Search Results (165)

Background and Clinical Significance: Brugada syndrome (BrS) is a rare inherited cardiac channelopathy, often associated with SCN5A loss-of-function mutations. Clinical presentations range from asymptomatic to malignant arrhythmias and sudden cardiac death. Physiological and pharmacological stressors affecting sodium channel function—such as pyrexia, certain medications, and possibly pregnancy—may unmask or exacerbate arrhythmic risk. However, there is limited information regarding pregnancy and obstetric outcomes. Obstetric management remains largely informed by isolated case reports and small case series. A literature review was conducted using OVID Medline and Embase, identifying case reports, case series, and one retrospective cohort study reporting clinical presentation, obstetric management, and outcomes in maternal BrS. A case is presented detailing coordinated multidisciplinary input, antenatal surveillance, and intrapartum and postpartum care to contribute to the growing evidence base guiding obstetric care in this complex setting. Case Presentation: A 30-year-old G2P0 woman with asymptomatic BrS (SCN5A-positive) was referred at 31 + 5 weeks’ gestation for multidisciplinary antenatal care. Regular review and collaborative planning involving cardiology, anaesthetics, maternal–fetal medicine, and obstetrics guided a plan for vaginal delivery with continuous cardiac and fetal monitoring. At 38 + 0 weeks, the woman presented with spontaneous rupture of membranes and underwent induction of labour. A normal vaginal delivery was achieved without arrhythmic events. Epidural block with ropivacaine and local anaesthesia with lignocaine were well tolerated, and 24 h postpartum monitoring revealed no abnormalities. Conclusions: This case adds to the limited but growing literature suggesting that with individualised planning and multidisciplinary care, pregnancies in women with BrS can proceed safely and without complication. Ongoing case reporting is essential to inform future guidelines and optimise maternal and fetal outcomes. Full article

Background/Objectives: Recent changes in obstetric practices and population demographics have prompted a re-evaluation of labor patterns. This study aimed to characterize labor patterns in a Greek pregnant population using ultrasound and compare them with established labor curves. Methods: A prospective cohort study was conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, over a two-year period (December 2022 to June 2024). Transabdominal ultrasound was used to determine the fetal head position and transperineal ultrasound was used to measure angle of progression (AoP) and head–perineum distance (HPD) during labor. Maternal and labor characteristics, including body mass index (BMI), parity, labor duration, and mode of delivery, were recorded. Statistical analysis included mixed linear models to assess the relationship between AoP, HPD, and cervical dilatation. Results: In total, 500 parturients were included in this study. Women entered the active phase of labor approximately 5 h before delivery, with AoP increasing sharply and HPD decreasing rapidly at this point. Cesarean section (CS) cases showed a slower increase in AoP compared to vaginal deliveries (VDs), with CS cases having a mean AoP of 117.9° (95% CI: 111.6–124.2°) at full dilation, compared to 133.4° (95% CI: 130.6–136.2°) in VD. HPD values declined more slowly in CS cases, with a mean HPD of 45.1 mm (95% CI: 40.6–49.6 mm) at full dilation, compared to 36.4 mm (95% CI: 34.3–38.5 mm) in VD. Epidural analgesia was associated with steeper increases in AoP and decreases in HPD in the final 2.5 h before delivery, while oxytocin administration accelerated these changes in the last 3–4 h. The mean time to delivery was 3.19 h (95% CI: 2.80–3.59 h) when AoP reached 125° and 3.92 h when HPD was 40 mm (95% CI: 3.53–4.30 h). BMI in women who gave birth via CS was significantly higher compared to VD (32.03 vs. 29.94 kg/m², p-value: 0.008), and the total duration of labor was shorter in VD compared to CS and operative vaginal delivery (OVD) (8 h vs. 15 h, p-value < 0.001 and 8 h vs. 12 h, p-value < 0.001, respectively). Birthweight was also lower in VD compared to CS (3103.09 g vs. 3267.88 g, p-value: 0.05). Conclusions: This study provides the first ultrasonographic characterization of labor patterns in a Greek population, highlighting the utility of ultrasound in objectively assessing labor progression. Full article

Semen collection is an important component of conservation and animal husbandry. Semen quality is generally improved using voluntary collection methods, particularly artificial vaginas (AVs). Most commercially available AVs are tube-shaped with few species-specific design augmentations. As genitalia are highly variable across taxa, incorporating species-specific genital morphologies into AV designs may enhance collected semen quality. We compared dolphin semen quality using: (1) silicone bioinspired artificial vaginas (BAVs) that reflect the internal shape of dolphin vaginas, and (2) manual stimulation. Sperm motility and kinematic parameters of five bottlenose dolphins (Tursiops sp.) were assessed using computer-aided sperm analysis (CASA). Sperm collected using BAVs showed non-significant increases in median progressive and rapid motility, and increases in median and mean linear motility, supporting a sexual selection functional hypothesis for the biodiverse vaginal folds unique to whales, dolphins, and porpoises. Sperm concentration decreased with BAV collection, while no consistent trends were detected in volume, pH, velocity, or plasma membrane integrity. Modifications to AVs for other species that incorporate genital morphologies may also optimize collected semen quality for application to artificial insemination. Full article

Background and Objectives: For many patients, the induction-to-delivery interval is shorter with Propess than with Prostin E2. However, some patients also require Prostin E2 to sufficiently boost their dinoprostone levels to achieve cervical change and vaginal delivery. In this study, we compared the efficacy of different timings of Prostin E2 administration after Propess use. Materials and Methods: This single-institution retrospective cohort study was conducted between January 2020 and August 2023. The inclusion criterion was an unfavorable cervix (Bishop score ≤ 6) after Propess use for 8 h. We divided the patients into three groups based on the addition of Prostin E2 at the 8th (group 1), 12th (group 2), and 24th (group 3) hour after Propess insertion. The primary outcome was the cesarean section rate. The secondary outcomes were the induction-to-birth interval, Bishop score at 24 h, neonatal outcomes, and the predictors of labor induction duration. Results: A total of 63 patients were analyzed across three groups based on the timing of Prostin E2 administration (8, 12, and 24 h). The gestational age differed significantly between groups (p < 0.001), with the highest age being observed in the 24 h group. The 8 h group had the shortest induction-to-birth interval (p < 0.001) and the highest Bishop scores after 24 h of Propess use (p < 0.001). Blood loss was lowest in the 12 h group (p = 0.027). No significant differences were found in relation to the mode of birth, tachysystole, neonatal birth weight, or Apgar scores. A multivariable analysis identified gestational age (β = 3.33; p = 0.015) and Bishop score after 24 h of PGE2 (β = −1.99; p < 0.001) as being independent predictors of labor duration. Conclusions: administering Prostin E2 to patients who had a poor response after Propess use was safe; additionally, adding it at the 8th hour after Propess initiation could result in a shorter induction-to-birth interval. Full article

Vulvar hygiene is an important part of general hygiene: the goals are to clear the vulvar area of microbial and cellular debris and vaginal and fecal secretions, ensure local comfort, provide natural levels of hydration, and protect the vulvar microbiota. There are few national and international guidelines on vulvar hygiene. We searched the PubMed database up until 30 November 2024, using logical combinations of the following terms: hygiene, washing, vulva, vulvar, microbiota, hydration, syndet, soap, detergent, water, and customs. The abstracts were reviewed, and potentially relevant full-text articles were retrieved and examined. The subregions of the vulva vary with regard to the presence of sweat and sebaceous glands, the keratin content, the water content, the pH, and the microbiota (notably Lactobacillus, Corynebacterium, Staphylococcus, and Prevotella). An alteration in the vulvar microbiota can cause an imbalance in the vaginal microbiota, and vice versa. Vaginal douching may have negative effects on vulvar microbiota. Hair removal might increase the risk of long-term dermatological complications. Repeated washing with water alone exposes the stratum corneum to damage, and washing with soap alters the stratum corneum proteins and lipids, increases skin water loss, and accentuates the risk of irritation. Syndet-based products have a mild detergent effect, promotion of hydration, a suitable pH for the vulvar area, and protection of the vulvar microbiota. Syndet-based products (containing a blend of surfactants, emollients, antioxidants, and buffering agents) appear to be the most appropriate for vulvar care. Full article

Background: Postpartum urinary retention (PPUR) typically resolves within the first three days following delivery. However, in rare instances, it may persist beyond 72 h and, in some cases, extend for several weeks. The current study aimed to evaluate long-term sequelae in women who endured PPUR following vaginal delivery. Methods: Between January 2013 and December 2019, 362 women who experienced PPUR following delivery at our institution were identified and subsequently invited to complete the UDI-6 questionnaire that serves to assess lower urinary tract symptoms. The questionnaires were filled out and returned by 242 women (66.8%). Results: Participants who had no urinary complaints (145/242; 60%) were assigned to Group 1. Of the 97 women allocated to Group 2 (97/242; 40%), 96 reported only mild urinary symptoms, while just 1 individual scored above the threshold of 33.3, suggesting elevated urinary distress. Risk factors known to be associated with PPUR were equally distributed among the two groups. A predominance of Caucasians was noted in Group 2 (p = 0.012). Voiding dysfunction (question 5 of UDI-6), taken separately, was proclaimed by 15 women from Group 2 (15/97 = 15.5%). When these were compared to the rest of the cohort (n = 227), an association with hypothyroidism was recognized (p = 0.036). Well-established risk factors for PPUR, such as nulliparity and epidural analgesia, were observed less frequently among women with persistent voiding dysfunction (p = 0.045 and p = 0.049, respectively), while postpartum uterine atony was more frequent (p = 0.047). Significant long-term effects after PPUR are uncommon. Conclusions: Hypothyroidism and postpartum uterine atony emerge as risk factors allied to long-term voiding dysfunction. Full article

The vaginal microbiota, a critical determinant of women’s health, is influenced by hormonal and metabolic parameters across the lifespan. While Lactobacillus species are beneficial markers of vaginal health, microbial composition undergoes pronounced alterations after menopause. This study aimed to elucidate the associations between vaginal microbiota composition, vaginal pH, menopausal status, and metabolic parameters in Asian women. Vaginal secretion samples were collected from 40 women (20 premenopausal, 20 postmenopausal). Full-length 16S rRNA gene sequencing was used to characterize the microbiota, categorized into Community State Types (CSTs): CST-I + II (Lactobacillus crispatus/gasseri, protective), CST-III (Lactobacillus iners, neutral), and CST-IV (anaerobic bacteria, harmful). Vaginal pH and clinical data were assessed in relation to microbial profiles. CST distribution differed significantly by menopausal status and vaginal pH. Harmful-type CST-IV was more prevalent in postmenopausal women (70% vs. 40%, p < 0.05), while CST-III was dominant in premenopausal women (45% vs. 5%). CST-IV was associated with elevated pH (median 6.00, p = 0.026) and increased abundance of anaerobes including Bacteroides, Fusobacterium, Porphyromonas, Prevotella, and Streptococcus. Oral antibiotic use reduced both beneficial and harmful CSTs, shifting toward neutral CST-III (75%, p = 0.048). Use of sodium–glucose cotransporter-2 (SGLT2) inhibitors in postmenopausal women was associated with a higher prevalence of protective CST-I + II (57.14% vs. 8.33%, p < 0.05), though no significant impact on pathogen presence was observed. This study highlights the dynamic interplay between menopausal status, metabolic interventions, and vaginal microbiota composition. Findings may inform targeted strategies to maintain vaginal health in aging populations. Full article

Nakaseomyces glabratus is an opportunistic fungal pathogen that primarily affects immunocompromised individuals. Unlike other Candida species, N. glabratus exhibits nondimorphic blastoconidial morphology and a haploid genome. It is a leading cause of both superficial (oral, esophageal, vaginal, or urinary) and systemic candidiasis. In this study, we evaluated 47 clinical isolates from Central Bulgaria (Plovdiv) and 1 wild strain isolated from the gut of the beetle Oxythyrea funesta (Coleoptera: Cetoniinae) collected in Sofia, Bulgaria. Growth was observed across a pH range of 3 to 9. The strains were assessed for the production of lipases, esterases, and proteases—enzymes associated with pathogenicity—and their relationship to virulence. Biofilm formation and exopolysaccharide production were also measured, with all strains showing similar profiles. No competitive inhibition of N. glabratus was observed against C. parapsilosis. All isolates exhibited resistance to micafungin, while resistance to both micafungin and anidulafungin was observed in 21 isolates (44%). These findings provide insight into the biochemical characteristics of N. glabratus populations from Southeast Europe, contributing to a better understanding of strain behavior under controlled laboratory conditions and addressing the gap in data on this species in the region. Full article

Background/Objectives: Genitourinary syndrome of menopause (GSM) encompasses a variety of symptoms associated with estrogen deficiency, affecting the genitourinary tract. Effective management often requires a multifaceted approach. Although radiofrequency (RF) treatment has been explored as a non-hormonal intervention for GSM, evidence remains limited and inconclusive. Oral collagen peptides have demonstrated systemic tissue benefits in dermatological studies, but with effects that are not yet well understood in the context of GSM. This pilot study investigated whether combining RF with an oral supplementation containing specific bioactive collagen peptides and ultra-low-molecular-weight hyaluronic acid would provide superior symptom relief compared to RF alone in women with GSM. Methods: Twenty menopausal women were randomized into two groups: Group 1 (n = 10) received vulvovaginal RF treatment every two weeks for two months; Group 2 (n = 10) received the same RF treatment alongside daily oral supplementation for four months. Subjective symptoms, objective signs, and vaginal pH were assessed at baseline (T0), post-RF treatment (T1), and three months post-RF treatment (T2), employing a two-way repeated-measures ANOVA to assess differences between groups over time. Results: Both groups showed substantial improvements in all the clinical parameters evaluated at T1 and T2 compared to T0. However, the magnitude of such improvements was higher among patients from Group 2, who achieved better outcomes at T2 compared to patients from Group 1, with differences being statistically significant regarding subjective symptoms (p < 0.001), objective signs (p < 0.001), and vaginal pH (p = 0.015), thus demonstrating the sustained benefits of the combination therapy over RF treatment alone during the follow-up time. Conclusions: Combined treatment with vulvovaginal RF and food supplements improved the signs and symptoms of GSM, and compared to RF treatment alone, it enhanced and maintained the benefits in a three-month follow-up period. Full article

The vaginal microbiota plays a crucial role in bovine reproductive health in the periparturient period. This study aimed to characterize the naturally occurring bacterial species in the vaginal microbiome of healthy Holstein Frisian cows and evaluate their antibiotic sensitivity. Vaginal samples were collected from 44 healthy cows on three dairy farms. A total of 54 bacterial species were detected, with Gram-positive bacteria comprising 87% of the isolates. The most prevalent genera were Bacillus, Streptococcus, and Staphylococcus. Antibiotic susceptibility tests indicated that some isolates carried resistance genes, but most remained sensitive to commonly used antibiotics. The average vaginal mucosa pH was 7.2. These findings provide valuable insights into the diversity of vaginal microbiota of healthy dairy cows. Understanding the bacterial composition and antibiotic susceptibility can support reproductive health management and prudent use of antibiotics in dairy herds. Full article

Background: Bacterial vaginosis (BV) is considered the most common cause of vaginal discharge, which is related to several public health issues, such as an increased risk for sexually transmitted infections, pelvic inflammatory disease, pregnancy-related problems such as abortion, stillbirth or premature birth, and tubal factor infertility. BV is not considered an infection but an imbalance in the vaginal microbiota, characterized by a substitution of the normal Lactobacilli flora by anaerobe. Reducing resistance against infections by several mechanisms, including bacterial homeostasis, stabilization of acid pH, inhibition of pathogens adhesion by polyamine degradation, production of anti-inflammatory molecules, surfactants, and antimicrobial substances like hydrogen peroxide, acids, and bacteriocins. Approximately half of women with BV can experience symptoms, which mainly include vaginal malodor, fishy discharge, stinging sensation, and increased vaginal pH. The treatment of BV is based primarily on promoting Lactobacilli restoration and eliminating dangerous microbiota with antibiotic therapy. However, there is a high rate of recurrence and relapse. Objective: Based on the current literature, this review aims to propose a list of ten BV hallmarks: dysbiosis, inflammation, apoptosis, pH basification, mucosal barrier integrity, pathway activation, epithelial damage, genomic instability, oxidative stress (OS), and metabolic reconfiguration. Conclusions: Understanding the causes of BV and the pathogenicity mechanisms is critical for preventing and improving the current therapeutic management of patients. Full article

Background and aim: Labor induction is increasing in obstetric practice. In women with an unfavorable cervix, cervical ripening is required for successful induction. We conducted this review to compare the effectiveness and tolerance of two interventions used for cervical ripening, topical prostaglandin E2 (dinoprostone) and transcervical Foley’s catheter. Methods: We systematically searched four biomedical databases on 15 November 2024, for relevant studies. The studies’ eligibility was determined after screening their titles, abstracts, and full texts. We extracted relevant data from the studies included. RevMan software V5.4 was used to conduct the random-effect meta-analysis. Misoprostol was excluded from this review due to variability in dosing protocols and inconsistent reporting across studies. A review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number: CRD420251026183. Results: This review included 41 studies that in total enrolled 12,877 women (6722 for Foley’s catheter and 6155 for dinoprostone). The efficacy of the two interventions was comparable as evidenced by the similarity in the induction to delivery time, Bishop score change, the rate of vaginal delivery within 24 h, and the risk of induction failure. Foley’s catheter was linked with lower risks of caesarian delivery (RR = 0.84, p = 0.006), uterine hyperstimulation (RR = 0.39, p < 0.001), postpartum hemorrhage (RR = 0.76, p = 0.03), and a 1-min Apgar score < 7 (RR = 0.75, p = 0.02). However, it was associated with an extra need for oxytocin augmentation (RR = 1.18, p < 0.001). The risks of instrumental delivery, intrapartum pyrexia, postpartum infection, meconium passage, umbilical cord arterial pH < 7.1, a 5-min Apgar score < 7, and neonatal intensive care requirement were comparable for the two interventions. Conclusions: In comparison with dinoprostone, Foley’s catheter is equally effective and well tolerated. We recommend Foley’s catheter use for women with a previous caesarian delivery and in low-resource settings. Full article

Background: Vulvar vaginal candidiasis (VVC) is a type of vaginitis resulting from a Candida infection of the vaginal mucosa. Traditional treatments using antibiotics often lead to resistance and disrupt the vaginal microenvironment, causing ongoing problems for patients. In response to these challenges, this study introduces a multifunctional intelligent responsive probiotic hydrogel designed to modulate the vaginal microecological environment to combat Candida albicans infection. Methods: The innovative CMCS-OHA-Lp/Lr hydrogel was formulated using oxidized hyaluronic acid (OHA) and carboxymethyl chitosan (CMCS) as carriers, incorporating Lactobacillus plantarum (Lp) and Lactobacillus rhamnosus (Lr) as active components. Comprehensive characterization of the CMCS-OHA-Lp/Lr hydrogel revealed its chemical structure, rheological properties, rapid self-healing properties, gel degradation, and the release of lactobacilli in vitro. Results: The findings demonstrated that the hydrogel’s cross-linking conferred significant physical properties. In addition, the in vitro release study of Lactobacillus showed that the cumulative release rates of Lp and Lr in the medium with pH 5.5 were 83.50 ± 2.70% and 73.31 ± 2.22%, which proved the pH-responsive release characteristics of probiotics in acidic vaginal environments. Furthermore, the storage activity of Lactobacillus indicated that the survival rates of the CMCS-OHA-Lp and CMCS-OHA-Lr hydrogels were 86.90 ± 0.20% and 85.50 ± 0.56%, respectively, proving that encapsulation within the hydrogels significantly enhanced the storage stability of probiotics. In vivo studies further confirmed that the hydrogel alleviated vulval edema symptoms and reduced C. albicans colonies in the vagina, thereby mitigating vaginal inflammation. Conclusions: In conclusion, this pH-responsive, self-healing, and shear-thinning hydrogel offers a promising approach for the clinical treatment of VVC and serves as an effective probiotic delivery vehicle. Full article

Objectives: We aimed to study the efficacy of fractional CO₂ laser for genitourinary syndrome of menopause (GSM) symptoms in breast cancer (BC) survivors through a randomized, sham-controlled study, followed by an open-phase study assessing the impact of additional treatments. Methods: BC survivors with GSM were randomized to receive either three sessions of intravaginal CO₂ laser or sham treatment every 3–4 weeks. The laser’s energy was 45–60 mJ/pixel. Outcomes were compared one month following the last session. Participants initially receiving laser treatment were offered three more sessions, while those receiving sham had six laser sessions in an open-label study. Results: Thirty-four BC survivors were randomized to laser (n = 19) or sham (n = 15) treatments. Dyspareunia and intercourse dryness scores improved in both groups one month post-treatment, without a significant advantage of laser over sham. The laser treatment resulted in a reduction in daily dryness (−1.30 ± 0.55, p = 0.017), an increase in vaginal hydration (3.24 ± 1.13, p = 0.004), and an increase in Vaginal Health Index (VHI) (2.26 ± 0.50, p < 0.001). Most participants (18/19 and 9/15, respectively) opted to continue laser treatments after unblinding, resulting in 27 patients receiving six laser treatments. Increasing the number of laser treatments was associated with a constant improvement in Visual Analogue Score (VAS) scores for dyspareunia, intercourse dryness, daily dryness, burning, discomfort, itch, and average VAS, as well as pH, VHI, and hydration. Conclusions Three fractional CO₂ laser treatments for BC survivors reduced daily dryness but did not improve dyspareunia and sexual dryness when compared to sham in this randomized trial. Increasing the number of treatment sessions seemed to improve outcomes; however, it remained clinically insufficient, even after six treatments. Full article

Vulvovaginal symptoms affect up to 39% of women. These symptoms have a significant impact on quality of life and are often linked to imbalances in the vaginal microbiota. This study evaluates the therapeutic efficacy of a zinc-containing hydroxyethyl cellulose-based hydrogel in 37 women with different vulvovaginal symptoms (itching, burning, irritation, pain, dryness, discharge, and odor). Over 12 weeks, participants applied the gel intravaginally with both assessments conducted at baseline and follow-ups. Results revealed substantial improvements in symptoms, including reductions in vaginal discharge, itching, and burning, as measured by the Vulvovaginal Symptom Questionnaire (VSQ-21), with scores decreasing from 10.78 ± 3.66 at baseline to 3.17 ± 4.16 at week 12 (p < 0.01). Vaginal Health Index (VHI) scores improved significantly, from 20.78 ± 1.74 at baseline to 23.64 ± 2.59 (p < 0.01). Cervicovaginal lavage (CVL) zinc levels decreased from 110 ± 102 µg/L at baseline to 62 ± 48 µg/L at week 4 (p < 0.01), increased to 80 ± 55 µg/L at week 8 (p = 0.04), and reached 99 ± 92 µg/L by week 12 (NS). A correlation analysis showed an inverse relationship between baseline CVL zinc levels and VSQ-21 scores (r = −0.3586, p = 0.034), while no significant correlation was observed with VHI scores (r = −0.0187, p = 0.9545). Vaginal pH levels decreased significantly, dropping from 4.03 ± 0.42 to 3.71 ± 0.48 (p < 0.01). These findings support the gel’s role as an effective, nonhormonal, drug-free, and local adjunct treatment for a variety of vulvovaginal symptoms. Full article