ABSTRACT
Cervical dilatation, along with hysteroscopy or endometrial curettage, is one of the most common procedures in gynecological practice. However, difficulty in entering the internal cervical os may be encountered; Therefore, there is a need for an effective cervical priming agent which can be used in general gynecological practice. Vaginal acidification might increase collagen degradation, It is known that cervical collagen degradation contributes to the ripening process. The present study was designed to evaluate the efficacy of acidifying vaginal cream in cervical tissue remodeling and softening. This study is a double-blinded clinical trial study, conducted in Obstetrics and Gynecology Department of Al-Azhar University Hospital [Damietta]. It included fifty perimenopausal women, their age ranged from 45-55 ys, planned for cervical dilatation before endometrial biopsy due to irregular uterine bleeding. They were divided into two main groups: Group I: women who were treated with acidifying vaginal cream [Eva base cream melted with acetic acid 5%]. Group II: women who were treated with neutral [placebo] vaginal cream [Eva base cream only]. Efficacy of acidifying vaginal cream on the cervix was assessed on the basis of improved cervical softening and degree of cervical changes on the histological examination. There was no significant difference in both groups during the preoperative assessment of the cervix and premedication. During operation in the study group [I] 1[st] Hegar's passed was No8 in 52% of cases and No9 in 28% of cases denoting the significant effect of acetic acid on cervical dilation in comparison with placebo group [II] in which the cervix was closed in 44% of cases and Hegar's No3 passed in 36% of cases showing statistical significance between the two groups. As regards the histological examination, it was found that in group [I] collagen dissociation grade II represent 56% and grade III 24% with statistical significance in comparison with placebo group [II] in which collagen was grade 0, in 76%. Also, the inflammatory changes in group [I] showed moderate changes in 72% of cases and 20% showed severe changes with statistical significance in comparison with the control group [II] in which 56% of cases showed no inflammatory changes. Vaginal acidification with 5% acetic acid as a cervical softening agent appeared to be safe, effective, with no adverse effects
Subject(s)
Humans , Female , Cervix Uteri , Vagina , Acetic Acid , Double-Blind MethodABSTRACT
Background: Occult hepatitis C virus [HCV] infection is a type of recently identified chronic infections that is evidenced only by detection of HCV- RNA in patients' liver tissue with consistently negative serum tests for antibodies to HCV and HCV-RNA
Aim: To study the prevalence of occult HCV infection among Egyptian patients with abnormal liver function tests and compare the characteristics of those patients with other patients with overt chronic hepatitis C infection
Methods: The presence of HCV-RNA was tested by reverse-transcription polymerase chain reaction [RT-PCR] in both liver tissue and peripheralblood mononuclear cells [PBMCs] for forty five patients with abnormal liver function tests. Clinical features of 27 patients with occult HCV infection [ 27 out of 45 patients who were negative for anti-HCV and serum HCV-RNA] were compared to 50 untreated patients with chronic HCV [anti-HCV antibodies and serum HCV-RNA positive], matched for age, gender, duration of abnormal liver function tests and body mass index
Results: HCV-RNA was detected in liver tissue of 27 [59.4%] out of 45 patients with abnormal liver function tests who were negative for both anti-HCV antibodies and serum HCV-RNA with abnormal liver function tests [i.e., who had occult HCV infection]. Twenty patients out of the 27 [74%] having intrahepatic HCV-RNA, had also viral RNA in their PBMCs. Regarding the biochemical characteristics there was significant impairment in classic HCV infection; serum bilirubin [P < 0.001], ALT [P = 0.009], AST [P = 0.013], alpha fetoprotein [P < 0.001], and fasting blood glucose [P < 0.008], but serum albumin, cholesterol, triglycerides and prothrombin time were significantly higher in occult HCV than chronic HCV [P <0.001]. No significant difference regarding Gamma-glutamyl transpeptidase [P< 0.10] was found. Necroinflammatory reactions, fibrosis, [P<0.0001] and cirrhosis [P = 0.03] were significantly higher in chronic HCV than occult HCV, but there was no significant difference regarding steatosis [P = 0.41]
Conclusion: Patients with abnormal liver functions may have intrahepatic HCVRNA in the absence of anti-HCV antibodies and serum HCV-RNA. Occult HCV infection is a milder disease than chronic HCV. Screening of those patients with persistently abnormal liver function for occult HCV-RNA can be firstly done by examining PBMCs