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Perkušić Petra - One of the best experts on this subject based on the ideXlab platform.
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DIAGNOSTIC OF GONORRHEA IN PREGNANT WOMEN AND NEWBORNS- MIDWIFE ACTIVITY
University of Split. University Department of Health Studies., 2020Co-Authors: Perkušić PetraAbstract:Fiziološka flora čovjeka je vrlo složena. Čovjeku su potrebni mikroorganizmi na koži i sluznicama da bi bio zdrav. Ti mikroorganizmi s ljudskim domaćinom imaju mutualistički odnos. Odnosno i jedni i drugi imaju koristi. Mikroorganizmi neprestano dobivaju nutrijente potrebne za život dok čovječja flora dobiva zaštitu i nutrijente. Ukoliko dođe do narušavanja imuniteta ili kontakta sa patogenim mikroorganizmima normalna flora se narušava te dolazi do infekcije. Ukoliko se infekcija razvije nakon spolnog odnosa sa zaraženom osobom tada je riječ o spolno prenosivim bolestima. Spolno prenosive bolesti su u populaciji oduvijek prisutne i biti će prisutne i u budućnosti s obzirom na širenje spolnim kontaktom. Ulazna vrata mikroorganizama spolno prenosivih bolesti su sluznice, najčešće sluznice spolnih organa. Gonoreja je spolno prenosiva bolest koja u većini slučajeva prolazi asimptomatski, a ukoliko se pojave simptomi to su gnojni iscjedak iz rodnice, bol u donjem djelu abdomena, bol prilikom odnosa, krvarenje nakon odnosa, spotting, neplodnost,... N. gonorrhoeae su gram negativni diplokoki koji ne stvaraju spore i teško preživljavaju u okolišu što znači da je za prijenos potreban direktni put. Bakterija je primarno patogena za čovjeka jer nije dio fiziološke flore. Prenosi se spolnim odnosom ili s majke na dijete prolaskom kroz zaraženi porođajni kanal. Gonoreja se dijagnosticira iz brisa cerviksa koji se nasijava na čokoladni agar te nakon 48 sati izrastu prozirne sitne kolonije nalik kapima rose. Na predmetnom stakalcu, mikroskopskom preparatu bojanom po gramu uočavamo gram negativne diplokoke unutar leukocita koji nalikuju zrnu kave. Za liječenje se prvo izrađuje antibiogram da bi se odredio antibiotik najbolje učinkovitosti. Potrebno je liječiti oba partnera jer ako se ne liječe oba partnera istovremeno dolazi do ponovne aktivacije bolesti.Primalja ima veliku važnost u prevenciji, dijagnostici i liječenju gonoreje. Primalja prvenstveno treba žene prosvjećivati i uputiti na važnost redovitih ginekoloških pregleda. Također primalja je i potpora ženama koje imaju gonoreju te im treba pružati empatiju jer su kod nas spolno prenosive bolest još uvijek tabu tema i žene zbog srama nekada ne žele otići na pregled iako imaju simptome spolno prenosivih bolesti. Primalja upućuje na pravilan način uzimanja lijekova za liječenje bolesti, ali i sudjeluje u prevenciji prijenosa bolesti s majke na dijete tako što nakon rođenja djeteta provodi Credeovu profilaksu srebrovom otopinom koja se kapa novorođenčetu u oči.Human physiological flora is very complex. Human needs microorganisms on his skin and mucous membranes to be healthy. These microorganisms have a relationship with the human host. That is, both benefit. Microorganisms are constantly getting the nutrients they need to live while the human flora is getting protection and nutrients. If you get a violation of immunity or contact with pathogenic microorganisms, the normal flora is disturbed and an infection occurs. If the infection develops after sexual intercourse with earned persons, then it is a sexually transmitted disease. Sexually transmitted diseases have always been present in the population and will be present in the future with wider sexual contact, which is the most common and natural human contact. The entrance door of the microorganism sexually transmits diseases in the mucosa, and the smallest mucosa of the genitals. Gonorrhea is a sexually transmitted disease that usualy passes asymptomatically, and symptoms appear to be purulent discharge from the Vagina, Pain in the abdomen, better situation, bleeding after intercourse, spotting, infertility,... N. gonorrhoeae are gram-negative diplococci that do not produce spores and are difficult to survive in the environment which means they should transmit the necessary direct, capillary pathway. The bacterium is a primary pathogen for humans because it is not part of the physiological flora. Sexual intercourse is transmitted either from mother to child by passing through an infected birth canal. Gonorrhea is diagnosed from a swab of the cervix that is seeded on chocolate agar and after 48 hours expresses transparent tiny colonies resembling rose drops. On the slide, a gram-stained microscopic specimen, we observe a gram of negative diplococci inside leukocytes resembling coffee beans. For treatment, an antibiogram is first made to determine which antibiotic is best. A doctor with both partners is needed if there is no re-execution of the partner and he will re-activate the disease. Midwives has great importance in the treatment, diagnosis and prevention of gonorrhea. The midwife can primarily protest the women and teach them on the importance of regular gynecological examinations. Also a midwife is the support of women who have gonorrhea and they need to be given empathy because in our country sexually transmitted diseases are still a taboo topic and women sometimes do not want to go for checkup out of shame even though they have symptoms of sexually transmitted diseases. The midwife was instructed in the proper way of taking medication to treat the disease, but also participated in the prevention of disease transmission from mother to child in order to carry out Crede's prophylaxis with a silver solution after the birth of a child
Rohna Kearney - One of the best experts on this subject based on the ideXlab platform.
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Pessaries (mechanical devices) for managing pelvic organ prolapse in women
The Cochrane database of systematic reviews, 2020Co-Authors: Carol Bugge, Elisabeth J Adams, Deepa Gopinath, Fiona Stewart, Melanie Dembinsky, Pauline Sobiesuo, Rohna KearneyAbstract:Background Pelvic organ prolapse is a common problem in women. About 40% of women will experience prolapse in their lifetime, with the proportion expected to rise in line with an ageing population. Women experience a variety of troublesome symptoms as a consequence of prolapse, including a feeling of 'something coming down' into the Vagina, Pain, urinary symptoms, bowel symptoms and sexual difficulties. Treatment for prolapse includes surgery, pelvic floor muscle training (PFMT) and Vaginal pessaries. Vaginal pessaries are passive mechanical devices designed to support the Vagina and hold the prolapsed organs back in the anatomically correct position. The most commonly used pessaries are made from polyvinyl-chloride, polythene, silicone or latex. Pessaries are frequently used by clinicians with high numbers of clinicians offering a pessary as first-line treatment for prolapse. This is an update of a Cochrane Review first published in 2003 and last published in 2013. Objectives To assess the effects of pessaries (mechanical devices) for managing pelvic organ prolapse in women; and summarise the principal findings of relevant economic evaluations of this intervention. Search methods We searched the Cochrane Incontinence Specialised Register which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 28 January 2020). We searched the reference lists of relevant articles and contacted the authors of included studies. Selection criteria We included randomised and quasi-randomised controlled trials which included a pessary for pelvic organ prolapse in at least one arm of the study. Data collection and analysis Two review authors independently assessed abstracts, extracted data, assessed risk of bias and carried out GRADE assessments with arbitration from a third review author if necessary. Main results We included four studies involving a total of 478 women with various stages of prolapse, all of which took place in high-income countries. In one trial, only six of the 113 recruited women consented to random assignment to an intervention and no data are available for those six women. We could not perform any meta-analysis because each of the trials addressed a different comparison. None of the trials reported data about perceived resolution of prolapse symptoms or about psychological outcome measures. All studies reported data about perceived improvement of prolapse symptoms. Generally, the trials were at high risk of performance bias, due to lack of blinding, and low risk of selection bias. We downgraded the certainty of evidence for imprecision resulting from the low numbers of women participating in the trials. Pessary versus no treatment: at 12 months' follow-up, we are uncertain about the effect of pessaries compared with no treatment on perceived improvement of prolapse symptoms (mean difference (MD) in questionnaire scores -0.03, 95% confidence interval (CI) -0.61 to 0.55; 27 women; 1 study; very low-certainty evidence), and cure or improvement of sexual problems (MD -0.29, 95% CI -1.67 to 1.09; 27 women; 1 study; very low-certainty evidence). In this comparison we did not find any evidence relating to prolapse-specific quality of life or to the number of women experiencing adverse events (abnormal Vaginal bleeding or de novo voiding difficulty). Pessary versus pelvic floor muscle training (PFMT): at 12 months' follow-up, we are uncertain if there is a difference between pessaries and PFMT in terms of women's perceived improvement in prolapse symptoms (MD -9.60, 95% CI -22.53 to 3.33; 137 women; low-certainty evidence), prolapse-specific quality of life (MD -3.30, 95% CI -8.70 to 15.30; 1 study; 116 women; low-certainty evidence), or cure or improvement of sexual problems (MD -2.30, 95% -5.20 to 0.60; 1 study; 48 women; low-certainty evidence). Pessaries may result in a large increase in risk of adverse events compared with PFMT (RR 75.25, 95% CI 4.70 to 1205.45; 1 study; 97 women; low-certainty evidence). Adverse events included increased Vaginal discharge, and/or increased urinary incontinence and/or erosion or irritation of the Vaginal walls. Pessary plus PFMT versus PFMT alone: at 12 months' follow-up, pessary plus PFMT probably leads to more women perceiving improvement in their prolapse symptoms compared with PFMT alone (RR 2.15, 95% CI 1.58 to 2.94; 1 study; 260 women; moderate-certainty evidence). At 12 months' follow-up, pessary plus PFMT probably improves women's prolapse-specific quality of life compared with PFMT alone (median (interquartile range (IQR)) POPIQ score: pessary plus PFMT 0.3 (0 to 22.2); 132 women; PFMT only 8.9 (0 to 64.9); 128 women; P = 0.02; moderate-certainty evidence). Pessary plus PFMT may slightly increase the risk of abnormal Vaginal bleeding compared with PFMT alone (RR 2.18, 95% CI 0.69 to 6.91; 1 study; 260 women; low-certainty evidence). The evidence is uncertain if pessary plus PFMT has any effect on the risk of de novo voiding difficulty compared with PFMT alone (RR 1.32, 95% CI 0.54 to 3.19; 1 study; 189 women; low-certainty evidence). Authors' conclusions We are uncertain if pessaries improve pelvic organ prolapse symptoms for women compared with no treatment or PFMT but pessaries in addition to PFMT probably improve women's pelvic organ prolapse symptoms and prolapse-specific quality of life. However, there may be an increased risk of adverse events with pessaries compared to PFMT. Future trials should recruit adequate numbers of women and measure clinically important outcomes such as prolapse specific quality of life and resolution of prolapse symptoms. The review found two relevant economic evaluations. Of these, one assessed the cost-effectiveness of pessary treatment, expectant management and surgical procedures, and the other compared pessary treatment to PFMT.
Mercieca-bebber R - One of the best experts on this subject based on the ideXlab platform.
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A systematic review of the impact of contemporary treatment modalities for cervical cancer on women's self-reported health-related quality of life.
'Springer Science and Business Media LLC', 2020Co-Authors: Lm Wiltink, King M, Müller F, Sousa Ms, Tang M, Pendlebury A, Pittman J, Roberts N, Mileshkin L, Mercieca-bebber RAbstract:PURPOSE:Given the high survival rate of cervical cancer patients, understanding women's health-related quality of life (HRQL) during and after treatment is of major clinical importance. We conducted a systematic review to synthesize all available evidence about the effects of each contemporary treatment modality for cervical cancer on all dimensions of women's HRQL, including symptoms, functioning, and global HRQL. METHODS:We searched four electronic databases from January 2000 to September 2019, cross-referenced and searched by author name for studies of patients treated for cervical cancer that reported patient-reported outcomes (PROs) before treatment and with at least one post-treatment measurement. Two independent reviewers applied inclusion and quality criteria and extracted findings. Studies were categorized by treatment to determine specific treatment effects on PROs. Results were narratively summarized. RESULTS:We found twenty-nine papers reporting 23 studies. After treatments with curative intent for early or locally advanced disease, lymphedema, diarrhea, menopausal symptoms, tight and shorter Vagina, Pain during intercourse, and sexual worries remained long-term problems; however, sexual activity improved over time. HRQL and psychological distress were impacted during treatment with also worsening of global HRQL but improved 3-6 months after treatment. In patients with metastatic or recurrent disease, Pain improved during palliative treatment or remained stable, with no differences in global HRQL found over time. CONCLUSION:Whereas most symptoms worsen during treatment and improve in the first 3 months after completing treatment, symptoms like lymphedema, menopausal symptoms, and sexual worries develop gradually and persist after curative treatment. These findings can be used to inform clinical practice and facilitate communication and shared decision-making. More research is needed in very early cervical cancer and the impact of fertility sparing therapy on PROs
Carol Bugge - One of the best experts on this subject based on the ideXlab platform.
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Pessaries (mechanical devices) for managing pelvic organ prolapse in women
The Cochrane database of systematic reviews, 2020Co-Authors: Carol Bugge, Elisabeth J Adams, Deepa Gopinath, Fiona Stewart, Melanie Dembinsky, Pauline Sobiesuo, Rohna KearneyAbstract:Background Pelvic organ prolapse is a common problem in women. About 40% of women will experience prolapse in their lifetime, with the proportion expected to rise in line with an ageing population. Women experience a variety of troublesome symptoms as a consequence of prolapse, including a feeling of 'something coming down' into the Vagina, Pain, urinary symptoms, bowel symptoms and sexual difficulties. Treatment for prolapse includes surgery, pelvic floor muscle training (PFMT) and Vaginal pessaries. Vaginal pessaries are passive mechanical devices designed to support the Vagina and hold the prolapsed organs back in the anatomically correct position. The most commonly used pessaries are made from polyvinyl-chloride, polythene, silicone or latex. Pessaries are frequently used by clinicians with high numbers of clinicians offering a pessary as first-line treatment for prolapse. This is an update of a Cochrane Review first published in 2003 and last published in 2013. Objectives To assess the effects of pessaries (mechanical devices) for managing pelvic organ prolapse in women; and summarise the principal findings of relevant economic evaluations of this intervention. Search methods We searched the Cochrane Incontinence Specialised Register which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 28 January 2020). We searched the reference lists of relevant articles and contacted the authors of included studies. Selection criteria We included randomised and quasi-randomised controlled trials which included a pessary for pelvic organ prolapse in at least one arm of the study. Data collection and analysis Two review authors independently assessed abstracts, extracted data, assessed risk of bias and carried out GRADE assessments with arbitration from a third review author if necessary. Main results We included four studies involving a total of 478 women with various stages of prolapse, all of which took place in high-income countries. In one trial, only six of the 113 recruited women consented to random assignment to an intervention and no data are available for those six women. We could not perform any meta-analysis because each of the trials addressed a different comparison. None of the trials reported data about perceived resolution of prolapse symptoms or about psychological outcome measures. All studies reported data about perceived improvement of prolapse symptoms. Generally, the trials were at high risk of performance bias, due to lack of blinding, and low risk of selection bias. We downgraded the certainty of evidence for imprecision resulting from the low numbers of women participating in the trials. Pessary versus no treatment: at 12 months' follow-up, we are uncertain about the effect of pessaries compared with no treatment on perceived improvement of prolapse symptoms (mean difference (MD) in questionnaire scores -0.03, 95% confidence interval (CI) -0.61 to 0.55; 27 women; 1 study; very low-certainty evidence), and cure or improvement of sexual problems (MD -0.29, 95% CI -1.67 to 1.09; 27 women; 1 study; very low-certainty evidence). In this comparison we did not find any evidence relating to prolapse-specific quality of life or to the number of women experiencing adverse events (abnormal Vaginal bleeding or de novo voiding difficulty). Pessary versus pelvic floor muscle training (PFMT): at 12 months' follow-up, we are uncertain if there is a difference between pessaries and PFMT in terms of women's perceived improvement in prolapse symptoms (MD -9.60, 95% CI -22.53 to 3.33; 137 women; low-certainty evidence), prolapse-specific quality of life (MD -3.30, 95% CI -8.70 to 15.30; 1 study; 116 women; low-certainty evidence), or cure or improvement of sexual problems (MD -2.30, 95% -5.20 to 0.60; 1 study; 48 women; low-certainty evidence). Pessaries may result in a large increase in risk of adverse events compared with PFMT (RR 75.25, 95% CI 4.70 to 1205.45; 1 study; 97 women; low-certainty evidence). Adverse events included increased Vaginal discharge, and/or increased urinary incontinence and/or erosion or irritation of the Vaginal walls. Pessary plus PFMT versus PFMT alone: at 12 months' follow-up, pessary plus PFMT probably leads to more women perceiving improvement in their prolapse symptoms compared with PFMT alone (RR 2.15, 95% CI 1.58 to 2.94; 1 study; 260 women; moderate-certainty evidence). At 12 months' follow-up, pessary plus PFMT probably improves women's prolapse-specific quality of life compared with PFMT alone (median (interquartile range (IQR)) POPIQ score: pessary plus PFMT 0.3 (0 to 22.2); 132 women; PFMT only 8.9 (0 to 64.9); 128 women; P = 0.02; moderate-certainty evidence). Pessary plus PFMT may slightly increase the risk of abnormal Vaginal bleeding compared with PFMT alone (RR 2.18, 95% CI 0.69 to 6.91; 1 study; 260 women; low-certainty evidence). The evidence is uncertain if pessary plus PFMT has any effect on the risk of de novo voiding difficulty compared with PFMT alone (RR 1.32, 95% CI 0.54 to 3.19; 1 study; 189 women; low-certainty evidence). Authors' conclusions We are uncertain if pessaries improve pelvic organ prolapse symptoms for women compared with no treatment or PFMT but pessaries in addition to PFMT probably improve women's pelvic organ prolapse symptoms and prolapse-specific quality of life. However, there may be an increased risk of adverse events with pessaries compared to PFMT. Future trials should recruit adequate numbers of women and measure clinically important outcomes such as prolapse specific quality of life and resolution of prolapse symptoms. The review found two relevant economic evaluations. Of these, one assessed the cost-effectiveness of pessary treatment, expectant management and surgical procedures, and the other compared pessary treatment to PFMT.
Lm Wiltink - One of the best experts on this subject based on the ideXlab platform.
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A systematic review of the impact of contemporary treatment modalities for cervical cancer on women's self-reported health-related quality of life.
'Springer Science and Business Media LLC', 2020Co-Authors: Lm Wiltink, King M, Müller F, Sousa Ms, Tang M, Pendlebury A, Pittman J, Roberts N, Mileshkin L, Mercieca-bebber RAbstract:PURPOSE:Given the high survival rate of cervical cancer patients, understanding women's health-related quality of life (HRQL) during and after treatment is of major clinical importance. We conducted a systematic review to synthesize all available evidence about the effects of each contemporary treatment modality for cervical cancer on all dimensions of women's HRQL, including symptoms, functioning, and global HRQL. METHODS:We searched four electronic databases from January 2000 to September 2019, cross-referenced and searched by author name for studies of patients treated for cervical cancer that reported patient-reported outcomes (PROs) before treatment and with at least one post-treatment measurement. Two independent reviewers applied inclusion and quality criteria and extracted findings. Studies were categorized by treatment to determine specific treatment effects on PROs. Results were narratively summarized. RESULTS:We found twenty-nine papers reporting 23 studies. After treatments with curative intent for early or locally advanced disease, lymphedema, diarrhea, menopausal symptoms, tight and shorter Vagina, Pain during intercourse, and sexual worries remained long-term problems; however, sexual activity improved over time. HRQL and psychological distress were impacted during treatment with also worsening of global HRQL but improved 3-6 months after treatment. In patients with metastatic or recurrent disease, Pain improved during palliative treatment or remained stable, with no differences in global HRQL found over time. CONCLUSION:Whereas most symptoms worsen during treatment and improve in the first 3 months after completing treatment, symptoms like lymphedema, menopausal symptoms, and sexual worries develop gradually and persist after curative treatment. These findings can be used to inform clinical practice and facilitate communication and shared decision-making. More research is needed in very early cervical cancer and the impact of fertility sparing therapy on PROs
