Importance:The research of new therapeutic modalities, especially with energy-based devices, has been increasing nowadays for genitourinary syndrome of menopause (GSM) management. Microablative fractional CO2 laser has been used for pelvic floor dysfunction management.Objective:To conduct a systematic review and meta-analysis of randomized controlled trials to compare fractional CO2 laser therapy versus sham therapy for GSM management.Evidence Review:We searched for the available randomized clinical trials in Cochrane Library, PubMed, ISI web of science, and Scopus during March 2021. We included randomized clinical trials that compared CO2 laser to sham among postmenopausal women with GSM diagnosis. We extracted the available data from included studies and pooled them in a meta-analysis model using RevMan software. Our main outcomes were total vaginal score assessment using the Vaginal Assessment Scale, sexual function using the Female Sexual Function Index, urinary symptoms using the Urogenital Distress Inventory-6, and satisfaction.Findings:Three studies met our inclusion criteria with a total number of 164 women. The CO2 laser was linked to a significant reduction in Vaginal Assessment Scale score when compared with the sham group (mean difference [MD] = −0.49, 95% CI [−0.75 to −0.22], P = 0.004). The CO2 laser was associated with a significant improvement in Female Sexual Function Index score in comparison with sham group (MD = 9.37, 95% CI [6.59-12.14], P < 0.001). In addition, a significant reduction in Urogenital Distress Inventory-6 score was reported among the CO2 laser group (MD = −6.95, 95% CI [−13.24 to −0.67], P = 0.03). More women were significantly satisfied among the CO2 laser group (risk ratio  = 1.98, 95% CI [1.36-2.89], P = 0.004).Conclusions and Relevance:CO2 laser therapy is a promising alternative for GSM management. Further randomized trials with larger sample sizes are required to confirm our findings.

No abstract

Background: serum amyloid A (SAA) is a cytokine-inducible acute-phase reactant whose plasma concentrations can exceed 1 mg/mL during an acute-phase response (500 to 1000 fold of plasma levels greater than in the non inflammatory state) thus representing an ideal marker for clinical use. Preterm premature rupture of membranes (PPROM) complicates only 2% of pregnancies but is associated with 40% of preterm deliveries and can result in significant neonatal morbidity (Prematurity, sepsis and pulmonary hypoplasia) and mortality. Aim of the work: this study aimed to find out association between maternal serum amyloid A level and preterm premature rupture of membranes. Also to compare SAA, CRP levels, N/L ratio in the study group. Patients and methods: this study is a cross sectional study conducted in Ain Shams University Maternity Hospital from December 2015-December 2016 on 58 pregnant women. Women have been allocated in this study, represented in two groups: 1-Study group: including 29 women complaining of preterm premature rupture of membranes. 2-Control group: including 29 women as control group with no complain. Venous blood sample was taken from each participant (study group within 1hour from onset of PPROM, control group during their follow up visit to the clinics). Serum amyloid A, Micro C reactive pretein, total WBCs and neutrophil/lymphocyte ratio (NLR) were calculated. Results: the results point out that PPROM cases had significantly lower GA and APGAR scores at 1 min and more prone to neonatal sepsis which may lead to death. PPROM women have significantly higher total WBC, N/L ratio CRP and serum amyloid A. There were significant positive correlations between amyloid-A, N/L ratio& CRP in both groups. Serum amyloid A level above 2 ng/ml is a risk factor for PPROM and low Apgar score at 1 min. but has low predictive value. CRP with cut off value 5.0 mg/dl has better predictive value in discrimination between PPROM group and control group.Conclusion: Results assessed possible association between maternal SAA, maternal and fetal parameters in pregnancies complicated with PPROM.

Background PPROM is defined as spontaneous rupture of the membranes before the onset of labour prior to 37 weeks gestation. It complicates 2-4% of all singletons and 7-20% of twin pregnancies and is associated with over 60% of preterm births. Aim of the Work to retrospectively compare the neonatal and maternal outcomes in women with preterm prelabor rupture of the membranes (PPROM) who delivered before versus who delivered after 34 weeks of gestation over a 5-year period (between January 2011 and December 2015). Patients and Methods This retrospective case-control study was conducted at Ain Shams University Maternity Hospital. The analysis covered the period between January 2011 and December 2015. The study included all women admitted to Ain Shams University Maternity Hospital during the period between January 2011 and December 2015 with a diagnosis of preterm prelabor rupture of the membranes (PPROM). Results The incidence of chorioamnionitis (p-value &lt;0.001) and maternal sepsis (p-value = 0.001) were both significantly higher in those delivering before 34 weeks. The gestational age at ROM was significantly lower and the latent period was significantly shorter in patients delivering before 34 weeks of gestation (p-values &lt;0.001). The Apgar score at 1 and 5 minutes as well as the birth weight were significantly lower in the group delivering before 34 weeks of gestation (p-values &lt;0.001). The incidence of low Apgar score at 1 and 5 minutes (p-value &lt;0.001 and 0.002, respectively), NEC (p-value = 0.006), IVH (p-value &lt;0.001), RDS (p-value = 0.005) and neonatal death (p-value &lt;0.001) were all significantly higher in patients delivering before 34 weeks of gestation. Conclusion In women with premature preterm rupture of membrane neonatal and maternal outcomes is better in those who delivered after 34 weeks of gestation when compared to those who delivered before 34 weeks of gestation.

No abstract

BackgroundAdolescents and providers can benefit from practical tools targeting lifestyle modification for obesity prevention and management. We created Conversation Cards for Adolescents© (CCAs), a patient-centered communication and behavior change tool for adolescents and providers to use in clinical practice. The purpose of our study is to (i) assess the feasibility of CCAs in a real-world, practice setting to inform full-scale trial procedures, (ii) assess user experiences of CCAs, and (iii) determine the preliminary effect of CCAs on changing behavioral and affective-cognitive outcomes among adolescents.MethodsStarting in early 2019, this prospective study is a nested mixed-methods, theory-driven, and pragmatic pilot randomized controlled trial with a goal to enroll 50 adolescents (13–17 years old) and 9 physicians practicing at the Northeast Community Health Centre in Edmonton, Alberta, Canada. Adolescents will collaboratively set one S.M.A.R.T. (specific, measurable, attainable, realistic, timely) goal with their physician to implement over a 3-week period; however, only those randomized to the experimental group will use CCAs to inform their goal. Outcome assessments at baseline and follow-up (3 weeks post-baseline) will include behavioral, affective-cognitive, and process-related outcomes.DiscussionIn examining the feasibility, user experiences, and preliminary effect of CCAs, our study will add contributions to the obesity literature on lifestyle modifications among adolescents in a real-world, practice setting as well as inform the scalability of our approach for a full-scale effectiveness randomized controlled trial on behavior change.Trial registrationClinicalTrials.gov Identifier: NCT03821896.

No abstract

No abstract