Awareness about vulvovaginal aesthetics procedures among medical students and health professionals in saudi arabia

Abstract Objective The present study aimed to explore the opinion and ethical consideration of vulvovaginal aesthetics procedures (VVAPs) among health professionals and medical students in Saudi Arabia. Methods This is a cross-sectional study performed between January 2020 and April 2020. Data was collected through electronic media, WhatsApp, and emails. The results were analyzed by applying the Students t-test, and correlations were considered significant if they presented a p-value<0.05. Results There is significant demand to educate doctors, health professionals, medical students, and gynecologists for the VVAPs to have a solid foundation, justified indications, and knowledge about various aesthetic options. Although female doctors, medical students, young doctors, and gynecologists have more knowledge about VVAPs, all health professionals ought to be aware of recent trends in vulvovaginal aesthetics (VVA). The present analysis determined that VVA should be under the domain of gynecologists, rather than under that of plastic surgeons, general surgeons, and cosmetologists. Themajority of the participants considered that vaginal rejuvenation, "G-spot" augmentation, clitoral surgery, and hymenoplasty are not justifiable on medical grounds. Conclusion The decision to opt for different techniques for vaginal tightening and revitalization should be taken very carefully, utilizing the shared decision-making approach. Ethical aspects and moral considerations are important key factors before embarking in the VVAPs purely for cosmetic reasons. Further research is required to determine the sexual, psychological, and body image outcomes for women who underwent elective VVAPs. Moreover, medical educators must consider VVAPs as part of the undergraduate and postgraduate medical curriculum.

Post-transplant outcome in chronic myeloid leukaemia

To determine post-transplant survival in chronic myeloid leukaemia patients undergoing allogeneic stem cell transplant. Longitudinal, descriptive study. Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan, between April 2002 and August 2007. All patients of chronic myeloid leukaemia in chronic phase having HLA identical donor and age under 55 years, normal hepatic, renal and cardiac functions with good performance status were selected. Patients in accelerated phase or blast crisis, poor performance status, impaired hepatic, renal, cardiac functions or pregnancy were excluded. Survival was calculated from the date of transplant to death or last follow-up according to Kaplan-Meier and Cox [proportional hazard] regression analysis methods. Thirty seven patients with chronic myeloid leukaemia underwent allogeneic stem cell transplant from HLA identical sibling donors. Thirty two patients were male and five were females. Median age of patients was 28 years. All patients and donors were CMV positive. Post-transplant complications encountered were acute GvHD [Grade II-IV] [n=13, 35.1%], chronic GvHD in 18.9% [n=7], Veno Occlusive Disease [VOD] in 5.4% [n=2], acute renal failure in 2.7% [n=1], haemorrhagic cystitis in 2.7% [n=1], bacterial infections in 40.5% [n=15], fungal infections in 16.2% [n=6], CMV infection in 5.4% [n=2], tuberculosis in 5.4% [n=2], Herpes zoster infection 2.7% [n=1] and relapse in 2.7% [n=1]. Mortality was observed in 27% [n=10]. Major causes of mortality were GvHD, VOD, septicemia, CMV infection and disseminated Aspergillosis. Overall Disease Free Survival [DPS] was 73% with a median duration of follow-up of 47.4 +/- 12 months. DPS was 81% in standard risk and 54.5% in high-risk group. Results of allogeneic stem cell transplant in standard risk group CML patients were good and comparable with other international centres, however, results in high-risk CML patients need further improvement, although, number of patients in this group is small

Pneumocystis carinii and Trichosporon beigelii pneumonia following allogeneic haemopoeitic stem cell transplantation

Pneumocystis Carinii and Trichosporon beigelii are opportunistic infections in immunocompromised patients. We report a case of a young lady who underwent haemopoeitic stem cell transplantation for relapsed acute lymphoblastic leukemia. This 25 years old female developed fever, dry cough and rapidly progressive dyspnoea during post transplant neutropenia and was found to be suffering from Pneumocystis carinii pneumonia. She was successfully treated with Co-trimoxazole. The patient again presented with similar symptoms on day 55 post transplant. This time Trichosporon beigelii was isolated from bronchoalveolar lavage and she responded to prompt antifungal therapy. Other complications encountered during the subsequent course were extensive subcutaneous emphysema and spontaneous pneumothorax that required chest intubation and brief hospitalization. The patient is presently nine months post transplant and is asymptomatic

Graft versus host disease in allogeneic stem cell transplantation - 3 l/2 years experience

To evaluate the frequency and outcome of graft versus host disease after allogeneic stem cell transplant in haematological disorders at Armed Forces Bone Marrow Transplant Centre, Rawalpindi from July 2001 to December 2004. Eighty-six patients with various haematological disorders namely aplastic anaemia [n=32], b-Thalassaemia [n=25], CML [n=22] ALL [n=3], AML [n=l] Fanconi's anaemia [n=2], and Gaucher's disease [n=l], underwent allogeneic stem cell transplantation. All patients received cyclosoprin, prednisolone and short course of methotrexate as GvHD prophylaxis. The patients who developed acute GvHD > grade-II or chronic extensive GvHD received steroids at a starting dose of 2 mg/kg body weight along with gradual increase in cyclosporine dosage [max dose 12.5 mg/kg]. The overall incidence of acute GvHD grade-II to IV was 44.2% [n=38/86] where as the incidence of chronic extensive GvHD was 14% [n=12/86]. Acute GvHD was 68% [n=17/25] in B-Thalassaemia, 50% [n=ll/22] in CML, 50% [n=2/4] in Acute Leukaemias and 25% [n=8/32] in Aplastic Anaemia. Chronic GvHD was 25% [n=l/4] in Acute Leukaemias, 18.8% [n=6/32] in Aplastic Anaemia, 18.2% [n=4/22] in CML and 4% [n=l/25] in B-Thalassaemia. The overall survival in acute GvHD was 84.2% [n=32] where as the overall survival in chronic GvHD was 50% [n=6]. The overall mortality in acute GvHD was 15.8% [n=6] and 50% in chronic GvHD [n=6]. The morbidity and mortality due to severe acute and chronic GvHD remains high despite standard prophylaxis against GvHD. New strategies are needed to prevent and treat GvHD

Graft versus host disease in allogeneic stem cell transplantation - 3 1/2 years experience

To evaluate the frequency and outcome of graft versus host disease after allogeneic stem cell transplant in haematological disorders at Armed Forces Bone Marrow Transplant Centre, Rawalpindi from July 2001 to December 2004. Eighty-six patients with various haematological disorders namely aplastic anaemia [n=32], b-Thalassaemia [n=25], CML [n=22], ALL [n=3], AML [n=1] Fanconi's anaemia [n=2], and Gaucher's disease [n=1], underwent allogeneic stem cell transplantation. All patients received cyclosoprin, prednisolone and short course of methotrexate as GvHD prophylaxis. The patients who developed acute GvHD > grade-II or chronic extensive GvHD received steroids at a starting dose of 2 mg/kg body weight along with gradual increase in cyclosporine dosage [max dose 12.5 mg/kg]. The overall incidence of acute GvHD grade-II to IV was 44.2% [n=38/86] where as the incidence of chronic extensive GvHD was 14% [n=12/86]. Acute GvHD was 68% [n=17/25] in

Allogeneic stem cell transplantation in chronic myeloid leukaemia 2 1/2 year experience

To evaluate out come of allogeneic Stem Cell Transplantation [SCT] in chronic myeloid leukaemia [CMC] at Armed Forces Bone Marrow Transplant Centre, Rawalpindi from April 2002 to October 2004. Twenty-two patients with CML underwent allogeneic SCT from HLA matched siblings. Patients were divided into standard [n=14] and high-risk [n=8] groups. Patients were subjected to conditioning regimens consisting of Busulphan and Cyclophosphamide. Cyclosporin, Prednisolone and Methotrexate were given for GvHD prophylaxis. All donors were subjected to PBSC harvest after G-CSF therapy for five days. All received G-CSF from Day+5 until ANC >0.5 x 109/l. The median age of the patients was 29 years [range 7-53 years] with a male to female ratio of 6.3:1. Engraftment was achieved in all patients. Median time to achieve neutrophil [ANC 0.5x109/l] and platelet [20x109/l] recovery was 13 days and 12 days respectively. Median stay in hospital was 18 days. Acute GvHD [Grade-II-IV] was observed in eleven patients [50%] while chronic GvHD was seen in four patients [18%]. One patient relapsed 8 months post transplant. Two patients [9%] developed Veno-occlusive disease [VOD] liver. One patient had haemorrhagic cystitis. Four patients [18%] had post transplant infectious complications, which included pseudomonas septicemia, aspergillosis, tuberculous pleural effusion and herpes zoster. Overall mortality was 22.7% [n=5]. The major causes of mortality were VOD liver, GvHD grade IV, Pseudomonas septicaemia and aspergillosis. Overall survival was 77.2% [n=17] and disease free survival was [n=16] 72.7%. Follow up ranges were from 23 to 828 days [median 212 days]. The preliminary results of SCT in this small series of patients with CML are very encouraging. To improve the long-term survival it is imperative that patients are transplanted early after diagnosis and conditioning regimens are selected carefully

Amniotic fluid interleukin - 6 in preterm labor

To evaluate the amniotic fluid levels of interleukin-6 [IL-6] in pregnant women and its potential role in the management of preterm labor. Cross sectional observational study. The Ain Shams University Maternity Hospital during the period from 1st of January 1997 to 30th of June 1997. 80 pregnant women in the third trimester were included in the study. Women included were divided into 4 groups, each consisting of 20 women: [i] group 1: women with term pregnancy not in labor, [ii] group 2: women with term pregnancy in labor, [iii] group 3: women with preterm labor and failed tocolysis, [iv] group 4: women with preterm labor and successful tocolysis. Amniotic fluid samples from these women were obtained and assessed for IL-6 level using an enzyme linked immunoassay. Mean amniotic fluid IL-6 levels were higher in preterm than term pregnancy [259.3 and 205.02 pg/ml respectively]. Mean amniotic IL-6 levels were also higher in women with preterm labor with failed tocolysis than in women with preterm labor with successful tocolysis. The cut off level for IL-6 amniotic fluid level at 159.93 pg/ml showed a sensitivity of 100%, specificity of 85%, positive predictive value of 86.75 and negative predictive value of 100% for the prediction of labor. Amniotic fluid IL-6 level can be a useful marker for labor and may be used as a prognostic factor in the management of preterm labor predicting the response to tocolysis