Correlation between cervical excisional procedures and the risk of preterm birth in subsequent pregnancies

Cervical excisional procedures stand as an important risk factor for preterm birth (PTB) in subsequent pregnancies in various articles in the medical literature. We performed an evidence-based review of the obstetrical outcomes succeeding excisional procedures for cervical dysplasia as follows: we reviewed 16 studies published between 2015 and 2020 that assessed whether there is an association between excisional cervical procedures and unfavorable obstetrical outcomes. Nevertheless, there are several other aspects of the problem, taken into account as possibly responsible for increasing the risk of PTB, as the grade of the dysplasia, the effect of depth/length/volume of the excised cone specimen, prophylactic procedures for the prevention of PTB, age, interval conization-pregnancy. The majority of the authors suggested an association between excisional procedures and preterm birth or other obstetrical events. However, some of them did not find statistically significant data in order to strongly affirm a correlation between conization and PTB, or, on the contrary, disproved the given hypothesis. There is no consensus regarding cervical excisions as being an individual risk factor for PTB, therefore more studies need to be conducted in order to come to a strong, universal conclusion.

P1192METABOLIC SYNDROME IN PATIENTS UNDERGOING PERITONEAL DIALYSIS (PD): A SINGLE CENTER EXPERIENCE

Background and Aims Metabolic syndrome (MS) is a set of alterations represents a cluster of risk factors that increase the probability of causing cardiovascular (CV) events by three times. The aim of our study was to analyze the prevalence of MS in patients with Chronic Renal Failure undergoing replacement treatment by peritoneal dialysis afferent to our center. Method We retrospectively studied 117 patients in PD (2015-2019 census period). The characteristics are reassumed in tab1. We assessed the prevalence and impact of MS considering hard outcome: death for IMA and cerebral death. Patients with at least 3 of the following diagnostic criteria (CD) were considered affected by MS: waist circumference> 102 cm in men or > 88 cm in women, high blood pressure (PA> 130/85 mmHg or under pharmacological treatment), HDL levels <40 mg/dl in men or <50 mg/dl in women, triglycerides> 150 mg/dl and fasting glucose> 100 mg/dl or under pharmacological treatment. Results The prevalence of MS in our cohort is 46% (54 patients), the patients who have 2 CD are 29% (34 patients), those with only 1 CD 25% (29 patients), no patient had 0 CD. Arterial hypertension represents the most represented risk factor (RF) (91.1%) in agreement with the literature and with the Framingham Offspring Study (non-dialysis patients). The others RF are distributed in this way: reduced HDL (55.8%), hypertriglyceridemia (40.2%), high waist circumference (38.2%), fasting hyperglycaemia (24.5%) (graph 1). Among the 54 patients with MS, 12 CV events occurred during the observation period, while among the 34 patients with two CD, 8 CV events occurred. Among the 29 patients with only 1 CD there was 1 death attributable to CV causes (graph 2). From these data it is clear that MS is a risk factor for CV events according to the literature. It is interesting to observe that comparing the group of patients with 2 CD and with 1 CD, it shows that the presence of 2 CD is a sufficient risk factor to increase the probability of CV events (OR = 8.6 & p <0.05 ). Conclusion The prevalence of MS in patients receiving peritoneal dialysis is elevated with a negative impact on the risk of CV events. At the same time, our data shows the importance of assessing each individual risk factor regardless of the presence of full-blown MS. In particular, we observed that the presence of 2 CD is sufficient to predispose CV events. This shows that timely treatment of RF, even in the absence of full-blown MS, could favor the reduction of the risk of CV events in patients in DP

The Effect of Ethnicity on Preterm Birth and its Influence on the Risk Factors for Prematurity

Preterm birth (PTB) affects 9.6% of pregnancies worldwide and is associated with a very high perinatal mortality that depends on the gestational age at delivery. As a result, PTB has a significant health and financial impact on health systems, families and societies. Its aetiology is not fully understood, but in most cases it is multifactorial, with several maternal, paternal, and epidemiological factors associated with increased risk. Other factors include parental ethnicity, maternal age and body mass index, socioeconomic status, and where the families live. This review examines the influence of ethnicity as an individual risk factor for PTB. It also explores its influence on the epidemiology of PTB and demonstrates that data on certain ethnicities are lacking, despite the fact that these ethnic clusters are within the very ‘high-risk groups’ that are adequately represented in some Western societies. This review examines the influence of ethnicity as an individual risk factor for PTB and also explores its influence on the different epidemiological aspects. A thorough revisit of the ethnic epidemiology unveiled other unnoticed risk factors that if addressed appropriately prematurity can be prevented. Moreover, certain ethnicities were not within the attention of researchers, despite the facts that they are very ‘high-risk groups’ and are also adequately represented in some Western societies.

Clinical outcomes after delayed thyroid surgery in patients with papillary thyroid microcarcinoma

Objective Active surveillance is an option for patients with papillary thyroid microcarcinoma (PTMC). However, the long-term clinical outcomes after delayed surgery remain unclear. We compared the long-term clinical outcomes of PTMC patients according to the time interval between initial diagnosis and surgery. Design and methods In this individual risk factor-matched cohort study, PTMC patients were classified into three groups according to the delay period: ≤6 months, 6–12 months and >12 months. Patients were matched by age, sex, extent of surgery, initial tumor size as measured by ultrasonography (US), and by the presence of extrathyroidal extension, multifocal tumors and central cervical lymph node metastasis. We compared the dynamic risk stratification (DRS) and the development of structural persistent/recurrent disease of patients. Results A total of 2863 patients were assigned to three groups. Their mean age was 50 years, 81% were female and 66% underwent lobectomy. The mean tumor size at the initial US was 0.63 cm. There were no significant differences in clinicopathological characteristics between groups after individual risk factor matching. Comparison of the DRS revealed no significant difference according to the delay period (P = 0.07). During the median 4.8 years of follow-up, there were no significant differences in the development of structural recurrent/persistent disease (P = 0.34) and disease-free survival (P = 0.25) between groups. Conclusions In PTMC patients, delayed surgery was not associated with higher risk of structural recurrent/persistent disease compared to immediate surgery. These findings support the notion that surgical treatment can be safely delayed in patients with PTMC under close monitoring.