International Journal of Women's Health最新文献

Objective: To compare the efficacy of autologous fascial retropubic midurethral sling, anterior vaginal wall epithelial flap midurethral suspension, tension-free vaginal tape-obturator and adjustable urethral suspension with a single incision for the treatment of female stress urinary incontinence.

Materials and methods: A total of 243 SUI patients who were admitted to Minda Hospital of Hubei Minzu University, were chosen and split into four groups based on various surgical techniques: the AFS group (59 cases), TVT-O group (61 cases), epithelial flap group (62 cases) and ASIS group (61 cases). A comparison of four patient groups' quality-of-life scores, urodynamic indices, urethral structure-related indices before and a year after treatment, complication rates and perioperative-related indices.

Results: There was no discernible difference in the treatment outcomes among the four groups(P>0.05). However, the ASIS group exhibited significantly reduced intraoperative hemorrhage, hospitalization duration and operative time compared to the mucosal flap and TVT-O groups(P<0.05). Both the TVT-O and ASIS groups demonstrated significantly higher hospitalization expenditures than the mucosal flap and AFS groups (P<0.05). No significant differences were observed in postoperative indwelling catheterization, IIQ-7 and I-QOL ratings, urodynamic indices or urethral structure-related indexes across the four patient groups(P>0.05). The TVT-O group showed a significantly higher incidence of postoperative medial thigh pain compared to the AFS, mucosal flap, and ASIS groups(P<0.05). Similarly, the AFS group had a significantly greater incidence of postoperative urine retention compared to the mucosal flap, TVT-O, and ASIS groups(P<0.05).

Conclusion: While all four surgical techniques demonstrated good efficacy and improved patients' quality of life, our study suggests that TVT-O had a significantly higher incidence of post-treatment medial thigh pain and ASIS may be a safer and less problematic surgical approach for the treatment of female SUI. This has important therapeutic implications.

Background: Understanding the timing of first sexual experience is crucial for informing reproductive health policies and interventions. However, little is known about this area of research in Rwanda. This study aims to estimate the determinants of time to first sexual experience among female youths in Rwanda.

Methods: A secondary data analysis of the Rwanda Demographic and Health Survey (RDHS 2019-2020) was conducted. Kaplan-Meier survival curves and Cox proportional hazards regression models were utilized to estimate the median age at first sexual experience and identify significant determinants; a significance level of 0.05 was considered. All analyses were performed using R (Version 4.3.3).

Results: The study found that 2090 (36.9%) of female youths in Rwanda had their first sexual experience before the age of 25, with 7.0% initiating sexual activity before 15. The median age at first sexual experience was 18 years (Interquartile range: 16-19). Determinants associated with a reduced hazard of early first sexual experience included being aged 20-24 years (75%) (AHR = 0.25, 95% CI: 0.23-0.29), living in rural areas (15%) (AHR = 0.85, 95% CI: 0.74-0.99), having tertiary education (38%) (AHR = 0.62, 95% CI: 0.42-0.90), being married (AHR = 0.49, 95% CI: 0.42-0.56), and listening to the radio at least once a week (13%) (AHR = 0.87, 95% CI: 0.76-0.99).

Conclusion: Enhancing educational opportunities, promoting stable partnerships, and increasing access to media information in rural areas may be effective strategies in delaying first sexual experience.

Objective: Vaginal cuff rupture is a rare but serious postoperative complication predominantly occurring after hysterectomy. Given that it can lead to partial or total evisceration, bowel strangulation, sepsis, and acute mesenteric ischemia. Any instance of this complication should be treated as a surgical emergency. In this context, we report a case of a vaginal stump following regular use of pessaries.

Case report: A 50-year-old woman was admitted to the hospital with sudden onset of bowel-like prolapse from the vagina. She had a 7-year history of vaginal prolapse and had previously undergone repair surgery and laparoscopic hysterectomy for uterine fibroids. Following her hysterectomy, she began using a pessary due to recurrent prolapse. Clinical assessment revealed vaginal evisceration of the intestines, necessitating emergency surgery. She was discharged smoothly on the eighth day post-operation. Three months later, she underwent a laparoscopic sacrocolpopexy.

Conclusion: The utilization of pessaries may heighten the risk of stump rupture in patients following hysterectomy, thereby demanding more vigilant attention from gynecologists.

Background: Mammary duct fistula is an abnormal tract formed between the wall of a breast duct and the adjacent tissue or skin, typically resulting from a rupture of the duct wall. This condition is characterized by inflammation due to the leakage of fluid from the surrounding breast tissue. Infection of the sinus tract can lead to the infection of adjacent lactiferous ducts or recurrence in the same sinus tract, ultimately resulting in abscess formation and a prolonged healing process. In severe cases, this condition may be accompanied by breast deformity and other complications.

Case presentation: A patient with a mammary duct fistula from the General Surgery Department of Dongzhimen Hospital, affiliated with the Beijing University of Chinese Medicine, underwent a modified surgical procedure. Post-surgery, the patient's nipple inversion was fully corrected with no recurrence observed.

Conclusion: The novel modified surgical procedure demonstrates effectiveness in preventing local recurrence, shortening the clinical course, and addressing pathogenic factors such as nipple inversion. This approach has the potential to improve the cure rate of mammary duct fistulas and is worthy of clinical promotion.

Introduction: Human Immunodeficiency Virus (HIV) remains a major global health issue. In Poland, men represent 79% of the HIV-infected population, but the proportion of women diagnosed has been increasing. This study examines the clinical condition of newly diagnosed HIV-1 patients in Lower Silesia at three key points: 2010, 2016, and 2020, to understand infection dynamics and improve regional screening and prevention efforts.

Objective: The objective of the study is to compare the clinical condition of newly diagnosed women and men with HIV-1 in Lower Silesia at three time points in order to identify trends and differences that can inform targeted public health strategies.

Methods: A retrospective analysis of medical records from the HIV clinic in Wroclaw was conducted for the years mentioned. The dataset included demographic information, transmission routes, clinical status, and co-infections.

Results: The study included 202 patients, of whom 27 were women. Heterosexual transmission was the primary route among women (2010/2016/2020 - 44.44%/57.14%/90.91%), while men predominantly acquired HIV-1 through homosexual contact (2010/2016/2020 - 52.94%/80.82%/75%). A significant decrease in infections from intravenous drug use was observed among men (Chi² = 24.85, df = 2, p < 0.001). Women consistently had lower CD4+ T cell counts, with a median (Q1, Q3) of 250 (108-288), significantly lower than men's 431 (280-550) (Mann-Whitney U-test: z = 4.23, p < 0.001). Women were also more frequently diagnosed as late presenters (OR: 6.07, 95% CI (2.34-15.82)).

Conclusion: This study identifies significant gender disparities in HIV-1 diagnosis in Lower Silesia, with women being six times more likely to be diagnosed as late presenters. This highlights the necessity for enhanced and targeted public health interventions, particularly within the context of antenatal care.

Introduction: The Systemic Immune-Inflammation Index (SII) is a novel biomarker that has been implicated in the pathogenesis of various neoplastic and non-neoplastic diseases. This study aimed to evaluate the association between SII and the conventional tumor marker CA125 (Carbohydrate antigen 125) in a population of postmenopausal women.

Methods: This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES), focusing on postmenopausal women with available data on SII and CA125. The SII was calculated using the formula: platelet count × neutrophil count/lymphocyte count. To evaluate the relationship between the SII and cancer antigen 125 (CA125), we conducted multivariate regression analyses. The linear association between these variables was further explored by fitting a smoothed curve to examine nuances in their relationship. Additionally, subgroup analyses were performed based on age, age at menarche and menopause, and hormone replacement therapy status to assess the heterogeneity of the relationship between SII and CA125 between different demographic groups.

Results: A total of 741 postmenopausal women with a mean age of 72.0 (±8.24) years were included in this analysis. The results demonstrated a significant positive correlation between SII and CA125 levels (β = 0.01; 95% CI, 0.00-0.02, p = 0.0128). Subgroup analyses and interaction tests revealed that variables such as age, age at menarche and menopause, and hormone replacement therapy did not significantly modify this association (p > 0.05).

Conclusion: This study demonstrated a positive correlation between SII and C125 in older female patients in the United States.

Background: Although both cervical intraepithelial neoplasia (CIN) II and CIN III carry the potential to progress into cervical cancer, to date, an optimal screening method for CIN2+ (CIN II, CIN III, and cervical cancer) cervical lesions is yet to be established.

Methods: In this retrospective study, data from 2035 patients treated at the Fourth Hospital of Hebei Medical University between 2019 and 2021 were analyzed. The screening efficacy of three methods-the ThinPrep cytologic test (TCT) alone, the high-risk-human papillomavirus (HR-HPV) test alone, and the combined TCT and HR-HPV screening for CIN2+ lesions-were assessed using cervical histopathology as the reference standard. Additionally, correlations between HPV16 cycle threshold (Ct) values, HPV18 Ct values, and the severity of cervical lesions were analyzed. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic utility of HPV16 Ct values for CIN2+ lesions.

Results: Compared with TCT or HR-HPV testing alone, the combined TCT and HR-HPV test had the highest sensitivity of 98.1% (P < 0.0001), the highest negative predictive value of 99.8% (P = 0.0001), and the lowest missed diagnosis rate of 1.9% (P < 0.0001) for screening CIN2+ lesions. Additionally, the combined test yielded the largest area under the ROC curve (AUC) value of 0.9480. There was a significant difference in HPV16 Ct values for various degrees of cervical lesions (P < 0.001), with the Spearman rank correlation test revealing a significant negative correlation (rs = -0.447, P < 0.001). The optimal HPV16 Ct value for diagnosing CIN2+ lesions was 29.995, with an AUC of 0.797 (P < 0.0001).

Conclusion: The combination of TCT and HR-HPV testing was the most effective method for screening CIN2+ lesions. Furthermore, HPV16 Ct values were negatively correlated with the severity of cervical lesions, with a threshold of 29.995 potentially indicating the presence of CIN2+ lesions.

Purpose: The purpose of this study is to examine the protective role of dietary vitamin B12 against depression, particularly as its prevalence is notably high among women experiencing urinary incontinence (UI). Nevertheless, the relationship between vitamin B12 intake, UI, and depression requires further clarification. This research aims to explore this association specifically among women.

Methods: This cross-sectional study analyzed data from 14,154 women sourced from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2018. Depression was measured using the Personal Health Questionnaire (PHQ-9). Vitamin B12 intake was assessed through 24-h dietary recall interviews. Weighted univariate and multivariate logistic regression models assessed the relationships between UI, vitamin B12 intake, and depression in women, with additional analyses conducted across different age, body mass index (BMI), and vaginal delivery groups. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Results: The study included 14,154 women, averaging 48.18±0.27 years in age, of whom 1609 (11.37%) exhibited depressive symptoms. Women with stress UI (OR=1.55, 95% CI: 1.26-1.91), urgency UI (OR=1.92, 95% CI: 1.52-2.44), and mixed UI (OR=2.60, 95% CI: 2.13-3.19) showed significantly greater odds of depression compared to those without UI. Vitamin B12 intake of ≥2.4 mcg/day was associated with lower odds of depression (OR=0.95, 95% CI: 0.080-1.14). In patients with UI, the odds of depression gradually decreased with a vitamin B12 intake of ≥2.4 mcg/day. A moderating role of vitamin B12 intake was observed among women with UI aged ≤ 64 years, with BMI ≥ 25 kg/m², and those with or without vaginal deliveries.

Conclusion: UI is linked to elevated depression odds, while vitamin B12 intake appears to moderate this relationship. It is essential for healthcare providers to prioritize early depression assessments in women with UI and to offer timely interventions to enhance their quality of life.

Background: Prior investigations have suggested a significant association between coagulation factors and ovarian cancer; however, the precise nature of the causal relationship remains elusive. Our objective is to thoroughly investigate this causal link and delineate the influence of coagulation factors on the risk of ovarian cancer through a rigorous two-sample Mendelian randomization (MR) analysis.

Methods: Genetic instrumental variables representing coagulation factors were sourced from four distinct data repositories. Summary statistics pertaining to ovarian cancer were obtained from two extensive Genome-Wide Association Studies (GWAS) for primary and replication analyses, respectively. The primary Mendelian randomization (MR) analysis utilized the inverse-variance weighted (IVW) method. To fortify the reliability of our findings, additional analyses were conducted, including the weighted-median method, MR-Egger regression, MR pleiotropy residual sum and outlier test, Cochran's Q statistic test, MR-Egger intercept analysis, and leave-one-out method, among others.

Results: We identified four coagulation factors that were associated with the risk of ovarian cancer in the primary analysis, [odds ratio (OR): 1.365, 95% confidence interval (CI): 1.209-1.542, P <0.001 for von Willebrand factor measurement(vWF); OR: 1.060, 95% CI: 1.018-1.104, P = 0.005 for A disintegrin and metalloproteinase with thrombospondin motifs 13 (ADATMS13); OR: 1.317, 95% CI: 1.002-1.730, P = 0.048 for activated partial thromboplastin time (aPTT); OR: 1.139, 95% CI: 1.063-1.221, P <0.001 for coagulation Factor VIII (FVIII)]. In the meta-analysis, we found that higher levels of coagulation factor VII measurement(FVII) (OR=1.0007, 95% CI: 1.0001-1.0013, P=1.0007) was associated with increased ovarian cancer risk. The results of sensitivity analyses for these coagulation factors were consistent (P<0.05).

Conclusion: Our systematic analyses have furnished evidence suggesting a plausible causal association between FVII and the susceptibility to ovarian cancer. Further investigations are warranted to delineate the mechanistic pathways through which coagulation factors influence the progression of ovarian cancer.

Background: Post-caesarean surgical site infections (PCSSIs) significantly impact maternal morbidity, mortality, and healthcare costs in low- and middle-income countries, particularly in sub-Saharan Africa, where preventive measures are often inadequate. Despite this burden, data on PCSSIs in this context are limited. This study aimed to evaluate the incidence and factors associated with PCSSIs at Mubende Regional Referral Hospital.

Methods: This prospective cohort study included 204 women who underwent caesarean sections from July to September 2023. Data was collected and participants were monitored for up to 28 days post-delivery to identify occurrences of surgical site infections (SSIs). Statistical analysis was conducted using STATA, with significance defined as a p-value of < 0.05.

Results: Most participants (63.2%) were aged 18-35 years, with over 67% having a parity of ≤4. Preoperative antibiotics were administered to 77.5% of participants. Most surgeries (64.2%) lasted 1-2 hours, and the overall incidence of surgical site infections (SSIs) was 16.18%. Significant risk factors associated with more than a twofold increase in SSI risk included unstable referral status (aRR = 2.02), obstructed labor (aRR = 2.97), chorioamnionitis (aRR = 2.73), and prolonged premature rupture of membranes (PROM) (aRR = 2.05). Prolonged labor increased SSI risk by 1.37-fold (aRR = 1.37), while receipt of preoperative antibiotics was linked to a reduced SSI risk (aRR = 0.77).

Conclusion: The post-caesarean SSI rate at Mubende Regional Referral Hospital is notably high, with key risk factors including unstable referral status, obstructed labor, prolonged labor, chorioamnionitis, and prolonged premature rupture of membranes (PROM). Administering preoperative antibiotics 30 minutes to 1 hour prior to surgery is linked to a reduced risk of SSI.