Attitudes About the Human Papillomavirus Vaccine Among Patients With and Without Cervical Dysplasia.

OBJECTIVES: The aims of the study are to examine the perception of the human papillomavirus (HPV) vaccine among those with and without a history of cervical dysplasia and to examine perceptions of the vaccine for their children. MATERIALS AND METHODS: Patients were recruited to complete a survey about the HPV vaccine for both themselves and their children. Patients in a colposcopy clinic with a history of abnormal cervical cytology and patients in a benign gynecology clinic without a history of abnormal cervical cytology were recruited. Participants' medical records were reviewed. Demographics and survey answers were described, and Fisher exact test was used to compare the groups. RESULTS: One hundred eighty-three patients participated: 73 in colposcopy clinic and 110 in benign clinic. The majority self-identified as Black (74% colposcopy, 71% benign, p = .588) and reported an income less than $39,000 a year (77% colposcopy, 65% benign, p = .089). Fifty-six percent in benign clinic agreed the HPV vaccine is a good way to protect oneself from disease compared with 48% in colposcopy clinic ( p = .022). When examining results based on cytology, fewer patients in the highest-grade cytology group agreed the vaccine was effective (30% high-grade, 48% normal, 57% low-grade, p = .027) or a good way to protect themselves from disease (29% high-grade, 53% normal, 62% low-grade, p = .002). There was otherwise no statistically significant difference between the groups on questions regarding self or child vaccination. CONCLUSIONS: In a majority Black, low-income population, patients without a history of abnormal cervical cytology have more favorable perceptions of the HPV vaccine's effectiveness in preventing disease. Those with the highest-grade cytology had more negative perceptions of the vaccine's effectiveness and protectability.

First trimester noninvasive fetal RHD genotyping using maternal dried blood spots.

OBJECTIVE: This study was aimed to evaluate whether maternal dried blood spots could be a potential source for the noninvasive fetal RHD genotyping, serving as a combined one-step test for both the First Trimester Screen and the fetal RHD genotyping. METHOD: Both the maternal dried blood spots and the peripheral blood samples from 19 RhD-negative pregnant women were obtained during the First Trimester Screen. DNA was extracted and sequential real-time PCRs were performed to determine the fetal RHD genotypes. Fetal RhD serological types were obtained after delivery. This study was approved by the Institutional Review Board, and informed consents were obtained. RESULTS: A total of 19/19 fetal RHD genotyping with maternal DBS were consistent with the follow-up serological RhD test results after birth. Eleven were RhD positive, and eight were RhD negative (RHD deletion or RHD-CE-D = 6, RHD pseudogene = 1, RHDVI = 1). Sensitivity = 100%, specificity = 100%, positive predictive value = 100%, negative predictive value = 100%. A total of 18/19 fetal gender were determined correctly with maternal DBS. One female fetus was falsely determined as male. Sensitivity = 100%, specificity = 91.6%, positive predictive value = 87.5%, negative predictive value = 100%. CONCLUSION: Maternal dried blood spots, with the benefits of flexible sample transportation and processing, could be utilized for the noninvasive prenatal fetal RHD genotyping and potentially be incorporated into the routine First Trimester Screen. Larger scale study is in progress to implement fetal RHD genotyping in routine prenatal care. © 2017 John Wiley & Sons, Ltd.

Preeclampsia-associated stresses activate Gadd45a signaling and sFlt-1 in placental explants.

Accumulating evidence suggests that placental stresses during pregnancy can play an important role in the pathogenesis of preeclampsia. A common signal pathway that senses and converts placental stresses into intracellular stress response may be contributing to this pathology. Based on our previous findings, we extended our investigation to establish that Gadd45a stress signaling regulates sFlt-1 levels, particularly in placenta, when exposed to various preeclampsia-associated stresses including AT-1 receptor agonist (Angiotensin II), hypoxia, and inflammatory cytokines. Using a placental explant model, we found that Gadd45a was induced in response to all the preeclampsia stresses stated above. Although stress induced Gadd45a was associated with the activation of its downstream effectors phospho-p38 and phospho-JNK, the subsequent regulation of sFlt-1 levels occurred through either one of these effectors, but not both. These observations indicate that Gadd45a signaling may work as a hub connecting placental stresses and the pathogenesis of preeclampsia. It also provides evidence to justify testing the role of Gadd45 in the etiology of preeclampsia using in vivo mouse (i.e., Gadd45a null mice) models.

Self-perceptions of body size in women at an inner-city family-planning clinic.

OBJECTIVE: The objective of the study was to determine the relationship between body mass index (BMI) and body size perception among female patients in an inner-city family-planning clinic. STUDY DESIGN: All participants (n = 81) were measured for height and weight and completed an anonymous survey. Self-perceived, current, and ideal body sizes were determined by using a standardized scale. Body image discrepancy was calculated by the difference between body image perception and measured BMI. RESULTS: Approximately two-thirds of the participants were obese or overweight. As measured BMI increased, the body image discrepancy increased, with significant differences in body perception in both obese (P < .001) and overweight (P < .001) women. Ideal body size increased with measured BMI. CONCLUSION: Overweight and obese women in an inner-city clinic are likely to underestimate their body size. Our data support the need for culturally sensitive education for this population, because many do not view themselves at risk for complications related to excessive weight.

Rapid testing for vaginal yeast detection: a prospective study.

OBJECTIVE: The purpose of this study was to determine the accuracy of rapid vaginal yeast detection assay compared with yeast cultures for the diagnosis of vulvovaginal candidiasis. STUDY DESIGN: This was a prospective study that involved 104 subjects, 34 asymptomatic women and 70 symptomatic women with vaginitis. Vaginal swabs were obtained from all subjects for wet mount, yeast culture, and the rapid yeast detection test. Overall, the prevalence rate was 39.4%, based on positive yeast cultures. The rapid yeast test performed by the physician was positive in 30 of 41 subjects with positive cultures and 13 of 63 subjects with negative cultures. RESULTS: The rapid yeast test had 73.1% sensitivity and 82.0% negative predictive value compared with the wet mount, which had 43.9% sensitivity and 70.9% negative predictive value. In symptomatic patients, the test had 77.4% sensitivity and 81% negative predictive value compared with wet mount, which had 51.6% sensitivity. Patient-performed test results were identical to the tests that were performed by the physicians. The cost of the rapid yeast test kit is estimated to be <$10, compared with a mean of $65 for the yeast culture. CONCLUSION: Rapid yeast detection assay is accurate and affordable compared with the gold standard yeast culture in the diagnosis of vulvovaginal candidiasis. Relative to the wet mount, it is more sensitive, cheaper, and accurate for the rapid diagnosis of vaginal yeast infection.

Douching with Water Works device for perceived vaginal odor with or without complaints of discharge in women with no infectious cause of vaginitis: a pilot study.

OBJECTIVE: To determine if douching with Water Works device for 1 month can (1) lower or eliminate perceived vaginal odor by subject; (2) have any effects on vaginal ecosystem. METHODS: Ten women with perceived vaginal odor with or without discharge, douched every day for 4 weeks in an open-label, nonrandomized pilot study. Primary outcome measures included perceived vaginal odor by subject, lactobacilli score from Nugent slide, and acceptance of the Water Works douching system. Secondary outcome included the safety of using this douching device. RESULTS: At week 4, there was improvement in vaginal odor (P=.0006) and there was no significant change in lactobacilli score. CONCLUSION: Douching with Water Works device is associated with reduction or elimination of vaginal odor without adversely affecting the vaginal ecosystem.

Risk of irritable bowel syndrome and depression in women with interstitial cystitis: a case-control study.

PURPOSE: We determined the risk of irritable bowel syndrome and depression in women with interstitial cystitis. MATERIALS AND METHODS: Cases consisted of 46 women with newly diagnosed interstitial cystitis. The control group consisted of 46 women presenting for an annual gynecologic examination. Data were collected using standardized, validated questionnaires. RESULTS: The 2 groups were similar with respect to age, race, parity, previous pelvic surgery and postmenopausal hormone use. Compared with controls patients with interstitial cystitis were more likely to be diagnosed with irritable bowel syndrome (OR 11, 95% CI 2.7 to 52, p <0.001) and depression (OR 3.97, 95% CI 1.17 to 14.1, p <0.05). In the interstitial cystitis group when we compared women with and without depression, we noted that women with depression were significantly more likely to complain of bladder pain, nocturia, abdominal pain and other bowel symptoms. CONCLUSIONS: The association of irritable bowel syndrome and depression appears to be greater in women with interstitial cystitis than in controls. Additionally, it appears that pain of bladder or bowel origin is a significant cause of depression in women with interstitial cystitis.

Sexual function in women with pelvic organ prolapse compared to women without pelvic organ prolapse.

PURPOSE: We compared sexual function in women with pelvic organ prolapse to that in women without prolapse. MATERIALS AND METHODS: We collected sexual function data using a standardized, validated, condition specific questionnaire. The study group consisted of 30 women with pelvic organ prolapse and it was compared with 30 unmatched controls without evidence of prolapse. RESULTS: The 2 groups were similar in age, race, parity and postmenopausal hormone use. Subjects in the study group were more likely to have undergone previous pelvic surgery. Mean total Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire scores +/- SD were lower in the study group compared with controls (81.4 +/- 7.3 vs 106.4 +/- 15.5, p <0.001). In the study group total questionnaire scores in women with prior pelvic surgery were similar to those in women without prior pelvic surgery (79.3 +/- 14.9 vs 82.9 +/- 10.2, p = 0.61). CONCLUSIONS: Pelvic organ prolapse appears to have a significant negative impact on sexual function.