ABSTRACT
BACKGROUND: Distinguishing hydatidiform moles (HMs) from nonmolar specimens and the subclassification of HM are important because complete hydatidiform mole (CHM) is associated with an increased risk of development of gestational trophoblastic neoplasia. However, diagnosis based solely on morphology has poor inter-observer reproducibility. Recent studies have demonstrated that the use of p57KIP2 immunostaining improves diagnostic accuracy for CHM. OBJECTIVES: To evaluate the accuracy of p57KIP2 immunostaining compared with molecular genotyping for the diagnosis of CHM. SEARCH STRATEGY: Major databases were searched from inception to March 2017 using the terms 'hydatidiform mole', 'p57', and 'genotyping', with their variations, and the search limit for the relevant study design. SELECTION CRITERIA: Any cross-sectional study, case series, case-control study, cohort study, or clinical trial that evaluated the accuracy of p57KIP2 immunostaining for the diagnosis of CHM compared with genotyping was included. Case reports, narrative reviews, expert opinions, and animal testing were excluded. DATA COLLECTION AND ANALYSIS: Extracted accuracy data were tabulated and pooled using a hierarchical bivariate random effects model. MAIN RESULTS: Bivariate meta-analysis produced a summary sensitivity of 0.984 (95% CI: 0.916-1.000) and specificity of 0.625 (95% CI: 0.503-0.736) with significant heterogeneity for specificity (I2 = 71.8, chi-square P = 0.029). The pooled summary diagnostic odds ratio was 56.54 (95% CI: 11.03-289.74) with no heterogeneity (I2 = 0.00%, chi-square P = 0.67). The diagnostic performance of the test was high with an area under the curve of (AUC) 0.980. CONCLUSIONS: p57KIP2 immunostaining is accurate when diagnosing CHM. It can be used as an adjunct test in a combination algorithmic approach. TWEETABLE ABSTRACT: A meta-analysis to evaluate the accuracy of p57KIP2 compared with genotyping to diagnose CHM.
Subject(s)
Cyclin-Dependent Kinase Inhibitor p57/genetics , Genotype , Hydatidiform Mole/diagnosis , Uterine Neoplasms/diagnosis , Female , Humans , Hydatidiform Mole/genetics , Immunohistochemistry , Pregnancy , Sensitivity and Specificity , Uterine Neoplasms/geneticsABSTRACT
The aim of this study was to evaluate the efficacy of the Portuguese version of the Medication Adherence Training Instrument (MATI) for improving adherence to antiretroviral therapy (ART) in southern Brazil. Two different follow-up modalities were compared in this 225 days randomized controlled study: one based on the MATI protocol and a conventional (non-MATI) clinical follow-up. There were no differences between the groups with the exception of socioeconomic class (P < 0.005). The mean length of continuance in treatment was 111.4 (SD = 13.9) and 137.6 (SD = 17.3) days in the MATI and non-MATI groups, respectively. A Mantel-Cox log-rank test revealed no significant difference between the two interventions (P = 0.34). Despite the sample size limitation, the results from this study indicate that the Portuguese version of the MATI was not more efficacious than the regular follow-up intervention for improving adherence of outpatients to ART.
Subject(s)
Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , Health Promotion/methods , Interviews as Topic/methods , Medication Adherence , Patient Education as Topic/methods , Adult , Brazil , Clinical Protocols , Humans , Kaplan-Meier Estimate , Middle Aged , Prospective Studies , Socioeconomic FactorsABSTRACT
PIP: 46 pregnant teenagers were analyzed from the obstetric viewpoint, and the findings were correlated with an evaluation of theier newborns in their 1st days of life. The low index of concomitant pathologies shown in this Brazilian study could be related to the process of seeking prenatal care and the perceptual changes in the teenager's psychosocial profile. It was surprise to find that this group was seeking prenatal care; few adverse situation were observed. It is believed that in this clinic basic information on birth-related diet, hygiene, and physiology could be, and was, given to the pregnant teenager. Prenatal care is the most important factor in the evolution of pregnancy in this type of patient. The changes in the psychosocial patterns are created by those who are in contact with and influence the groups' school of thought on a daily basis. This small casuistry characterizes an important social situation that in some ways can contribute to new considerations. Prenatal care needs to be encouraged to combat the negative results arising from a lack of these services. The gap created between pediatricians and gynecologists, in which these teenagers find themselves, will be closed as these 2 professions are geared by training to care for the pregnant teenagers.^ieng
