Asunto(s)

Eccema , Piel , Humanos , Eccema/microbiología , Femenino , Masculino , Piel/microbiología , Cohorte de Nacimiento , Lactante , Recién Nacido , Microbiota , Hong Kong

RESUMEN

Previous studies reporting the association between gut microbiota dysbiosis and maternal obesity were mostly confined at the phylum level or at postpartum period. This study aimed to investigate the dynamic changes in gut microbial communities associated with maternal obesity at different time points of pregnancy. We performed 16S rRNA gene V3-V4 amplicon sequencing on stool samples from 110 women in all three trimesters and 1-month postpartum. Maternal gut microbial communities associated with maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) were explored. The influence of maternal obesity on gut microbiota trajectories was determined based on longitudinal shifts in community clusters across the trimesters. The richness index of alpha diversity decreased with the progression of pregnancy, particularly in women with excessive GWG. The evenness index in 2nd trimester was found inversely associated with GWG. Various taxonomic differences in 1st trimester were associated with excessive GWG, whereas limited taxonomic differences in 2nd and 3rd trimesters were associated with pre-pregnancy BMI or GWG. Meanwhile, the gut microbiota trajectory with especially depleted genus Faecalibacterium in 1st trimester was associated with excessive GWG (adjusted odds ratio 5.7, 95% confidence interval 1.2-28.1). Moreover, the longitudinal abundances of genus Lachnospiraceae ND3007 group across gestations were depleted in women with overweight/obese pre-pregnancy BMI, while genus Bifidobacterium enriched in women with excessive GWG. Our study shows that dysbiosis of the gut microbiota in early pregnancy may have a significant impact on excess GWG. The abundance of the genus Faecalibacterium in 1st trimester may be a potential risk factor. Clinical trial number: NCT03785093 (https://classic.clinicaltrials.gov/ct2/show/NCT03785093).

Asunto(s)

Índice de Masa Corporal , Disbiosis , Heces , Microbioma Gastrointestinal , Ganancia de Peso Gestacional , ARN Ribosómico 16S , Humanos , Femenino , Embarazo , Adulto , Heces/microbiología , ARN Ribosómico 16S/genética , Disbiosis/microbiología , Bacterias/clasificación , Bacterias/genética , Bacterias/aislamiento & purificación , Obesidad/microbiología , Adulto Joven , Obesidad Materna , Faecalibacterium/genética

RESUMEN

OBJECTIVE: To compare the extent to which visceral adiposity, as measured by mesenteric fat thickness, contribute to cardiometabolic risk, especially insulin resistance, in women with PCOS and healthy control. METHODS: This is a cross-sectional study with a total of 190 women with PCOS fulfilling the Rotterdam diagnostic criteria. Women without PCOS were recruited from a previous study, which comprised 416 healthy women controls with normal glucose tolerance. All subjects underwent OGTT, biochemical assessment, and sonographic assessment with measurements of mesenteric, preperitoneal and subcutaneous fat thickness. RESULTS: Mesenteric fat thickness was strongly correlated to cardiometabolic traits including blood pressure, fasting and 2-h glucose, triglycerides, HOMA-IR; and was negatively correlated to HDL-C in both cohorts (all p < 0.01). In PCOS, positive correlation was observed between mesenteric fat thickness and free androgen index (p < 0.01). Compared with controls, the regression line between mesenteric fat and HOMA-IR is much steeper in PCOS (p < 0.01). CONCLUSION: Women with PCOS remain more insulin resistant compared to controls at any given degree of visceral adiposity.

Asunto(s)

Enfermedades Cardiovasculares , Resistencia a la Insulina , Síndrome del Ovario Poliquístico , Adiposidad , Índice de Masa Corporal , Enfermedades Cardiovasculares/etiología , China , Estudios Transversales , Femenino , Humanos , Síndrome del Ovario Poliquístico/complicaciones

Asunto(s)

Lactancia Materna , Deficiencia de Vitamina D/epidemiología , Suplementos Dietéticos , Femenino , Voluntarios Sanos , Hong Kong , Humanos , Lactante , Masculino , Proyectos Piloto , Factores de Riesgo , Vitamina D/administración & dosificación , Deficiencia de Vitamina D/prevención & control

RESUMEN

INTRODUCTION: A survey conducted during 2005 to 2007 by the Centre for Food Safety in Hong Kong suggested that only 5% of the local population had a sufficient dietary intake of iodine. The study, however, was limited as biochemical data (ie urinary iodine concentration) were lacking. Pregnant women are vulnerable to iodine deficiency because of their increased requirement. Recent studies have shown that iodine deficiency in early pregnancy is associated with poorer cognitive development in early childhood. This study reports the iodine status of women during early gestation at an obstetric unit in Hong Kong. METHODS: Healthy pregnant women with no history of hyperemesis gravidarum were enrolled into a study when they first made a booking in an antenatal clinic of a public hospital to investigate their iodine status during early pregnancy. All subjects were asked to collect their morning urine for measurement of iodine and creatinine levels. Daily dietary intake of iodine was assessed in a subgroup of participants by structured interview using a standard food frequency questionnaire. RESULTS: A total of 600 pregnant women were enrolled at a median of 7.0 weeks of gestation. The median urinary iodine concentration and urinary iodine-to-creatinine ratio were 100 µg/L and 98 µg/g, respectively; 429 (71.5%) participants had iodine insufficiency according to the World Health Organization classification. Daily dietary intake of iodine was assessed in 146 participants. The median daily intake of iodine was 69.5 µg and 122 (83.6%) participants had an intake below the 250 µg recommended during pregnancy by the World Health Organization. CONCLUSIONS: Local pregnant women continue to have an inadequate dietary intake of iodine and remain iodine-deficient.

Asunto(s)

Alimentos Fortificados , Yodo/deficiencia , Complicaciones del Embarazo/epidemiología , Adulto , Femenino , Hong Kong/epidemiología , Humanos , Yodo/administración & dosificación , Servicios de Salud Materna , Embarazo , Complicaciones del Embarazo/prevención & control , Complicaciones del Embarazo/orina , Atención Prenatal

RESUMEN

There has been a marked increase in the prevalence of diabetes in Asia, including China, over the last few decades. While the increased prevalence of diabetes has often been attributed to the nutritional transition associated with recent economic development, emerging data suggest that early-life exposures also play a major role in shaping developmental trajectories, and contributes to alter an individual's susceptibility to diabetes and other non-communicable diseases (NCDs). Early-life exposures such as in utero exposure to undernutrition has been consistently linked with later risk of diabetes and obesity. Furthermore, in utero exposure to maternal hyperglycemia, maternal obesity and excess gestational weight gain are all linked with increased childhood obesity and later risk of diabetes. Emerging data have also highlighted the potential link between early-feeding practices, the role of one-carbon metabolism in metabolic programming and endocrine disrupting chemicals (EDCs) with later risk of diabetes. These different developmental exposures may all be highly relevant to the current epidemic of diabetes in China. For example, the prevalence of gestational diabetes has increased markedly over the last two decades, and may contribute to the diabetes epidemic by driving macrosomia, childhood obesity and later risk of diabetes. In order to address the current burden of diabetes, a lifecourse perspective, incorporating multisectoral efforts from public health policy down to the individuals, will be needed. Several major initiatives have been launched in China as part of its national plans for NCD prevention and treatment, and the experience from these efforts would be invaluable.

Asunto(s)

Diabetes Mellitus Tipo 2/epidemiología , Diabetes Gestacional/epidemiología , Desnutrición/epidemiología , Fenómenos Fisiologicos Nutricionales Maternos , Obesidad/epidemiología , Complicaciones del Embarazo/epidemiología , China/epidemiología , Dieta , Femenino , Conductas Relacionadas con la Salud , Política de Salud , Humanos , Estilo de Vida , Metaanálisis como Asunto , Embarazo , Efectos Tardíos de la Exposición Prenatal , Prevalencia , Salud Pública , Factores de Riesgo

Asunto(s)

Eccema/microbiología , Heces/microbiología , Microbiota , Estudios de Casos y Controles , China/etnología , Susceptibilidad a Enfermedades , Eccema/etnología , Humanos , Lactante , Proyectos Piloto , Estudios Prospectivos

RESUMEN

AIM: To investigate the relationship between birthweight and cardiometabolic traits in two cohorts: one of Chinese adolescents and one of Chinese adults. METHODS: Birthweight and clinical data, including anthropometric traits, fasting plasma glucose and fasting plasma insulin levels, blood pressure and lipid profiles were collected from 2035 adolescents and 456 adults. A subset of 735 subjects underwent an oral glucose tolerance test to measure the glucose and insulin concentrations at 0, 15, 30, 60 and 120 min. RESULTS: Among adolescents, birthweight showed U-shaped relationships with larger body size, obesity, abdominal obesity in girls, insulin resistance and worse lipid profiles (0.0013 < P(quadratic) < 0.0499), as well as an inverse association with fasting plasma glucose (P(linear) = 0.0368). After further adjustment for adiposity, decreasing birthweight was associated with elevated fasting plasma glucose levels, greater insulin resistance and worse lipid profiles (3.1 × 10⁻5 < P(linear) < 0.0058). Among adults, high birthweight was associated with larger body size and abdominal obesity in men, while low birthweight was associated with elevated glucose levels at 15, 30, 60 and 120 min and a greater area under the curve at 0-120 min, as well as with ß-cell dysfunction (6.5 × 10⁻5 < P(linear) < 0.0437). Adjustment for adult adiposity did not substantially change the relationships. There was significant interaction between birthweight and abdominal obesity in elevating fasting plasma insulin and homeostasis model assessment of insulin resistance (P > 0.05), with abdominally obese adolescents in the lowest birthweight category (≤ 2.5 kg) having the highest risk of insulin resistance. CONCLUSIONS: Both high and low birthweights are associated with an increased risk of cardiometabolic abnormalities including obesity, abdominal obesity, hyperglycaemia, dyslipidaemia and insulin resistance, as well as with ß-cell dysfunction.

Asunto(s)

Peso al Nacer , Dislipidemias/epidemiología , Hiperglucemia/epidemiología , Resistencia a la Insulina , Células Secretoras de Insulina/metabolismo , Insulina/metabolismo , Obesidad/epidemiología , Adolescente , Adulto , Pueblo Asiatico , Índice de Masa Corporal , Estudios de Cohortes , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/etnología , Diabetes Mellitus Tipo 2/fisiopatología , Dislipidemias/sangre , Dislipidemias/etnología , Dislipidemias/fisiopatología , Femenino , Hong Kong/epidemiología , Humanos , Hiperglucemia/sangre , Hiperglucemia/etnología , Hiperglucemia/fisiopatología , Insulina/sangre , Resistencia a la Insulina/etnología , Secreción de Insulina , Masculino , Persona de Mediana Edad , Obesidad/sangre , Obesidad/etnología , Obesidad/fisiopatología , Obesidad Abdominal/sangre , Obesidad Abdominal/epidemiología , Obesidad Abdominal/etnología , Obesidad Abdominal/fisiopatología , Factores de Riesgo , Factores Sexuales , Salud Urbana/etnología

RESUMEN

There has been a marked increase in the prevalence of diabetes in Asia over recent years. Diabetes complicating pregnancy, in particular gestational diabetes, has also increased markedly in the region. Multi-ethnic studies have highlighted the increased risk of gestational diabetes mellitus among the different Asian populations. Prevalence of gestational diabetes in Asian countries varies substantially according to the screening strategy and diagnostic criteria applied, and ranges from 1% to 20%, with evidence of an increasing trend over recent years. The International Association for Diabetes in Pregnancy Study group criteria have been adopted by some Asian countries, although they present significant challenges in implementation, especially in low-resource settings. Studies on offspring of mothers with gestational diabetes have reported adverse cardiometabolic profiles and increased risk of diabetes and obesity. Gestational diabetes is likely to be a significant factor contributing to the epidemic of diabetes and other non-communicable diseases in the Asian region. In recognition of this, several large-scale prevention and intervention programmes are currently being implemented in different Asian countries in order to improve glucose control during pregnancy, as well as overall maternal health. Lessons emerging from gestational diabetes studies in Asia may help inform and provide insights on the overall burden and treatment strategies to target gestational diabetes, with the ultimate aim to reduce its adverse short- and long-term consequences.

Asunto(s)

Pueblo Asiatico , Diabetes Mellitus Tipo 2/prevención & control , Diabetes Gestacional/diagnóstico , Tamizaje Masivo/organización & administración , Obesidad/prevención & control , Embarazo en Diabéticas/diagnóstico , Asia/epidemiología , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Gestacional/epidemiología , Diagnóstico Precoz , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Recién Nacido , Obesidad/epidemiología , Innovación Organizacional , Embarazo , Embarazo en Diabéticas/epidemiología , Prevalencia , Salud Pública , Factores de Riesgo

RESUMEN

INTRODUCTION: It is well known that women with history of gestational diabetes (GDM) are at risk of future DM. Whether they are at a higher risk of hypertension and cardiovascular risk remained to be determined. OBJECTIVES: To determine whether Chinese women who have been diagnosed GDM according to the new IADPSG criteria have a higher risk of hypertension & arterial stiffness than women with normal glucose tolerance (NGT) during pregnancy. METHODS: Chinese women who had participated in the HAPO study between 2001 and 2006 in Hong Kong were followed up at a median of 6years postpartum. All underwent anthropometric & BP measurements. Central systolic and diastolic blood pressures (SBP & DBP), augmentation index (AI) and pulse wave velocity (PWV) were assessed by using SphygmoCor(®) PVx.A total of 608 women (494 NGT, 114 GDM) were followed up till early 2012. RESULTS: Although there was no significant difference in the rate of hypertension, the central SBP (106±12 vs 102±13mmHg, p=0.03), AI (22.1±8.3 vs 18.9±8.5%, p<0.001) and PWV (6.8±1.0 vs 6.6±0.8, p=0.03) were all higher in women with history of GDM. CONCLUSION: The findings suggest a higher risk of subclinical atherosclerosis amongst women with GDM despite the blood pressure may appear normal at the time of follow up.

RESUMEN

OBJECTIVE: To explore the experience and attitudes of physicians in clinics, and to facilitate physicians' promotion of HPV vaccination. DATA SOURCES: Primary data collected from conducting semi-structural in-depth interviews from May to June 2010 with 12 physicians in one district in Hong Kong to understand their experience of providing HPV vaccines, the difficulties in promoting HPV vaccines, and their attitudes towards HPV vaccination. STUDY DESIGN: Physicians identified 4 categories of factors related to their experiences of and attitudes to providing HPV vaccination: (a) background information on HPV vaccination provided by physicians, (b) factors influencing women to receive vaccination, (c) physicians' recommendations to the public on HPV vaccines, and (d) physicians' perspectives on HPV vaccine promotion. CONCLUSIONS: Our findings show that public knowledge on HPV and cervical cancer is insufficient and the role of government in vaccine promotion is unclear. Promotion strategies such as physicians' recommendation, financial assistance and health education provided by the government will influence HPV vaccination and its promotion.

Asunto(s)

Educación Médica , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Médicos , Recolección de Datos/métodos , Femenino , Hong Kong , Humanos , Papillomaviridae/inmunología , Infecciones por Papillomavirus/inmunología , Vacunas contra Papillomavirus/inmunología , Aceptación de la Atención de Salud , Neoplasias del Cuello Uterino/inmunología , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/virología , Vacunación/métodos

RESUMEN

OBJECTIVE: The aim of this project was to determine the clinical effectiveness and cost-effectiveness of hysterectomy, first- and second-generation endometrial ablation (EA), and Mirena® (Bayer Healthcare Pharmaceuticals, Pittsburgh, PA, USA) for the treatment of heavy menstrual bleeding. DESIGN: Individual patient data (IPD) meta-analysis of existing randomised controlled trials to determine the short- to medium-term effects of hysterectomy, EA and Mirena. A population-based retrospective cohort study based on record linkage to investigate the long-term effects of ablative techniques and hysterectomy in terms of failure rates and complications. Cost-effectiveness analysis of hysterectomy versus first- and second-generation ablative techniques and Mirena. SETTING: Data from women treated for heavy menstrual bleeding were obtained from national and international trials. Scottish national data were obtained from the Scottish Information Services Division. PARTICIPANTS: Women who were undergoing treatment for heavy menstrual bleeding were included. INTERVENTIONS: Hysterectomy, first- and second-generation EA, and Mirena. MAIN OUTCOME MEASURES: Satisfaction, recurrence of symptoms, further surgery and costs. RESULTS: Data from randomised trials indicated that at 12 months more women were dissatisfied with first-generation EA than hysterectomy [odds ratio (OR): 2.46, 95% confidence interval (CI) 1.54 to 3.93; p = 0.0002), but hospital stay [WMD (weighted mean difference) 3.0 days, 95% CI 2.9 to 3.1 days; p < 0.00001] and time to resumption of normal activities (WMD 5.2 days, 95% CI 4.7 to 5.7 days; p < 0.00001) were longer for hysterectomy. Unsatisfactory outcomes associated with first- and second-generation techniques were comparable [12.2% (123/1006) vs 10.6% (110/1034); OR 1.20, 95% CI 0.88 to 1.62; p = 0.2). Rates of dissatisfaction with Mirena and second-generation EA were similar [18.1% (17/94) vs 22.5% (23/102); OR 0.76, 95% CI 0.38 to 1.53; p = 0.4]. Indirect estimates suggested that hysterectomy was also preferable to second-generation EA (OR 2.32, 95% CI 1.27 to 4.24; p = 0.006) in terms of patient dissatisfaction. The evidence to suggest that hysterectomy is preferable to Mirena was weaker (OR 2.22, 95% CI 0.94 to 5.29; p = 0.07). In women treated by EA or hysterectomy and followed up for a median [interquartile range (IQR)] duration of 6.2 (2.7-10.8) and 11.6 (7.9-14.8) years, respectively, 962/11,299 (8.5%) women originally treated by EA underwent further gynaecological surgery. While the risk of adnexal surgery was similar in both groups [adjusted hazards ratio 0.80 (95% CI 0.56 to 1.15)], women who had undergone ablation were less likely to need pelvic floor repair [adjusted hazards ratio 0.62 (95% CI 0.50 to 0.77)] and tension-free vaginal tape surgery for stress urinary incontinence [adjusted hazards ratio 0.55 (95% CI 0.41 to 0.74)]. Abdominal hysterectomy led to a lower chance of pelvic floor repair surgery [hazards ratio 0.54 (95% CI 0.45 to 0.64)] than vaginal hysterectomy. The incidence of endometrial cancer following EA was 0.02%. Hysterectomy was the most cost-effective treatment. It dominated first-generation EA and, although more expensive, produced more quality-adjusted life-years (QALYs) than second-generation EA and Mirena. The incremental cost-effectiveness ratios for hysterectomy compared with Mirena and hysterectomy compared with second-generation ablation were £1440 per additional QALY and £970 per additional QALY, respectively. CONCLUSIONS: Despite longer hospital stay and time to resumption of normal activities, more women were satisfied after hysterectomy than after EA. The few data available suggest that Mirena is potentially cheaper and more effective than first-generation ablation techniques, with rates of satisfaction that are similar to second-generation techniques. Owing to a paucity of trials, there is limited evidence to suggest that hysterectomy is preferable to Mirena. The risk of pelvic floor surgery is higher in women treated by hysterectomy than by ablation. Although the most cost-effective strategy, hysterectomy may not be considered an initial option owing to its invasive nature and higher risk of complications. Future research should focus on evaluation of the clinical effectivesness and cost-effectiveness of the best second-generation EA technique under local anaesthetic versus Mirena and types of hysterectomy such as laparoscopic supracervical hysterectomy versus conventional hysterectomy and second-generation EA. FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Asunto(s)

Técnicas de Ablación Endometrial/métodos , Histerectomía/métodos , Levonorgestrel/uso terapéutico , Menorragia/tratamiento farmacológico , Menorragia/cirugía , Anticonceptivos Femeninos/efectos adversos , Anticonceptivos Femeninos/economía , Anticonceptivos Femeninos/uso terapéutico , Análisis Costo-Beneficio , Técnicas de Ablación Endometrial/efectos adversos , Técnicas de Ablación Endometrial/economía , Femenino , Humanos , Histerectomía/efectos adversos , Histerectomía/economía , Levonorgestrel/efectos adversos , Levonorgestrel/economía , Menorragia/economía , Satisfacción del Paciente , Complicaciones Posoperatorias/epidemiología , Años de Vida Ajustados por Calidad de Vida , Tiempo , Resultado del Tratamiento

RESUMEN

OBJECTIVE: Visceral fat is believed to be important in the pathogenesis of metabolic syndrome and fatty liver. In this study, we examined the relationship between mesenteric fat thickness and other sonographic indices of adiposity and the presence of fatty liver among subjects with polycystic ovary syndrome (PCOS). SUBJECTS AND METHODS: A total of 117 Chinese subjects with PCOS were evaluated (mean age, 28.6 ± 6.5 yr; mean body mass index, 24.3 ± 5.3 kg/m(2)). Anthropometric measurements and metabolic risk profile, including a standard oral glucose tolerance test, were assessed in all subjects. All subjects underwent an ultrasound examination for measurement of thickness of mesenteric, preperitoneal, and sc fat as well as evaluation for fatty liver. RESULTS: Forty-six (39.3%) of the subjects had fatty liver. PCOS subjects with fatty liver had higher body mass index, waist circumference, waist-hip ratio, and systolic blood pressure; a more unfavorable lipid profile with higher triglyceride; lower high-density lipoprotein cholesterol; higher fasting glucose and insulin; higher 2-h glucose during oral glucose tolerance test; lower SHBG; and higher alanine aminotransferase. Subjects with fatty liver had increased thickness of preperitoneal, mesenteric, and sc fat, as well as increased carotid intima-media thickness. Abdominal fat thickness showed moderate correlation to alanine aminotransferase as well as fasting insulin. On multivariate logistic regression, fasting insulin and mesenteric fat thickness were identified as independent predictors of fatty liver among subjects with PCOS. CONCLUSION: Fatty liver is present in a significant proportion of Chinese patients with PCOS. Sonographic measurement of mesenteric fat is an independent determinant of fatty liver among subjects with PCOS and identifies subjects at increased cardiovascular risk.

Asunto(s)

Tejido Adiposo/diagnóstico por imagen , Hígado Graso/diagnóstico por imagen , Hígado Graso/etiología , Mesenterio/diagnóstico por imagen , Síndrome del Ovario Poliquístico/complicaciones , Adulto , Antropometría , Recuento de Células Sanguíneas , Análisis Químico de la Sangre , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Lípidos/sangre , Pruebas de Función Hepática , Síndrome del Ovario Poliquístico/diagnóstico , Valor Predictivo de las Pruebas , Factores de Riesgo , Grasa Subcutánea/anatomía & histología , Ultrasonografía , Circunferencia de la Cintura , Relación Cintura-Cadera , Adulto Joven

RESUMEN

OBJECTIVE: To evaluate the relative effectiveness of hysterectomy, endometrial destruction (both "first generation" hysteroscopic and "second generation" non-hysteroscopic techniques), and the levonorgestrel releasing intrauterine system (Mirena) in the treatment of heavy menstrual bleeding. DESIGN: Meta-analysis of data from individual patients, with direct and indirect comparisons made on the primary outcome measure of patients' dissatisfaction. DATA SOURCES: Data were sought from the 30 randomised controlled trials identified after a comprehensive search of the Cochrane Library, Medline, Embase, and CINAHL databases, reference lists, and contact with experts. Raw data were available from 2814 women randomised into 17 trials (seven trials including 1359 women for first v second generation endometrial destruction; six trials including 1042 women for hysterectomy v first generation endometrial destruction; one trial including 236 women for hysterectomy v Mirena; three trials including 177 women for second generation endometrial destruction v Mirena). Eligibility criteria for selecting studies Randomised controlled trials comparing hysterectomy, first and second generation endometrial destruction, and Mirena for women with heavy menstrual bleeding unresponsive to other medical treatment. RESULTS: At around 12 months, more women were dissatisfied with outcome with first generation hysteroscopic techniques than with hysterectomy (13% v 5%; odds ratio 2.46, 95% confidence interval 1.54 to 3.9, P<0.001), but hospital stay (weighted mean difference 3.0 days, 2.9 to 3.1 days, P<0.001) and time to resumption of normal activities (5.2 days, 4.7 to 5.7 days, P<0.001) were longer for hysterectomy. Unsatisfactory outcomes were comparable with first and second generation techniques (odds ratio 1.2, 0.9 to 1.6, P=0.2), although second generation techniques were quicker (weighted mean difference 14.5 minutes, 13.7 to 15.3 minutes, P<0.001) and women recovered sooner (0.48 days, 0.20 to 0.75 days, P<0.001), with fewer procedural complications. Indirect comparison suggested more unsatisfactory outcomes with second generation techniques than with hysterectomy (11% v 5%; odds ratio 2.3, 1.3 to 4.2, P=0.006). Similar estimates were seen when Mirena was indirectly compared with hysterectomy (17% v 5%; odds ratio 2.2, 0.9 to 5.3, P=0.07), although this comparison lacked power because of the limited amount of data available for analysis. CONCLUSIONS: More women are dissatisfied after endometrial destruction than after hysterectomy. Dissatisfaction rates are low after all treatments, and hysterectomy is associated with increased length of stay in hospital and a longer recovery period. Definitive evidence on effectiveness of Mirena compared with more invasive procedures is lacking.

Asunto(s)

Anticonceptivos Femeninos/administración & dosificación , Endometrio/cirugía , Histerectomía , Dispositivos Intrauterinos Medicados , Levonorgestrel/administración & dosificación , Menorragia/terapia , Adulto , Femenino , Humanos , Tiempo de Internación , Satisfacción del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Análisis de Regresión , Resultado del Tratamiento

RESUMEN

BACKGROUND: During general anaesthesia (GA) for Caesarean section (CS), fetal oxygenation is increased by administering an inspired oxygen fraction (Fi(o(2))) of 1.0. However, it is unclear whether such high Fi(o(2)) will increase oxygen free radical activity. METHODS: We randomized 39 ASA I-II parturients undergoing elective CS under GA to receive 30% (Gp 30), 50% (Gp 50), or 100% (Gp 100) oxygen with nitrous oxide and sevoflurane adjusted to provide equivalent minimum alveolar concentration. Baseline maternal arterial blood before preoxygenation and maternal arterial, umbilical arterial and venous blood at delivery were sampled for assays of the by-product of lipid peroxidation, isoprostane, and for measurement of blood gases and oxygen content. RESULTS: Maternal and umbilical isoprostane concentrations were similar among the three groups at delivery, despite significantly increased maternal and fetal oxygenation in Gp 100. However, paired comparisons of maternal delivery vs baseline concentration of isoprostane showed an increase at delivery for all groups [Gp 30: mean 342 (sd 210) vs 154 (65) pg ml(-1), P=0.016; Gp 50: 284 (129) vs 156 (79) pg ml(-1), P=0.009; Gp 100: 332 (126) vs 158 (68) pg ml(-1), P<0.001]. The magnitude of increase was similar in all three groups and independent of the Fi(o(2)) or duration after induction. CONCLUSIONS: GA for CS is associated with a marked increase in free radical activity in the mother and baby. The mechanism is unclear but it is independent of the inspired oxygen in the anaesthetic mixture. Therefore, when 100% oxygen is administered with sevoflurane for GA, fetal oxygenation can be increased, without inducing an increase in lipid peroxidation.

Asunto(s)

Anestesia por Inhalación/métodos , Anestesia Obstétrica/métodos , Cesárea , Peroxidación de Lípido , Terapia por Inhalación de Oxígeno/métodos , Adulto , Femenino , Sangre Fetal/metabolismo , Humanos , Recién Nacido , Cuidados Intraoperatorios/métodos , Isoprostanos/sangre , Intercambio Materno-Fetal , Oxígeno/sangre , Presión Parcial , Embarazo , Resultado del Embarazo , Adulto Joven

RESUMEN

BACKGROUND: Controversy still exists if the administration of supplementary oxygen to patients having emergency Caesarean section (CS) under regional anaesthesia is beneficial or potentially harmful. Therefore, in a prospective double-blinded study, we randomized patients having emergency CS under regional anaesthesia to receive either air or 60% oxygen until delivery and compared the effects on fetal oxygenation and lipid-peroxidation in the mother and baby. METHODS: We recruited 131 women having emergency CS under regional anaesthesia. Either 21% (air group) or 60% oxygen (oxygen group) was administered using a Venturi-type facemask until delivery. We compared the oxygen exposure duration, umbilical arterial (UA) and venous (UV) blood gases and oxygen content, and plasma concentration of 8-isoprostane. Subanalysis was performed according to whether or not fetal compromise was considered present. RESULTS: Data from 125 patients were analysed. For the oxygen group vs the air group, there were greater values for UA PO(2) [mean 2.2 (SD 0.5) vs 1.9 (0.6) kPa, P=0.01], UA O(2) content [6.6 (2.5) vs 4.9 (2.8) ml dl(-1), P=0.006], UV PO(2) [3.8 (0.8) vs 3.2 (0.8) kPa, P<0.0001], and UV O(2) content [12.9 (3.5) vs 10.4 (3.8) ml dl(-1), P=0.001]. There was no difference between the groups in maternal, UA, or UV 8-isoprostane concentration. Apgar scores and UA pH were similar between the groups. Similar changes were observed regardless of whether fetal compromise was considered present (n=37) or not (n=88). CONCLUSIONS: Breathing 60% oxygen during emergency CS under regional anaesthesia increased fetal oxygenation with no associated increase in lipid-peroxidation in the mother or fetus.

Asunto(s)

Anestesia de Conducción/métodos , Anestesia Obstétrica/métodos , Cesárea , Terapia por Inhalación de Oxígeno , Adolescente , Adulto , Puntaje de Apgar , Método Doble Ciego , Urgencias Médicas , Femenino , Sangre Fetal/metabolismo , Humanos , Peroxidación de Lípido , Persona de Mediana Edad , Oxígeno/sangre , Terapia por Inhalación de Oxígeno/efectos adversos , Oxihemoglobinas/metabolismo , Presión Parcial , Embarazo , Estudios Prospectivos , Adulto Joven

RESUMEN

OBJECTIVE: To study the prophylactic use of levonorgestrel intrauterine system (LNG-IUS) in the prevention of endometrial pathology in women having breast cancer treated with tamoxifen. DESIGN: Randomised controlled trial. SETTING: A tertiary teaching hospital. POPULATION: One hundred and thirteen women (66 premenopausal/47 postmenopausal) who required adjuvant tamoxifen for breast cancer after the completion of postoperative radiotherapy and chemotherapy. METHODS: Women were randomised to treatment group (prophylactic LNG-IUS insertion before the commencement of tamoxifen) or control group. Uterine cavity was examined by outpatient hysteroscopy and endometrial biopsy before and at 12 months after commencement of tamoxifen. MAIN OUTCOME MEASURES: De novo endometrial pathology at 1 year of tamoxifen. RESULTS: Women in the treatment group had a much lower incidence of endometrial polyp (1.8 versus 15.5%, P= 0.017) (relative risk: 0.12; 95% CI: 0.02-0.91) at 12 months. There was no significant difference in the incidence of submucosal fibroid between the two groups (1.8 versus 3.4%, P= 1.0). LNG-IUS was retained in 95% women in the treatment group at 1 year. CONCLUSION: LNG-IUS reduces the occurrence of de novo endometrial polyp in women treated with tamoxifen for breast cancer.

Asunto(s)

Antineoplásicos Hormonales/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Dispositivos Intrauterinos Medicados , Levonorgestrel/administración & dosificación , Tamoxifeno/efectos adversos , Enfermedades Uterinas/prevención & control , Adulto , Anciano , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Hiperplasia Endometrial/inducido químicamente , Hiperplasia Endometrial/prevención & control , Neoplasias Endometriales/inducido químicamente , Neoplasias Endometriales/prevención & control , Femenino , Humanos , Persona de Mediana Edad , Pólipos/inducido químicamente , Pólipos/prevención & control , Posmenopausia , Premenopausia , Enfermedades Uterinas/inducido químicamente

RESUMEN

OBJECTIVES: To explore the relationship between the levels of maternal oxidative stress and glycaemia during pregnancy and to compare the predictive values of 8-epimer of prostaglandin F(2alpha) (8-isoPGF(2alpha)) and mean arterial pressure (MAP) in midpregnancy for the development of hypertensive complications in later pregnancy. DESIGN: Prospective observational study as an ancillary study to the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study. SETTING: Obstetric clinics and wards of a university teaching hospital in Hong Kong. POPULATION: Selected women with singleton pregnancies attending the antenatal clinic. METHODS: Pregnant women who met HAPO inclusion criteria were recruited for the study. Glucose tolerance was assessed by a 75-g 2-hour oral glucose tolerance test (OGTT) at 24-32 weeks of gestation. Fasting plasma samples for 8-isoPGF(2alpha) estimation and urine samples for 8-isoPGF(2alpha) and 2,3-dinor 8-isoPGF(2alpha) assays were collected and blood pressures measured during the OGTT visit. Random plasma and urine samples were also obtained at 34-37 weeks. Glucose results were unblinded to the attending obstetrician if limits preset under the HAPO protocol were met. MAIN OUTCOME MEASURES: Maternal plasma 8-isoPGF(2alpha) and urinary 8-isoPGF(2alpha) and 2,3-dinor 8-isoPGF(2alpha) both at the time of OGTT (24-32 weeks) and at 34-37 weeks of gestation. Incidence of pre-eclampsia and gestational hypertension. RESULTS: Of the 408 women who attended for OGTT at 24-32 weeks, two met the glucose criteria for unblinding and 25 had missing 8-isoPGF(2alpha) values and thus were excluded from analysis. Of the 381 women, 338 (88.7%) attended for random plasma samples at 34-37 weeks. Significant correlations were observed between maternal fasting plasma isoprostane and both fasting (r= 0.20; P < 0.001) and 2-hour (r= 0.39; P < 0.001) plasma glucose levels at the time of OGTT. Gestational hypertension/pre-eclampsia occurred in 17 (4.2%) women, and at the time of OGTT, they had significantly higher fasting plasma 8-isoPGF(2alpha) (P < 0.001), urine 8-isoPGF(2alpha) (P < 0.005) and urine 2,3-dinor 8-isoPGF(2alpha) to creatinine ratios (P < 0.001), as well as higher MAP (P < 0.001) than women who remained normotensive. At 34-37 weeks, only random plasma 8-isoPGF(2alpha) was significantly higher (P < 0.001) among the women with gestational hypertension/pre-eclampsia. CONCLUSIONS: Plasma markers of oxidative stress were positively correlated with plasma glucose at the time of OGTT (24-32 weeks). Women who subsequently developed gestational hypertension/pre-eclampsia had significantly higher plasma and urine markers of oxidative stress at the time of OGTT but only higher plasma markers at 34-37 weeks. Plasma 8-isoPGF(2alpha) appears to be a very good predictor of subsequent gestational hypertension/pre-eclampsia when measured at the time of OGTT, but its ability to discriminate deteriorates as pregnancy advances.

Asunto(s)

Hipertensión Inducida en el Embarazo/diagnóstico , Estrés Oxidativo/fisiología , Preeclampsia/diagnóstico , Adulto , Glucemia/metabolismo , Dinoprost/análogos & derivados , Dinoprost/metabolismo , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Embarazo , Segundo Trimestre del Embarazo , Diagnóstico Prenatal/métodos , Estudios Prospectivos

RESUMEN

OBJECTIVE: The factors accounting for the low 'ever breastfeeding' rate in Hong Kong remain unclear. The objective of this survey was to study the intention and planned duration of breastfeeding in Chinese women in Hong Kong, and to investigate the sociodemographic and atopic factors affecting the intention to breastfeed. METHODS: All Chinese mothers who were Hong Kong residents and who delivered their babies in a University teaching hospital were given a self administered and anonymous Chinese questionnaire within 1 day postpartum. The questionnaire included items on sociodemographic data, the presence of allergic diseases in the families, and the intention and planned duration of breastfeeding for their newborn babies. RESULTS: A total of 1374 eligible questionnaires were collected. About one-third of mothers were born outside Hong Kong and the majority (78%) of them were aged between 25 and 40 years. Logistic regression revealed that only socioeconomic factors, namely older maternal age (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.14-3.89), parity (OR 3.08, 95% CI 1.02-9.27) and higher educational background (OR 2.87, 95% CI 1.92-4.27), significantly affected the intention to breastfeed. In addition, mothers born outside Hong Kong and those with first babies, had a longer intended duration of breastfeeding (P-values < 0.001 and 0.033, respectively). A family history of atopic disorders in parents or siblings did not influence the breastfeeding intention of these Chinese mothers. CONCLUSION: Several sociodemographic factors, rather than a history of atopic disorders, of Chinese mothers in Hong Kong affected their intention to breastfeed and the planned duration of breastfeeding.

Asunto(s)

Lactancia Materna/psicología , Madres/psicología , Adulto , Pueblo Asiatico , Asma/epidemiología , Femenino , Hong Kong/epidemiología , Humanos , Hipersensibilidad , Intención , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios

RESUMEN

Vaginal dermoid cyst is a rare finding. Preoperative diagnosis of this lesion is difficult as the sonographic features are similar to those of an epidermal inclusion cyst. We report a case of vaginal dermoid cyst and present its sonographic characteristics.

Asunto(s)

Quiste Dermoide/diagnóstico , Teratoma/diagnóstico , Neoplasias Vaginales/diagnóstico , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Terminología como Asunto