August 2024

Recent Research Publications- August 2024

DermDx: Painful Vulvar Cyst.

Stockdale CK, Elas DE.

Clinical Advisor June 27, 2024.

For a full text of the article, click here: https://www.clinicaladvisor.com/slideshow/derm-dx/dermdx-painful-vulvar-cysts/

​Verrucous Keratosis of the Vulva: Clinical Image.

Elas DE, Stockdale CK.

Clin Image Case Rep J. 2024; 6(6): 403

For a full text of the article, click here: https://www.literaturepublishers.org/archive/Verrucous-Keratosis-of-the-Vulva:-Clinical-Image.html

Changing the paradigm: Elimination – Not only of cervical cancer.

Bornstein J, Sacinti KG, Preti M, Billan S, Razeghian H, Stockdale CK.

Gynecol Oncol Rep. 2024 Jul 3;54:101445. doi: 10.1016/j.gore.2024.101445. PMID: 39045263; PMCID: PMC11263942.

The WHO’s initiative to eliminate cervical cancer by 2030 does not address the increasing incidence of vulvar, anal, and oropharyngeal cancers linked to high-risk HPV. Currently, the prevention of these three cancers faces various obstacles, such as a lack of specialized screening programs, well-defined management guidelines, and widespread public awareness. Without any interventions, the incidence of these three cancers will likely rise in the upcoming years, increasingly affecting younger individuals. We recommend expanding the WHO’s initiative to include vulvar, anal, and oropharyngeal cancers. This involves developing screening and management protocols similar to those for cervical cancer, implementing gender-neutral HPV vaccination programs, establishing clear referral pathways to specialized centers, promoting public awareness, and providing education to healthcare providers and high-risk individuals.

For a full text of the article, click here: https://www.sciencedirect.com/science/article/pii/S2352578924001243

Diagnosis of pregnancy disorder in the first-trimester patient plasma with Raman spectroscopy and protein analysis

Mathew AP, Cutshaw G, Appel O, Funk M, Synan L, Waite J, Ghazvini S, Wen X, Sarkar S, Santillan M, Santillan D, Bardhan R.

Bioeng Transl Med. 2024;e10691. doi:10.1002/btm2.10691.

Gestational diabetes mellitus (GDM) is a pregnancy disorder associated with short- and long-term adverse outcomes in both mothers and infants. The current clinical test of blood glucose levels late in the second trimester is inadequate for early detection of GDM. Here we show the utility of Raman spectroscopy (RS) for rapid and highly sensitive maternal metabolome screening for GDM in the first trimester. Key metabolites, including phospholipids, carbohydrates, and major amino acids, were identified with RS and validated with mass spectrometry, enabling insights into associated metabolic pathway enrichment. Using classical machine learning (ML) approaches, we showed the performance of the RS metabolic model (cross-validation AUC 0.97) surpassed that achieved with patients' clinical data alone (cross-validation AUC 0.59) or prior studies with single biomarkers. Further, we analyzed novel proteins and identified fetuin-A as a promising candidate for early GDM prediction. A correlation analysis showed a moderate to strong correlation between multiple metabolites and proteins, suggesting a combined protein-metabolic analysis integrated with ML would enable a powerful screening platform for first trimester diagnosis. Our study underscores RS metabolic profiling as a cost-effective tool that can be integrated into the current clinical workflow for accurate risk stratification of GDM and to improve both maternal and neonatal outcomes.

For a full text of the article, click here: https://aiche.onlinelibrary.wiley.com/doi/10.1002/btm2.10691

Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN): An introduction to the Urinary Urgency Phenotyping Protocol LURN II.

Cameron AP, Yang CC, Bradley CS, Griffith JW, Kirkali Z, Clemens JQ, Kreder KJ, Kenton KS, Andreev VP, Amundsen CL, Jelovsek JE, Helfand BT, Lai HH; LURN Study Group.

Neurourol Urodyn. 2024 Jul 29. doi: 10.1002/nau.25566. Epub ahead of print. PMID: 39075835.

Aims: The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is undertaking a new cohort study in LURN II including cases and controls.

  • This new cohort was enrolled to specifically study urinary urgency and urgency urinary incontinence, lower urinary tract symptoms (LUTSs) that are often difficult to treat due to a lack of understanding of their phenotypes and pathophysiologies.
  • This paper will focus on the motivation for the second iteration of LURN and highlight the new research techniques and plans for more thorough phenotyping of this population.

Conclusions: This paper will outline the gaps in understanding in treating LUTSs, specifically urinary urgency.

For a full text of the article, click here: https://onlinelibrary.wiley.com/doi/10.1002/nau.25566

​Outcomes Related to Prenatal Zika, Dengue, and Other Flavivirus Infections in the Zika en Embarazadas y Niños Prospective Cohort Study in Colombia.

Tannis A, Newton S, Rico A, Gonzalez M, Benavides M, Ricaldi JN, Rodriguez H, Zambrano LD, Daza M, Godfred-Cato S, Thomas JD, Acosta J, Maniatis P, Daniels JB, Burkel V, Ailes EC, Valencia D, Gilboa SM, Jamieson DJ, Mercado M, Villanueva JM, Honein MA, Ospina ML, Tong VT.

Am J Trop Med Hyg. 2024 Jul 9:tpmd230873. doi: 10.4269/ajtmh.23-0873. Epub ahead of print. PMID: 38981499.

Zika virus (ZIKV) infection in pregnancy is associated with severe abnormalities of the brain and eye and other adverse outcomes. Zika en Embarazadas y Niños was a prospective cohort study conducted in multiple Colombian cities that enrolled pregnant women in their first trimester. Specimens collected from pregnant women (n = 1,519) during February 2017-September 2018 and their infants (n = 1,080) during June 2017-March 2019 were tested for prenatal ZIKV infection by nucleic acid amplification tests or IgM antibody testing. Zika virus infection in pregnancy was present in 3.2% of pregnant women (incidence rate [IR] per 1,000 person-months = 5.9, 95% CI: 4.3-7.8). Presumptive ZIKV infection was present in 0.8% of infants (IR = 1.6, 95% CI: 0.7-2.9). Five percent of infants with prenatal ZIKV exposure or infection presented with Zika-associated abnormalities; 4.7% were small for gestational age. Understanding the risk of ZIKV infection during pregnancy and associated adverse outcomes can help inform counseling efforts.

For a full text of the article, click here: https://www.ajtmh.org/view/journals/tpmd/aop/article-10.4269-ajtmh.23-0873/article-10.4269-ajtmh.23-0873.xml

Reply to Editorial Comment on "A Single Injection of Platelet-Rich Plasma Injection for the Treatment of Stress Urinary Incontinence in Females: A Randomized Placebo-Controlled Trial".

Ashton L, Nataksuka H, Johnson CM, Kenne K, Kreder KJ, Kruse R, Wendt L, Takacs EB, Vollstedt AJ.

Urology. 2024 Jul 24:S0090-4295(24)00596-X. doi: 10.1016/j.urology.2024.07.030. Epub ahead of print. PMID: 39059587.

For a full text of the article, click here: https://www.sciencedirect.com/science/article/pii/S009042952400596X?via%3Dihub

Predictors of Postpartum Hemorrhage and Associated Outcomes at a Midwest Academic Medical Center.

Mooberry M, Voss N, Wendt L, Kenne KA, Jackson JB, Rysavy MB.

Womens Health Rep (New Rochelle). 2024 Apr 26;5(1):358-366. doi: 10.1089/whr.2023.0192. PMID: 39035139; PMCID: PMC11257117.

  • Postpartum hemorrhage (PPH) remains a significant cause of maternal morbidity and mortality around the world, with rates increasing in the United States. The objective of this study was to determine predictors of, and outcomes associated with, PPH at a Midwest academic health center.
  • : Demographic and clinical data were obtained from the electronic medical record on all consecutive delivering patients between May 1, 2020, and April 30, 2021. Associations between PPH and perinatal characteristics and outcomes were assessed using logistic regression models. A significance threshold of 0.05 was used for all comparisons.

Results: Of the 2497 delivering patients during the study period, 437 (18%) experienced PPH. Chronic hypertension, gestational hypertension, and preeclampsia with and without severe features were all associated with increased odds of PPH (odds rations [ORs], respectively, 1.61 (95% CI:1.13-2.24, p = 0.006), 1.62 (95% CI 1.18-2.21, p = 0.003), 1.81 (95% CI 1.14-2.80, p ≤ 0.001), and 1.92 (95% CI 1.29-2.82, p = 0.009). There were also increased odds of PPH with type I diabetes: 2.83 (95% CI 1.45-5.30, p = 0.001), type II diabetes: 2.14 (95% CI 1.15-3.82, p = 0.012), twin delivery: 3.20 (95% CI 2.11-4.81, p ≤ 0.001), cesarean delivery: 5.66 (95% CI 4.53-7.09, p ≤ 0.001), and assisted vaginal delivery: 3.12 (95% CI1.95-4.88, p ≤ 0.001). Infants of mothers with PPH had high odds of NICU admission (CI = 1.34-2.07, p < 0.001) and hypoxic ischemic encephalopathy (CI = 1.64-7.14, p < 0.001).

  • Our findings confirm previous literature that preexisting and pregnancy-related hypertension, diabetes mellitus, multiple gestation, cesarean delivery, and assisted vaginal delivery are important predictors of PPH. In addition, we found that neonates of mothers with PPH had more adverse outcomes. These results may help to inform clinical care as rates of PPH continue to rise in the United States.

For a full text of the article, click here: https://www.liebertpub.com/doi/pdf/10.1089/whr.2023.0192

Association Between Physical Activity and Pelvic Floor Disorders in Parous Ugandan Women.

Fleecs JD, Ngobi MD, Kiweewa FM, Vemulapalli R, Jensen JE, Steffen HA, Wendt LH, Jackson JB, Kenne KA.

Int Urogynecol J. 2024 Jul 13. doi: 10.1007/s00192-024-05859-4. Epub ahead of print. PMID: 39002045.

Introduction and hypothesis: The aim was to assess the association between the degree of physical activity (PA) and the presence of pelvic floor disorders (PFDs) in a cohort of parous Ugandan women.

  • In this cross-sectional study, PFDs were measured using symptom assessment, standardized questionnaires (Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire), and a standardized physical examination (POP-Q and cough stress test [CST]). Degree of PA was assessed using the International Physical Activity Questionnaire. Interquartile ranges were used to describe the age, parity, and body mass index (BMI) of participants. To examine the association between PA and PFDs, a log transformation was applied to the weekly minutes of PA variable and a logistic regression model was constructed with weekly minutes of moderate/vigorous PA, age, BMI, and parity as the predictors.
  • : A total of 159 women were enrolled. Median age was 35 (IQR 32-37), median parity 4 (IQR 3-5), and median BMI 29.0 (IQR 24-33). The prevalence of PFD as determined by symptom assessment was 28% (n=44). The most frequent stage of prolapse identified by POP-Q was stage II (57%, n=91). Thirty-six percent of the women (n=58) reported vigorous PA. Ninety-nine percent of the cohort (n=158) reported moderate PA. When controlling for age, parity, and BMI there was a significant positive association between PFD (defined as a combination of stage II prolapse, positive CST, and urinary incontinence (UI)) and moderate PA (OR 2.20, 95% CI 1.08-5.14, p value 0.045).
  • Pelvic floor disorders are common among parous Ugandan women and are associated with moderate PA when controlling for age, BMI, and parity. Understanding the risk factors associated with PFD in this population may better equip providers to screen and care for individuals.

For a full text of the article, click here: https://link.springer.com/article/10.1007/s00192-024-05859-4

Reliability and Validation of the PFIQ-7 and PFDI-20 in the Luganda Language

Jensen JE, Ngobi MD, Kiweewa FM, Fleecs JD, Vemulapalli R, Steffen HA, Wendt LH, Jackson JB, Kenne KA.

Int Urogynecol J. 2024 Jul 12. doi: 10.1007/s00192-024-05866-5. Epub ahead of print. PMID: 38995423.

Introduction and hypothesis: Pelvic floor disorders (PFDs) impact women worldwide and are assessed using instruments such as the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7). There are no known valid PFD instruments in Uganda. This study's purpose was to translate and test the reliability and validity of the PFDI-20 and PFIQ-7 in Luganda. It was predicted that these instruments would be reliable and valid to assess the presence and impact of PFD in parous Luganda-speaking women.

  • The translated PFDI-20 and PFIQ-7 were administered to parous Luganda-speaking women and readministered 4-8 months after. The Pelvic Organ Prolapse Quantification (POP-Q) examination determined the presence of pelvic organ prolapse (POP) and a cough-stress test (CST) measured urinary leakage. Analysis was completed using Cronbach's α co-efficient for internal consistency and Spearman's correlation coefficients and Wilcoxon rank sum tests for construct validity.
  • Of the 159 participants, 93 (58.3%) had stage II POP or higher. The PFDI-20 and PFIQ-7 demonstrated minimal bother and impact on activities of daily living respectively. The Urinary Distress Inventory 6 (UDI-6) scores on the PFDI-20 showed a strong positive association with the presence of urinary incontinence. When PFD was defined by responses to symptom assessment, the translated PFDI-20 and PFIQ-7 could differentiate between individuals with and without PFD.
  • The UDI-6 section of the PFDI-20 was found to be valid in Luganda. The PFIQ-7 and the entirety of the PFDI-20 were not found to be reliable or valid, likely because of the low prevalence of PFDs in the study population.

For a full text of the article, click here: https://link.springer.com/article/10.1007/s00192-024-05866-5

A Single Injection of Platelet-Rich Plasma Injection for the Treatment of Stress Urinary Incontinence in Females: A Randomized Placebo-Controlled Trial.

Ashton L, Nakatsuka H, Johnson CM, Kenne K, Kreder KJ, Kruse R, Wendt L, Takacs EB, Vollstedt AJ.

Urology. 2024 Jun 26:S0090-4295(24)00499-0. doi: 10.1016/j.urology.2024.06.047. Epub ahead of print. PMID: 38942391.

  • To determine the efficacy of a single injection of platelet-rich plasma (PRP) into the anterior vaginal wall at the mid-urethra compared to placebo, as there is emerging evidence that PRP may help treat female stress urinary incontinence (SUI).
  • This was a single-blind, randomized, placebo-controlled clinical trial at a single institution. Females with bothersome, demonstrable stress-predominant urinary incontinence were enrolled. Participants were randomized to either injection of 5 mL autologous PRP or saline at the anterior vaginal wall at the mid-urethra. The primary outcome was composite treatment success at 6 months, defined as a negative cough stress test and an answer of "much better" or "very much better" on the Patient's Global Impression of Improvement.

Results: Fifty patients were enrolled in the study and randomized to the PRP group (n = 25) or the saline placebo group (n = 25). There was no statistically significant difference in the primary outcome between the 2 groups. Adverse events were minor, and the rate of adverse events was similar between both groups.

Conclusion: In this randomized placebo-controlled study, we were unable to demonstrate a difference in SUI treatment success between PRP and saline injections. At this time, there is insufficient evidence to offer a one-time PRP injection into the anterior vaginal wall for treatment of female SUI.

For a full text of the article, click here: https://www.sciencedirect.com/science/article/pii/S0090429524004990?via%3Dihub

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