Managing Vulvodynia with Central Sensitization: Challenges and Strategies.

Background: Vulvodynia is defined as a chronic idiopathic vulvar pain condition. This study aimed to investigate the effect of central sensitization on the prognosis of neuromodulator treatment for vulvodynia. Method: A total of 105 patients with vulvodynia who underwent pelvic mapping pain exploration were included and scored according to the Convergence PP Criteria for pelvic pain and central sensitization. The patients were treated according to chronic pelvic pain guidelines, and their response to treatment was evaluated. Results: A total of 35 out 105 patients (33%) with vulvodynia had central sensitization, which was associated with comorbidities, dyspareunia, pain with micturition, and pain with defecation. Dyspareunia and pain with defecation were independent prognostic factors for central sensitization. Patients with central sensitization experienced more pain during intercourse, urination, or defecation, had more comorbidities, and responded worse to treatment. They required more treatment, with a longer response time (over 2 months). Patients with localized vulvodynia were treated with physiotherapy and lidocaine, while patients with generalized vulvodynia were treated with neuromodulators. Amitriptyline was effective in treating patients with generalized spontaneous vulvodynia and dyspareunia. Conclusions: Overall, this study highlights the importance of considering central sensitization in the diagnosis and treatment of vulvodynia and the need for individualized treatment based on the patient's symptoms and underlying mechanisms. Vulvodynia patients with central sensitization had more pain during intercourse, urination, or defecation, and responded worse to treatment, requiring more time and medication.

Understanding the Female Physical Examination in Patients with Chronic Pelvic and Perineal Pain.

(1) Background: The objective was to compare the exploration of chronic pelvic pain syndrome (CPPS) patients in different locations and establish the role of physical examination in CPPS patients. (2) Methods: We reviewed clinical data from 107 female patients with CPPS unresponsive to conventional therapies at Puerta de Hierro University Hospital Madrid, Spain, from May 2018 to June 2022. Patients were classified into three groups: (a) pelvic pain; (b) anorectal pain; or (c) vulvar/perineal pain. (3) Results: Although the demographics of patients with CPPS were different, their physical examinations were strikingly similar. Our study observed a comorbidity rate of 36% and 79% of central sensitization of pain. Seventy-one percent of patients had vulvar allodynia/hyperalgesia. Pain on examination was identified in any pelvic floor muscle, in any pelvic girdle structure, and neuropathic pain in 98%, 96%, and 89%, respectively. Patients with vulvar and perineal pain were more different from the other groups; these patients were younger and had fewer comorbidities and less central sensitization, less anorectal pain, more pain during intercourse, and greater nulliparity (p = 0.022; p = 0.040; p = 0.048; p = 0.000; p = 0.006; p = 0.005). (4) Conclusions: The findings of this study are related to the understanding of the pathophysiology of CPPS. The physical examination confirms the central sensitization of female patients with CPPS, helps us to determine the therapeutic management of the patient, and can be considered as a prognostic factor of the disease.

Prevención de la transmisión perinatal del virus de la hepatitis B / Prevention of the perinatal transmission of hepatitis B virus

El objetivo del estudio consistió en verificar el patrón de prevalencia de la infección en una población de bajo riesgo como son las embarazadas en nuestro país y proponer medidas de prevención. Se estudiaron sin método de muestreo 453 mujeres embarazadas de tres diferentes zonas del país: 295 de la región de San Carlos, 90 de Pérez Zeledón y 118 que acudieron a la consulta prenatal del Hospital R.A. Calderón Guardia entre 1995 y 1996. Ninguna de las mujeres embarazadas estudiadas fue positiva por HbsAg. El otro marcador anti-HBs fue positivo en una proporción del 1.8 por ciento. Se discute la importancia de implementar un tamizaje universal del HbsAg e incorporarlo a las pruebas de rutina del control prenatal.

Alfa-fetoproteína sérica materna: determinación de los valores medios normales en mujeres embarazadas costarricenses / Maternal seric alpha-fetoprotein: determination of the normal middle values in Costa Rican pregnant women

The present study focuses on the normal mean values of AFP in 124 Costa Rican pregnant women. In these women, 554 determinations were done between the 15th and 20th week of gestation. For this purpose, an IRMA test was used and normal values were stablished. The concentration values of AFP were expressed as multiples of the median, considering a value of 2.5 MM as th normal superior limit and of 0.25 as th inferior limit. The confidence limits of the median were 25-57 KU/1 and the 2.5MM value was located between 60-143 KU/1