A. Serva’s research while affiliated with University of L'Aquila and other places

Background The anal symptoms occurring during pregnancy and post-partum, mainly related to Haemorrhoidal Disease (HD), have been reported with in a wide range of incidence in the literature. Although in many cases the course of the disease is mild and self-limiting, sometimes it is severe enough to affect quality of life. Methods Our study has been conducted through a questionnaire administered via social media with the aim of obtaining epidemiologic data on the incidence of the symptoms of HD in an unselected population of pregnant women. In addition, we looked for the presence of those factors notoriously predisposing or associated to HD (constipation, straining on the toilet, low dietary fibres and fluid intake). Results Out of 133 patients 51% reported symptoms of HD during pregnancy, mainly in the second and third trimester. Constipation, straining on the toilet, low dietary fibres and fluid intake were not significantly related to incidence of HD. Only a previous history of HD was correlated to onset of symptoms of HD in pregnancy and reached a statistical significance (odds ratio = 5.2, p < 0.001). Conclusion Although with the limitations posed by the nature of our retrospective study via a self-assessment interview, our results suggest that the occurrence of HD in pregnancy seems not sustained by the classical risk factors observed in the general population. At the moment, specific therapeutic measures are lacking and treatment relies on empiric suggestions concerning diet, fluid intake, bowel care, local ointment. Further studies are needed in order to identify a targeted etiologic treatment.

Background: The anal symptoms occurring pregnancy and post-partum, mainly related to Haemorrhoidal Disease (HD), have been reported with a wide range of incidence in the Literature. Although in many cases the course of the disease is mild and self-limiting, sometimes it is severe enough to give a bad quality of life. Methods: Our study has been conducted by means of a questionnaire administered via of a social media with the aim of obtaining an epidemiologic data on incidence of symptoms of HD in an unselected population of pregnant women. In addition, we investigated for the presence of those factors notoriously predisposing or associated to haemorrhoidal disease (constipation, straining on the toilet, low dietary fibers and fluid intake). Results: Out of 133 patients 51% reported Symptoms of HD during pregnancy, mainly in the second and third trimester. Constipation, straining on the toilet, low dietary fiber and fluid intake were not significantly related to incidence of haemorrhoids. Only a previous history of haemorrhoidal disease correlated to onset of hemorrhoids in pregnancy and reached a statistical significance (odds ratio = 5.2, p<0.001). Conclusion: Although with the limitations posed by the nature of our retrospective study via a self-assessment interview, our results suggest that the occurrence of HD in pregnancy seems not sustained by the classical risk factors observed in the general population. At the moment, specific therapeutic measuresare lacking and treatment relies on empiric suggestions concerning diet, fluid intake, bowel care, local ointment. Further studies are needed in order to identify a targeted etiologic treatment, taking in mind however, that surgery can be an option in selected cases.

Study Objective To create a predictive model score by estimating rate of intra-operative and post-operative complications and by defining the risk of 30-day major post-operative complications (Clavien-Dindo≥3) according to the presence of 10 different variables analyzed at the time of minimally invasive (MI) hysterectomy. Design A single center single-arm retrospective study. Data of consecutive patients who have undergone MI hysterectomy between May 2018 and April 2021 have been analyzed. Perioperative surgical outcomes, occurrence of intra- and post-operative complications, 30 days-readmissions were registered. Univariate and multivariable analyses were performed. Setting Miulli's Hospital surgery rooms (Bari). Patients or Participants 445 patients were included in the study. Interventions A standardized surgical approach of MI hysterectomy was adopted by laparoscopic or robotic-lps assisted approach. Measurements and Main Results The majority of patients developed a minor event. Major complications (grade III) were observed in 14 patients. The percentage of intraoperative and postoperative complications (Clavien-Dindo classification) was: 44 patients (9.88%) showed a related surgical complication. None showed a grade IV or V complication. Univariate analysis was performed on patients who had developed intra- or post-operative complications from those who did not experience complications. BMI (p-value 0.045) and surgeon's experience (p-value 0.015) were found to be associated with a different surgery time. No one clinic-pathological characteristics were found to be correlated with complications. About major postoperative complications, it was found a statistically significant association for the variables BMI (p-value 0,006), previous surgery (p-value 0,015), and surgeon experience (p-value 0,035). The three significant variables were inserted in a reproducible predictive model in order to stratify the risk of post-operative complications: the score of our predictive model was directly proportional to the severity of complications. Conclusion MI hysterectomy should be considered as a safe approach, and it's associated with a low risk of intra- and post-operative complications. Overall, we developed a risk assessment tool including factors not previously considered in the Literature.

Introduction: The human Sex Ratio at Birth is the parameter which reflects the relationship between males and females at birth. It is not 50:50, but approximately 0.515 in favour of males. There are many factors that can influence Sex Ratio at Birth and its variations are not easily demonstrable. Evidence acquisition: Our aim has been to investigate the environmental and human agents capable of causing variations in the Sex Ratio at Birth by providing a narrative review of the scientific literature. Evidence synthesis: Studies demonstrated that male and female embryos/foetuses response to stress in different way and the male ones show less resistance. This phenomenon seems to persist for approximately six months after a stressful event, suggesting a purpose of reproductive regulation and protection of the perpetuation of the species. Although the relationship of dependence with parenting decisions, thanks to prenatal diagnosis and assisted fertility techniques is easily understood, it is more complex to correlate its variations with environmental pressures that act through secondary mechanisms. The Covid-19 pandemic, natural catastrophes, terroristic attacks, economic crises are some of the difficulties encountered in recent times. Conclusions: The impact of all the factors reported is not explained only with a possible a priori determination of sex at conception, but also with secondary effects in the pregnancy outcomes. Thus, the determination of sex appears to be a complex and multifactorial mechanism, besides a matter of genetics. The pandemic and climate changes are the present important opportunities of research for possibly reaching more certain answers.

Study Objective Compare the ultrasonography and the hysteroscopy findings in asymptomatic postmenopausal patients showing endometrial thickening. Design Observational study (Canadian Task Force Classification II-2). Setting San Salvatore Hospital of L'Aquila, Department of Obstetrics and Gynecology. Patients or Participants 315 asymptomatic postmenopausal women with endometrial thickening >4 mm. Interventions Diagnostic hysteroscopy, endometrial biopsy. Measurements and Main Results That patients had normal endometrium (8.6%), atrophic endometrium (26.7%), single benign polyp (47.6%), multiple polyps (8.6%), myoma (1.9%), focal hyperplasia (3.8%), diffuse hyperplasia (0.9%) and endometrial carcinoma (1.9%). In 30 women under therapy for breast cancer (thickening >5 mm) the hysteroscopic exam showed normal endometrium (50%), multiple polyps (20%), focal hyperplasia (20%) and diffuse hyperplasia (10%). For this subcategory of patients, the histopathological analysis confirmed the hysteroscopic diagnosis in 100% of case. It is not statistically valid to give to the homogeneity data of the endometrial thickening a direct association with the suspicion of polyp, as well as the ascription of a direct association with all the other suspicions except polyp to a non-homogeneous thickening cannot be considered statistically valid. The ROC analysis shows that the best cut-off for suspected polyp in ultrasonography is ≤6 mm (sensibility of just 66.0%, specificity of just 58.18%). By the ROC analysis, an 8 mm cut-off of ultrasound thickness was identified, above which the suspicion of endometrial carcinoma is strongly solid (specificity of 84.47% and a sensibility of 100%). Conclusion Hysteroscopy has a positive predictive value (PPV) of 100%and a negative predictive value (NPV) of 97.952% in detecting a risk of malignancy, with a specificity of 100% and a sensibility of 77.78%, demonstrating that hysteroscopy is the gold standard for the diagnosis of malignant endometrial pathology or an endometrial condition at severe risk of malignancy. A direct endoscopic exam is the only valid exam in the diagnosis of the intracavitary pathologies, especially in asymptomatic postmenopausal patients.