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UNLABELLED: Dyspareunia is genital pain before, during or after penile-vaginal sexual intercourse. The prevalence of dyspareunia ranges from 8 to 22%. Sexual intercourse concomitant with a pelvic organic lesion is likely to cause pain in most cases. However, in these cases, the pain depends not only on sexual intercourse. In its basic definition, dyspareunia in women is considered an idiopathic affection without a typical organic constitution. It is only present with penile-vaginal penetration. Long-term hypoxia in perineal muscles can cause muscle and perimuscular changes, leading to chronic pain not sufficiently responding to standard therapy. During the entrance examination to our previous study on dyspareunia, we noted significantly lower pulse oximetry levels in the perineal area of affected women. We aimed to compare pulse oximetry oxygen saturation (SpO2) of dyspareunia-affected women to healthy, pain-free women. A retrospective study was performed. The study participants were women who had participated in our previously published study on dyspareunia. This retrospective study was approved by the Ethical Committee. The study included 62 women: 31 dyspareunia-affected women in the treatment group and 31 healthy women in the control group. METHOD: During their examinations, women in the dyspareunia and control groups were measured for SpO2. The procedure was performed in the vulvo-perineal rear region, involving the commissure and the bulbospongiosus muscle. Median and mean SpO2 were compared between the treatment and control groups. Testing for sample size accuracy was performed retroactively. RESULTS: There were 31 participants in each group. The SpO2 data were skewed and did not follow a Gaussian distribution. The Mann-Whitney U test was run to determine differences in perineum oximetry between the treatment group and controls. The median SpO2 was 91 in the treatment group and 92 in the control group. This difference was statistically significant, p = 0.002. Sample size accuracy was assured by post hoc calculation. CONCLUSIONS: Idiopathic dyspareunia is inherent in cohabitation muscle pain that standard therapy could not explain nor treat. We detected clinically meaningfully decreased levels of SpO2 in affected patients. We compared pelvic oximetry between dyspareunia-affected women in the treatment and control groups. This comparison showed significant hypoxia in the perineal muscle area (p = 0.002). Our results may help us understand the source of this pain and guide treatment accordingly.

Článek

Beta-thalassemia minor a maior v těhotenství
[Beta-thalassemia minor and maior in pregnancy]

Transfuze a hematologie dnes. 2022 ; 28 (4) : 228-232.

ISSN 1213-5763
Medvik
Zdroj

Prezentujeme kazuistiku 35leté primigravidy/nulipary, která je nosičkou recesivní formy β-talasémie. Před první návštěvou v naší ambulanci byla diagnóza známá od dětství, a to na základě vyšetření krevního obrazu a rodinné anamnézy, nicméně nebyla geneticky potvrzena. Partner měl v dětství anémii a taktéž u něj byla potvrzena heterozygotní forma β-talasémie. Oběma bylo pomocí DNA-sekvenování verifikováno nosičství β-talasémie s mutací IVS I-6. T>C až během probíhající gravidity. Prvotrimestrální screening plodu byl negativní, z biopsie choriových klků a následného genetického vyšetření se však potvrdila homozygotní varianta β-talasémie. β-thalassemia maior je závažné vrozené onemocnění s nejvyšším výskytem v subtropických geografických oblastech. I přes velký pokrok v terapii zůstává stále vysoká morbidita i mortalita postižených jedinců. Díky globálním společenským změnám a migraci se u nás mohou objevovat choroby, které se dříve ve střední Evropě nevyskytovaly. Zdravotnictví by mělo být připravené na nové výzvy a dokázat jim čelit účinnou primární i sekundární prevencí vč. prenatální diagnostiky.

We present a case of a 35-year-old primigravid nulliparous woman, which is a carrier of recessive form of beta thalassemia. Prior to the first visit at our clinic, the diagnosis was not genetically confirmed, it was based only on the blood-count in the childhood. Her partner also had childhood anaemia, and heterozygous form was suspected. They both underwent a genetic counselling; both were diagnosed with beta thalassemia minor by DNA sequencing. The first trimester foetal screening was negative, but the homozygous form of beta thalassemia was confirmed from a chorionic villus biopsy and subsequent genetic examination. Beta thalassemia maior is a serious congenital autosomal recessive disease with the highest incidence in subtropical geographical areas. Despite great progress in therapy, the morbidity and mortality of affected individuals remains high. Due to global social changes and migration, genetic rare diseases that did not occur in Central Europe may emerge. Healthcare should be well prepared and be able to cope with an effective primary and secondary prevention including the prenatal testing.

MeSH
anemie etiologie MeSH
beta-talasemie * diagnóza genetika patologie MeSH
dospělí MeSH
genetické testování MeSH
hematologické komplikace těhotenství * MeSH
indukovaný potrat MeSH
lidé MeSH
neinvazivní prenatální testování metody MeSH
těhotenství MeSH
výsledek terapie MeSH
Check Tag
dospělí MeSH
lidé MeSH
těhotenství MeSH
ženské pohlaví MeSH
Publikační typ
kazuistiky MeSH

Článek

Chlamydia trachomatis and Neisseria gonorrhoeae PCR detection in women treated for ectopic pregnancy

Journal of obstetrics and gynaecology. 2022 ; 42 (5) : 1370-1373. [pub] 20211214

J Obstet Gynaecol
ISSN 1364-6893
Medvik
Zdroj

The aim of this study was to determine the presence of Chlamydia trachomatis (ChT) and Neisseria gonorrhoae (NG) in the genital tract of women with ectopic pregnancy and to compare the positive results with patients' self-reported history of PID. Overall 40 women were eligible for the study. The samples for the ChT and NG Polymerase Chain-reaction (PCR) detection were obtained from the cervix, endometrium and fallopian tube. The results of testing for NG at all sites were negative as were the results from cervical testing for ChT. The prevalence of ChT in the upper genital tract was 12.5%. No statistically significant correlation was found between the positive cases and the previous signs of PID and laparoscopic findings. We found statistically significant relationship between signs of pelvic inflammation in a pacients' history and histopathological findings of tubal inflammation. 12.5% prevalence of ChT confirms the ascending genital infection. There was no association between the positive PCR result and clinical history of pelvic inflammation.IMPACT STATEMENTWhat is already known on this subject? Pelvic inflammatory disease, Chlamydia trachomatis and Neisseria gonorrhoae infections are the main risks for ectopic pregnancy. Clinical history of PID and perioperative adhesions may suggest prior upper genital infection.What do the results of this study add?Chlamydia trachomatis positive PCR result can be found in the upper genital tract without the positivity of cervical smear in women with ectopic pregnancy. Our study is unique in assessing the endometrial biopsy for the presence of Chlamydia trachomatis and Neisseria gonorrhoae.What are the implications of these findings for future clinical practice and/or future clinical research? There is no statistically significant association between positive PCR result and clinical history of PID or pelvic adhesions found during laparoscopy for tubal pregnancy. Therefore there is no need for the preventive antibiotic treatment in patients with these findings.