Role of the vaginal microbiome in miscarriage: exploring the relationship.

Miscarriage is a devastating pregnancy loss that affects many women worldwide. It is characterized as a spontaneous miscarriage that occurs before 20 weeks of gestation which affects more than 25% of pregnancies. While the causes of miscarriage are complex and multifactorial, recent research has suggested a potential role of the vaginal microbiota. The vaginal microbiome is a dynamic ecosystem of microbes that are essential for preserving vaginal health and avoiding infections. Vaginal dysbiosis has been accompanied with numerous adverse pregnancy complications, such as preterm birth. However, the effect of the vaginal microbiome in miscarriage is not fully understood. This review aims to investigate the link between vaginal microbiota and miscarriage. Also, we investigate the various mechanisms through which the vaginal microbiota may affect miscarriage. Additionally, we examine the implications of these research findings, specifically the possibility of vaginal microbiome screening and targeted interventions to prevent miscarriage.

Effect of antenatal dietary myo-inositol supplementation on the incidence of gestational diabetes mellitus and fetal outcome: protocol for a double-blind randomised controlled trial.

INTRODUCTION: Gestational diabetes mellitus (GDM) affects 23.6% of Qatari women and is associated with maternal and perinatal morbidity and long-term risk of developing type 2 diabetes. A number of challenges exist with current interventions, including non-compliance with dietary advice, the reluctance of mothers to ingest metformin tablets or use insulin injections. These challenges highlight the importance of pursuing evidence-based prevention strategies. Myo-inositol is readily available as an US Food and Drug Administration-approved food supplement with emerging but limited evidence suggesting it may be beneficial in reducing the incidence of GDM. Further studies, such as this one, from different ethnic contexts and with differing risk factors, are urgently needed to assess myo-inositol effects on maternal and neonatal outcomes. METHODS AND ANALYSIS: This study is a prospective, randomised, double-blinded, placebo controlled clinical trial to either myo-inositol supplementation or placebo.We plan to enrol 640 pregnant women attending antenatal care at Sidra Medicine, Doha, Qatar, 320 in each arm. All participants will complete at least 12 weeks of supplementation prior to undertaking the Oral Glucose Tolerance Test at 24-28 weeks. The daily use of the trial supplementation will continue until the end of pregnancy. All outcome measures will be collected from the electronic medical records. ETHICS AND DISSEMINATION: Ethical approval for the study was obtained on 12 April 2021 from Sidra Medicine (IRB number 1538656). Results of the primary trial outcome and secondary endpoints will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: Prospectively registered on 26 May 2021. Registration number ISRCTN16448440 (ISRCTN registry).

Omouma: a prospective mother and child cohort aiming to identify early biomarkers of pregnancy complications in women living in Qatar.

BACKGROUND: Pregnancy is governed by multiple molecular and cellular processes, which might influence pregnancy health and outcomes. Failure to predict and understand the cause of pregnancy complications, adverse pregnancy outcomes, infant's morbidity and mortality, have limited effective interventions. Integrative multi-omics technologies provide an unbiased platform to explore the complex molecular interactions with an unprecedented depth. The objective of the present protocol is to build a longitudinal mother-baby cohort and use multi-omics technologies to help identify predictive biomarkers of adverse pregnancy outcomes, early life determinants and their effect on child health. METHODS/DESIGN: One thousand pregnant women with a viable pregnancy in the first trimester (6-14 weeks of gestation) will be recruited from Sidra Medicine hospital. All the study participants will be monitored every trimester, at delivery, and one-year post-partum. Serial high-frequency sampling, including blood, stool, urine, saliva, skin, and vaginal swabs (mother only) from the pregnant women and their babies, will be collected. Maternal and neonatal health, including mental health and perinatal growth, will be recorded using a combination of questionnaires, interviews, and medical records. Downstream sample processing including microbial profiling, vaginal immune response, blood transcriptomics, epigenomics, and metabolomics will be performed. DISCUSSION: It is expected that the present study will provide valuable insights into predicting pregnancy complications and neonatal health outcomes. Those include whether specific microbial and/or epigenomics signatures, immune profiles are associated with a healthy pregnancy and/or complicated pregnancy and poor neonatal health outcome. Moreover, this non-interventional cohort will also serve as a baseline dataset to understand how familial, socioeconomic, environmental and lifestyle factors interact with genetic determinants to influence health outcomes later in life. These findings will hold promise for the diagnosis and precision-medicine interventions.

Colposcopic and Histological Outcome of Atypical Squamous Cells of Undetermined Significance and Atypical Squamous Cell of Undetermined Significance Cannot Exclude High-Grade in Women Screened for Cervical Cancer.

Objectives: The objectives of the study are to assess the prevalence of colposcopic and histological abnormalities in patients diagnosed with ASCUS and ASC-H and to compare the prevalence of CIN in each group. Methods: Population-based cross-sectional retrospective study was conducted in one of tertiary hospitals in UAE. All cervical smears reported as ASCUS or ASC-H in 2015 were included in this study. The local guideline in 2015 was to refer all cases of ASC for colposcopy assessment. Results: Overall 7,418 cervical smears were processed at our laboratory service, 5.6% (n=413) were reported as ASC. 95% of them (n=394) were ASCUS and 5% (n=19) were ASC-H. The overall prevalence of high grade CIN in patients with ASC-H is 26% compared with 0.8% for patients with ASCUS regardless the age. The relative risk of patients with ASC-H is 8 folds higher than patients with ASCUS to have low grade CIN but 29 fold higher risk of having High grade CIN and the P value =0.0001.Conclusion: ASC-H cytology confers a substantially higher risk for high grade CIN than ASCUS regardless of age. HPV test is an important triage test in patients with ASCUS to predict cellular changes and CIN.

Age Specific Cytological Abnormalities in Women Screened for Cervical Cancer in the Emirate of Abu Dhabi.

BACKGROUND: Cervical cancer is the second most common cancer in women worldwide, with about 500,000 new cases and 270,000 deaths each year. Globally, it is estimated that over one million women currently have cervical cancer, most of whom have not been diagnosed, or have no access to treatment that could cure them or prolong their lives. In the United Arab Emirates (UAE) cervical cancer is the third most common cancer in women. MATERIALS AND METHODS: A population-based cross-sectional retrospective survey of cervical smear abnormalities was conducted in the Emirate of Abu Dhabi, UAE, from January 2013 to December 2013 by collecting consecutive liquid-based cytology samples from the Department of Pathology at the SKMC Hospital in Abu Dhabi city. RESULTS: The total number of women screened for cervical cancer for the year 2013 at SKMC was 4,593, with 225 (4.89%) abnormal smears. The majority of the abnormal smear results were atypical squamous cells of undetermined significance (ASCUS) 114 (2.48%). This study showed 60% increase in the rate of abnormal cervical smears in the UAE over the last 10 years. In this study the highest incidence of high grade abnormalities were seen in women above the age of 61 years (1.73%), this might be due to the fact that this group of women missed the chance of screening of cervical cancer earlier in their lives or could be explained by the well-known second peak of HPV infection seen in many prevalence studies. CONCLUSIONS: We conclude that the rate of abnormal cervical smear in the screened Abu Dhabi women is not different from the rate in developed countries. A notable increase in both low and high grade abnormalities has occurred within the last decade.

Acceptability of human papilloma virus vaccination among women in the United Arab Emirates.

BACKGROUND: Human papilloma virus (HPV) is a common sexually transmitted infectious agent. It is estimated that 10% of all women worldwide are infected with HPV, that is some 660 million each year. HPV vaccination has a reported efficacy of more than 98% for protection against infection in females. In 2008 the Abu Dhabi Health Authority in the United Arab Emirates (UAE) introduced free HPV vaccination for all eligible schoolgirls in both public and private schools. METHODS: A cross-sectional study of 640 women aged 18-50 years in the Emirate of Abu Dhabi in UAE from April 2012 to October 2012 was conducted. RESULTS: Thirty-seven percent of the women in our sample had heard about HPV vaccination, and 80% of these would consider getting vaccinated themselves, and 87% would recommend vaccination to relatives or friends. Most women in the study (69%) had a favorable opinion about the vaccine. Only 17% of the women felt it might not be culturally acceptable, and 1% felt that there might be religious objections to HPV vaccination. Vaccine safety and recommendation by a doctor (36% each) were the factors identified most frequently by our sample of women which would enhance the uptake of the HPV vaccination. CONCLUSIONS: Knowledge about HPV vaccination among women in our sample was below average (37%); however, 80% of those who had heard about HPV vaccination were willing to be vaccinated themselves, and 87% would recommend vaccination to relatives and friends.

Awareness and knowledge about human papillomavirus infection and vaccination among women in UAE.

BACKGROUND: Cervical cancer is the second commonest female cancer worldwide. The 50-55 cases of cervical cancer are reported annually in the UAE. There is a scarcity of data from Middle Eastern region regarding knowledge and attitude of women towards HPV infection, cervical cancer prevention and HPV vaccine. The aim of our study was to assess the knowledge of women regarding HPV infection and vaccine in UAE. MATERIALS AND METHODS: A cross-sectional survey of 640 women aged 18-50 years was conducted in Al-Ain district in UAE using convenience sampling. Women with previous diagnosis of cervical cancer, non- residents of UAE, younger than 18 or older than 50 years of age and those unable to speak Arabic or English were excluded from the study. Logistic regression analysis was performed to assess the association of HPV knowledge with independent factors like age, education etc. RESULTS: Only 29% of our sampled women have ever heard of HPV infection. Only 15.3% women recognized it as STI. Only about 22% women have also heard of the HPV vaccine. Three quarter of the women in our study thought that cervical cancer can be prevented. About 28% recognized vaccine as a preventive measure against cervical cancer. Age (AOR 1.049, 95%CI 1.02-1.08) and husband's level of education were found to be significant (p value 0.015) after adjusting for women's age. CONCLUSIONS: The knowledge of HPV infection and vaccine is low in the UAE. Few women recognized HPV as sexually transmitted infection. Increasing age and husband's education are associated with better knowledge of HPV infection.

The practice of defensive medicine among hospital doctors in the United Kingdom.

BACKGROUND: Defensive medicine is defined as a doctor's deviation from standard practice to reduce or prevent complaints or criticism. The objectives of this study were to assess the prevalence of the practice of defensive medicine in the UK among hospital doctors and the factors affecting it. METHODS: A quantitative study was designed, with a detailed seventeen point questionnaire. Defensive medicine practice was assessed and tested against four factors age, gender, specialty and grade. Three hundred hospital doctors from three UK hospitals received the questionnaire. RESULTS: Two hundred and four (68%) out of 300 hospital doctors responded to the survey. Seventy eight percent reported practicing one form or another of defensive medicine. Ordering unnecessary tests is the commonest form of defensive medicine reported by 59% of the respondents. This is followed by unnecessary referral to other specialties (55%). While only 9% of the sampled doctors would refuse to treat high risk patients, double this number would avoid high risks procedures all together (21%). A linear regression module has shown that only senior grade was associated with less practice of defensive medicine. CONCLUSION: Defensive medical practice is common among the doctors who responded to the survey. Senior grade is associated with less practice of defensive medicine.

Acceptability of human papillomavirus vaccination among male university students in the United Arab Emirates.

OBJECTIVE: To assess the knowledge about and acceptability of human papillomavirus (HPV) vaccination among male university students in the United Arab Emirates (UAE). METHODS: Between June and August 2012 we approached 356 male university students from the UAE and asked them to fill out a 12-item self-administered questionnaire. RESULTS: Knowledge of HPV was low among the university students who participated (32%). Less than half of the students (46%) indicated they would accept HPV vaccination, and around 30% were unsure of their decision. Safety (68%), protection of their female partner (65%) and doctor's recommendation (64%) were rated as the factors most likely to increase the uptake of HPV vaccination among participating students. The factors rated most likely to stop students from using the vaccine were fear of side effects (85%), absence of clear benefits (38%) and objections from a religious authority (25%). Marital status and sexual activity were associated with greater knowledge of HPV but not with greater acceptance of vaccination among university students in the UAE. CONCLUSION: Overall acceptability of and knowledge about HPV infection and vaccination were low in a sample of male university students in the UAE. Marital status and sexual activity are associated with greater knowledge of HPV infection but have no effect on the acceptability of HPV vaccination.

Gynecological cancer services in Arab countries: present scenario, problems and suggested solutions.

Gynecological malignancies account for 9% of all female cancers worldwide. In the Arab countries Breast cancer is the leading cancer in women followed by cervical cancer. Ovarian cancer ranks as fourth leading cancer in women. There are huge differences in the available resources among Arab countries. However the challenges facing the provision of gynecological cancers services shared similarities like the cultural and religious background. Most of the gynecological cancers are diagnosed at a later stage in Arab countries due to the lack of reproductive health awareness especially among older women combined with the cultural stigma of seeking medical advice for gynecological symptoms. This article discusses the current situation of gynecological cancer services in Arab countries and suggests some practical solutions.

Knowledge, attitude and practice of school nurses in the United Arab Emirates about HPV infection and vaccine.

BACKGROUND: In 2008, the Health Authority in Abu Dhabi (the capital of the United Arab Emirates) introduced HPV vaccine free of charge for high school girls entering grade 11, becoming the first state in the Middle East to do so. The objectives of this study were to assess the knowledge, attitude and practice of school nurses in the Emirate of Abu Dhabi about HPV infection and the vaccine. MATERIALS AND METHODS: A quantitative study was designed and conducted from June to August 2012 in Emirate of Abu Dhabi. Data were collected through direct face to face interviews. from one hundred and twenty five nurses. RESULTS: Knowledge of HPV infection and HPV vaccine was almost universal among the school nurses (97%). The majority of the participants (71%) thought that the HPV vaccine was good. Cultural unacceptability (45%) and lack of women's concern about their own health (21%) were rated as the top barriers for the successful introduction of the vaccine in the UAE. More than half of the sampled nurses (58%) have either given this vaccine to school girls or taken it themselves. The majority (95%) did not come across any side effects from the vaccine. The level of qualification and the place of work did not significantly affect the correct knowledge of HPV infection or cervical cancer prevention methods. CONCLUSIONS: The knowledge and attitude of the sampled school nurses in Abu Dhabi State about HPV infection and vaccine is very good in both the public and private sectors. However, a knowledge gap in cervical cancer screening methods was identified.

Evaluation of the sensitivity, specificity, positive and negative predictive values of preoperative magnetic resonance imaging for staging endometrial cancer. A prospective study of 100 cases at the Dorset Cancer Centre.

OBJECTIVES: The objectives were to evaluate the sensitivity and specificity of preoperative magnetic resonance imaging (MRI) in predicting myometrial invasion and disease stage in cases of endometrial carcinoma. STUDY DESIGN: Prospective analytic study in 100 sequential cases of endometrial carcinoma referred to the Dorset Cancer Centre between January 1999 and July 2004. The study included 100 women with histologically proven endometrial malignancy, the mean age of the studied population being 68.6 years +/-2S.D. The preoperative MRI findings were compared with final surgical and histological staging; the latter was taken as the gold standard. The main outcome measures were the sensitivity and specificity of preoperative MRI for staging endometrial cancer. RESULTS: A total of 100 consecutive cases of endometrial cancer were analysed, of which 62 cases were classified as stage Ia/Ib (early disease) by histology. MRI accurately predicted the degree of invasion in 54 cases and overestimated in 8, giving a sensitivity of 87% and specificity of 90%. In stage Ic disease the sensitivity and specificity of MRI were 56 and 86%, respectively. However, MRI showed significantly reduced sensitivity for predicting stage II endometrial cancer at 19% but was found to be both sensitive and specific for predicting advanced endometrial cancer (stages III and IV); the sensitivity and specificity were 100 and 99%, respectively. CONCLUSIONS: The accuracy of MRI scanning in predicting early and advanced endometrial disease is very good, but there is reduced accuracy with stage Ic and stage II disease. MRI is a valuable imaging modality in the preoperative assessment of cases of endometrial cancer.