the eight-week screening period, patients were randomized to receive daily ribavirin 1200 mg or placebo, during the 48-week treatment period. Follow-up observations were performed during a 16 week post-treatment period. Up to 80 male and female outpatients with mild to moderate chronic active hepatitis C virus infection were enrolled in this study. RESULTS: During the treatment period ALT values were significantly lower in the ribavirin group. Neither in the ribavirin group, nor in the placebo group significant statistical differences of the HCV RNA values were found. Significantly lower portal inflammation was noticed in ribavirin group after the treatment. Analysis of laboratory data demonstrated that ribavirin therapy was associated with mild to moderate reversible anemia. Investigator's evaluation of the effect of the therapy on patient's well being showed statistically significant differences in the benefit of the ribavirin group. CONCLUSION: In this study ribavirin was more effective than placebo in reducing ALT levels during the treatment period of the applied therapy in patients with chronic active hepatitis C.