A role of Croatian family doctors in the provision of women's health care: a study based on routinely collected data

The aim of this study was to investigate how often Croatian FDs are involved in the provision of women's health, having in mind that women's health is primarily organized by the gynecological service. Only the data related to women's health were collected from the Croatian health statistical yearbooks from 1995 to 2012, in which ICD X was used. Results showed that total number of diagnoses are increasing. The greatest increase is observed in the category named as other diseases of female organs, then diagnoses related to the pregnancy, delivery and postpartum and malignant diseases, especially, breast cancer. Contrary, number of menopausal disorders continuing decreased. Diagnoses related to family planning (Z30) are relative small in amount and stabile. Results indicated that policy makers should take in account readiness of FDs to be involved in the provision of women's health.

[Gynecological care to children and adolescents. Twelve-year experience at National Pediatrics Institute, Mexico]

BACKGROUND

In major regions of the world, the importance of gynecological care to children and adolescents has been recognized. There are multiple publications, journals and associations dedicated to this purpose. In Mexico, it has not been the case.

OBJECTIVE

The aim of this publication is to raise awareness to the medical community about the importance of sub specialized gynecological care to children and adolescents.

MATERIAL AND METHODS

Retrospective study. The number of office evalu- ations issued by the Department of Gynecology of the National Institute of Pediatrics (INP) from January 1, 2002 to December 31, 2013 were counted. Results were grouped by age groups. Group 1: 1 year or less. Group 2: 2 to 9 years. Group 3: 10 to 18 years. The major causes of morbidity were analyzed by groups and in general.

RESULTS

In the 12 year period reported, 21,190 girls granted gynecological consultation: 15.2% were first consultations (n = 3,221), 74.76% subsequent consultations (n = 15,842) and 10.04% evaluations and interconsultations (n = 2,127). The yearly average was 1,766 consultations. From 2002 to 2005, two certififyed obstetrician-gynecologists (OB-GYN) worked in the Departament, with the subsecuent increase in the number of attentions; 2005 was the year with the highest productivity (2,265). From 2006, only one OB-GYN continued laboring, and the number of visits decreased gradually. 2013 was the year with fewer productivity (1,351). The main causes of morbidity were: abnormal uterine bleeding (26.48%), inflammatory conditions of vagina and vulva (13.58%), dysmenorrhea (12.31%); which occupied 52.37% of the total (10,404 / 19,867). 81% of the patients corresponded to group 3 (17,079/21,190). To a younger patient, corresponded a smaller number of visits.

CONCLUSION

It is required to institute the subspecialty of Child and Adolescent Gynecology in Mexico and to establish Services formed by subspecialists in this matter in the top pediatric hospitals of the country.

Human genital myiasisin extremes of age

Genital myiasis is a very rare entity associated with poor personal hygiene, restricted mobility, and immunosuppressed status and ulcerating lesions. With the reported incidence of only 0.7%, only a few cases have been published so far in literature but none from Nepal. Despite such rare occurrence, we present here two such cases which we encountered in an interval of three days; one in an unmarried teenager and another in a postmenopausal lady with fungating ulcerative growth of vulval carcinoma. Both were successfully managed.

Balneotherapy and coenzyme Q10 in clinical and experimental medicine

Balneotherapy or Spa therapy is used in neurological, cardiovascular, musculoskeletal, dermatological and gynecological diseases, in infertility as well as in metabolic disturbances. Beneficial effects of balneotherapy at the metabolic level is not fully understood. Authors have documented enhancement of antioxidants concentrations (coenzyme Q10- CoQ(10-OX) and alpha-tocopherol) of women with gynecological diseases by treatment with natural mineral water (Spa Lucky balneotherapy, Slovakia). In an experiment with rats, drinking of Spa Lucky mineral water decreased oxidative stress and enhanced concentrations of antioxidants CoQ(9-OX), CoQ(10-OX) in the myocardium, and alpha-tocopherol in uterus, ovaries and myocardium. Drinking of Spa Lucky water by rats stimulated myocardial mitochondrial respiration and energy production, and diminished skeletal muscle mitochondrial function. Simultaneous ingestion of coenzyme Q10 with drinking spa water returned mitochondrial parameters to the values of the control group. This pilot study helps explain the role of antioxidants, oxidative stress and mitochondrial energy production in beneficial effects of Spa Lucky balneotherapy.

Update on the treatment of genital warts

This review summarizes new treatments from the last seven years employed for the treatment of genital warts caused by human papillomavirus (HPV). Imquimod 3.75% is a new agent with fewer side effects and perhaps a better dosing schedule than imquimod 5%, but is not more effective. Sinecatechins/Polyphenon E 15%, a novel extract from green tea can be effective against genital warts but requires three times a day dosing and is not more effective than existing treatments; the treatment course is 12-16 weeks. Photodynamic therapy combined with other destructive modalities might increase the cure rate for genital warts. The quadrivalent vaccine against HPV 6, 11, 16, 18 is decreasing the incidence of warts in the western world but the evidence does not support vaccination as a treatment for those already infected by HPV. Hyperthermia and immunomodulators might be positive additions to the armamentarium of clinicians. In sum, there are new tools that physicians can use but none is really a great advance over what was available a decade ago.

Laparoscopic treatment of endometriosis

Endometriosis can be considered as a chronic disease which is characterized by the presence of ectopic endometrium outside the endometrial cavity and which is associated with symptoms as pelvic pain and infertility. Medical treatment is often not sufficient in patients with moderate to severe endometriosis and deep infiltrative endometriosis (DIE), therefore requiring surgical intervention. Over the past 15 years, we have built a multidisciplinary surgical team to perform a radical but fertility preserving resection of extensive endometriosis with involvement of surrounding organ systems, realizing a good clinical outcome with low complication and recurrence rate, a very good improvement of QOL and a high pregnancy rate. However, for future research evaluating surgical treatment of extensive endometriosis, it is important to reach agreement on study design and on reporting clinical outcome data. A multicenter study with clear patient identification and well defined outcome parameters needs to be set up. Moreover, prevention of DIE with colorectal extension is important, ideally by early identification and management of girls and women at risk. Years of pain and disability as well as a lot of money could be saved when patients, at risk of developing extensive forms of endometriosis could be diagnosed during adolescence.

Update on adolescent gynecology

Adolescent gynecology is an important part of clinical care of adolescent females. This discussion provides a basic review of current issues in adolescent gynecology, including consideration of current pubertal concepts with attention also given to delayed and precocious puberty. Causes of breast masses are reviewed, including discussion of the ANDI classification. It is recommended that physicians provide sexuality education to their adolescent patients, in addition to the community, to reduce the high rates of unintended adolescent pregnancy and STIs in teens that continue in the United States. Finally, attention is provided to ovarian masses and their management. Adolescent medicine physicians may have to work with a variety of specialists in their care of adolescents and the many gynecologic conditions that may arise.

Predictive factors and treatment of recurrence of endometriosis

Endometriosis remains an enigmatic disease process. The key is early recognition of symptoms and treatment. Treatment may begin with hormonal suppression. If medical suppression fails or if fertility is desired, surgical intervention should be used. During primary surgical intervention, the goal is for optimal treatment to decrease disease burden. However, despite adequate treatment, reoperation is needed in a good proportion of woman. Factors contributing to recurrence are multifactorial and some can be predicted and some pain recurrence occurs despite obvious evidence. Recurrent surgery should also aim to decrease disease burden and conservative versus definitive treatment is based on patient's childbearing status. In addition, use of medical treatment can temper recurrence rates. There is still tremendous work that must still be completed in the field of pain recurrence and disease recurrence with endometriosis.

[Obstetric-gynecologic care for female soldiers: status and prospects]

The article presents the analysis of primary gynecologic pathology in female soldiers for the last years. The basic disease groups are marked out. The information about the very medical help standard in different hospitals is given. This paper presents the perspective directions of development of the delivery of obstetrical and gynecological care for women due to level of military medical establishments of the Russian Federation Ministry of Defense.

Primary dysmenorreah-leading problem of adolescent gynecology (review)

Adolescent gynecology is a rapidly developing area. Dysmenorrhea is one of the most common complaints among women of young reproductive age. About 25-95% of young women suffers with dysmenorrhoea and is associated with significant psychological, physical, behavioral and social distress. This review summarizes epidemiology, strategies of establishing the diagnosis, discussion of pathophysiology of the disease and risk factors. We performed a comprehensive search through MEDLINE, EMBASE, Scopus, MD consult and Web of Science. Inclusion criteria specified review and research articles reporting primary dysmenorreah in adolescents. The search resulted in 214 articles. We point out a variety of noninvasive nutritional and psychological therapeutic interventions that have been suggested to relieve dysmenorrheal. This review of Primary Dysmenorreah identifies gaps in the literature, some contradictions and highlights the need for further study.

Inflammatory linear verrucous epidermal nevus with genital involvement

An 18-year-old woman was admitted to our clinic complaining of pruritic lesions on her inguinal and genital areas that had been present since birth. She had previously used topical steroids and a combination of topical steroids and calcipotriol for approximately 6 months; however, the treatment was unsuccessful. Her medical history was unremarkable. On dermatologic examination, mild erythematous, lichenified, and verrucous papules occurring in a linear pattern on the right inguinal area and on the region extending from the right labium majus to the perianal area were noted (Figure). Additionally, an erythematous area with central erosion surrounded by maceration was noted on the intergluteal area. Two separate punch biopsy samples were obtained from the erythematous, lichenified, verrucous, papular lesion on the inguinal area and from the erythematous, eroded, macerated lesion on the intergluteal area. Histopathological examination of both biopsy specimens revealed a thin orthokeratotic layer and scattered parakeratotic layers, as well as papillomatosis and acanthosis of the epidermis with a slight hyperpigmentation of the basal layer. A mild, perivascular, chronic inflammatory cell infiltration was noted in the dermis. Based on the clinical and histopathological findings, the patient was considered to have inflammatory linear verrucous epidermal nevus, and cryotherapy was initiated. At the 2-week follow-up after the first application, it was observed that the itching complaint decreased substantially and the eroded lesions in the intergluteal area were re-epithelialized. On clinical follow-up, no improvement was observed in the papular component of the lesion after 4 sessions of cryotherapy. The patient voluntarily discontinued the follow-up after 4 sessions of cryotherapy.

[Modern ways of treating female genital infections]

In article various ways of increase of efficiency of treatment of is mixed the bacterial-virus infection of the bottom department of sexual ways at women by means of application in complex therapy of homologous bacteriophages, pectovit, antiviral -immunomodulation therapies and sated with oxygen (oxygenic) water solutions of antiseptic tanks are considered. The scientifically-practical urgency of this problem is represented and actual for the decision of an important social and economic problem of improvement of quality of life, decrease in number of infectious complications and perfection of the medical help to sick women with frequent recidives an infection of the bottom department of sexual ways.

[Health assessment of newborns with congenital urinary malformation]

Improvement in diagnosis of prenatal congenital urinary malformations (CUM) resulted in increased detection of CUM cases among newborns. To facilitate medical care for CUM newborns, we have developed an objective method of CUM newborns' health assessment. We studied 40 case histories of newborns with prenatally detected CUM admitted to urological clinics (20 with diagnosis of poor health and 20 with moderate condition severity) and 40 CUM newborns examined outpatiently (moderate health hazard). The computer analysis of the available data has established 13 most informative diagnostic criteria: 4 sonographic criteria, 3 lab criteria and 6 physical exam criteria estimated by 4 points - from 0 to 4. The criteria were pooled to a table which was used as a scale to assess general health condition. After delivery, CUM newborn gets inpatient health assessment by a neonatologist using 13 criteria. According to the total score, the condition is assessed as satisfactory (0-5), moderately severe (6-11), severe ( > 12). Efficacy of such health assessment was proved in a population study of 312 prenatal CUM newborns. Grouping of such newborns helps design of programs of further examination and management.

Probiotics--an alternative treatment for various diseases

Modulating the microbiota of the gastrointestinal tract through probiotics is an alternative to the conventional treatment of various diseases, based on synthetic drugs. The lifestyle, nutrition and stress of the present modern society could be among the factors responsible for modifications in the intestinal microbiota, correlated with specific diseases. The present study describes the positive effects of probiotics use, with special reference to the yeasts use in several frequently encountered diseases, such as hypercholesterolemia, the irritable bowel syndrome, gastritis and several uro-genital disorders.