Acute Pelvic Inflammatory Disease Research Articles

Characteristics of Acute Pelvic Inflammatory Disease in Surgically Treated Females Over Ten Years - A Single-Center Study

Background: Pelvic inflammatory disease (PID) is a public health problem that demands rapid diagnosis and treatment and may severely impair female reproductive health. Objective: To analyze anamnestic information, laboratory findings, and clinical and microbiological features of patients with severe acute PID that underwent a surgical procedure. Methods: This retrospective study enrolled 97 cases that were surgically treated in the Department of Obstetrics and Gynecology, University Hospital „ Sveti Duh“ between 2009 and 2019. Results: Most women were within the age group 35-44 (38.14%). Lower abdominal pain was the most common symptom (92.78%). Compared to intraoperatively confirmed PID, C-reactive protein (CRP) yielded the highest sensitivity (88.10%) while cervical motion tenderness possessed the highest specificity (53.85%). The tubo-ovarian abscess was detected in 35.05% of intraoperative specimens, mainly occurring in women between 45-54 years (P=0.017) and absent between 15-24 (P=0.012) and 25-34 years (P=0.049). The length of hospital stay was influenced by the number of symptoms (ρ=0.316, P=0.002), admission CRP levels (ρ=0.620, P<0.001), and admission body temperature (ρ=0.386, P<0.001). Out of 59.30% of positive cultures, one pathogen was isolated in 70.59%, mainly Escherichia coli (41.18%). Admission CRP levels impacted the efficacy of microbiologic isolation (P=0.001). The empirical treatment was mostly based on the clindamycin/gentamicin combination (51.72%). Conclusion: Severe clinical picture that requires surgical treatment can be expected in women >35 years. Longer hospital stay was associated with more symptoms, higher CRP, and temperature values on admission. It is important to have a low threshold for diagnosis and to consider both aerobic and anaerobic pathogens when selecting antibiotic treatment.

A New Marker for the Diagnosis of Acute Pelvic Inflammatory Disease: Immature Granulocyte.

The goal is to assess the role of immature granulocytes (IG) in the diagnosis of acute pelvic-inflammatory-disease (PID) and to determine whether they are useful for discriminating mild/moderate and severe PID. Patients admitted with the diagnosis of acute PID were retrospectively assessed. Diagnosis was based on CDC criteria. Patients were grouped as severe and mild/moderate PID based on need for hospitalization. Control group consisted of patients in whom PID was excluded by laparoscopy. Sample size was calculated with statistical methods. IGs were compared within the groups. Cutoff values were determined for prediction of diagnosis and severity of acute PID. There were 74 severe, 32 mild/moderate acute PID, and 41 control patients. Thirty patients had surgery following no response to antibiotic treatment or tubo-ovarian abscess. IGs were significantly higher in the severe group compared to mild/moderate and control groups. ROC analysis showed IG counts (≥ 0.035 µL) and percentages (≥ 0.35%) were significantly effective in predicting acute PID and were associated with severity when they were ≥ 0.055 µL and ≥ 0.42%, respectively. IG count ≥ 0.085 was found to have 58.6% sensitivity and 63.1% speci-ficity for prediction of surgical intervention need. IGs are components of simple CBC tests and are easily obtainable, cheap markers. They were found to be elevated in acute PID and correlated significantly with the severity of the disease. These markers may serve as adjunctive markers for the diagnosis of acute PID and may be useful in discrimination between mild/moderate and severe PID.

Ultrasonographic evaluation of common findings in acute abdomen amongst paediatric age group in Kano Metropolis, Nigeria

Acute abdomen is very common complaint for paediatric patients presenting to the paediatric emergency departments and outpatient clinics and its management is time consuming. Ultrasound is reliable for the diagnosis of acute abdomen. This study was aimed at evaluating the commonest ultrasonographic findings in paediatric age group presented with acute abdomen in Kano metropolis, Nigeria. This was rospective, cross sectional study conducted from September, 2020 to December, 2022. A convenience sampling method was employed and a sample size of 170 paediatric patients with ages ranging between 0 and 18 years. Paediatrics presenting with non-traumatic acute abdomen were included in the study, while those with traumatic acute abdomen were excluded. GE LOGIQ F6 US machine with transducer frequency of 3.5 MHz-8 MHz was used as an instrument for data collection. The selected patients were scanned in supine position. Data generated was analyzed using SPSS version 22.0. Results generated indicate that the commonest symptoms of acute abdomen among paediatric in Kano metropolis besides abdominal pain were vomiting (63.5%) and running fever (55.8%). The commonest ultrasonographic findings of acute abdomen were gastroenteritis (17.1%), acute appendicitis (12.9%), nonspecific abdominal pain (10.0%) mesenteric adenitis (7.6%) and acute cholecystitis (7.1%). Intussusception, intestinal obstruction and intestinal perforation accounted for 5.9% each. Pyelonephritis, and cystitis accounted for 4.1% and 4.7% respectively. There was 2.9% for each acute hepatitis, renal calculus and pelvic inflammatory disease (PID). Midgut malrotation and volvulus and acute peritonitis accounted for 1.8% each. The common findings in acute abdomen among paediatrics in Kano metropolis, Nigeria were gastroenteritis, acute appendicitis, nonspecific abdominal pain and mesenteric adenitis.

Scope of Homoeopathy in Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infectious and inflammatory ailment of the upper female genital tract, which includes the uterus, fallopian tubes, and associated pelvic tissues. In India, the prevalence of pelvic inflammatory disease ranges between 1 and 2%. N gonorrhoeae and C trachomatis are the organisms most usually isolated in instances of acute PID. Homoeopathic treatments are beneficial in the treatment of both acute and chronic pelvic inflammatory illness, as well as in preventing additional complications. Keywords: Pelvic inflammatory disease, PID, Homoeopathy

Gonococcal Pelvic Inflammatory Disease with Sepsis Criteria: Review of 2 Cases

Background: Infection caused by Neisseria Gonorrhoeae increases the risk of pelvic inflammatory disease (PID). Gonococcal PID tends to be clinically more severe than non-gonococcal ones. The main is to present two cases of gonococcal PID, with rapid clinical and analytic progression, leading to severe sepsis, but without imaging manifestations. Clinical presentation: 1. 41-year-old patient with replacement of intrauterine releasing levonorgestrel device (IUD), presented abdominal pain and green vaginal discharge. Abdominal examination revealed signs of peritoneal irritation and blood test showed leukocytosis, increased C Reactive Protein and procalcitonin, as well as coagulation abnormalities. Imaging tests (vaginal ultrasound/tomography) revealed no structural pathology, without collections. Given the criteria of severe sepsis, broadspectrum intravenous (iv) antibiotic therapy was started and laparoscopy and IUD removal were performed. Cervical and IUD cultures were positive for Neisseria gonorrhoeae. 2. 20-year-old woman, with an IUD, consulted for abdominal pain, low-grade fever and green vaginal discharge. Abdominal examination suggested peritoneal sensitivity and laboratory tests leukocytosis, increased C Reactive Protein and procalcitonin with coagulation abnormalities. Imaging tests (vaginal ultrasound/tomography) showed no structural pathology, without collections. Despite analgesia and broad-spectrum iv antibiotics, the patient worsened, proceeding to remove the IUD. Given the criteria compatible with severe sepsis, laparoscopy was decided. Endocervical and IUD cultures revealed Neisseria gonorrhoeae. Conclusions: Facing the situation of an acute PID with severe and fast clinical worsening even without findings in imaging tests, we should consider gonococcal ethiology as a possible cause. Surgical approach shouldn’t be delayed in order to control the infection and rule out other possible diagnosis.

CORRECTION OF HORMONAL DISORDERS IN WOMEN WITH ABNOMAL UTERINE BLEEDING AND CHRONIC PSYCHO-EMOTIONAL STRESS

The aim of the research was to evaluate the effectiveness of the optimized treatment in the correction of hormonal disorders in women with abnormal uterine bleeding (AUB) and chronic psycho-emotional stress.
 Materials and methods. 100 women of reproductive age with AUB and chronic psycho-emotional stress were examined. I group included 50 patients who received complex optimized treatment, II group included 50 persons who received standard treatment. The control group included 30 healthy women without AUB and chronic psycho-emotional stress. The standard approach provided for diagnostic and therapeutic measures in accordance with the recommendations of the order of the Ministry of Health of Ukraine N 353 dated 13.04.2016. Inclusion criteria: AUB, age 18-45 years, satisfactory condition of the sample of the material from the uterine cavity for histological examination, chronic psychogenic stress, patient consent. Exclusion criteria: pregnancy, premenstrual dysphoric disorder, acute pelvic inflammatory disease, mental disorders, blood diseases associated with coagulation disorders, hypothyroidism, hyperthyroidism, hormonal adrenal tumors, chronic intestinal diseases, severe somatic pathology. Optimized treatment additionally included recommendations for lifestyle changes, melatonin, vitamin D, medicament’ correction of iron deficiency without anemia. Estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, progesterone, prolactin, and cortisol levels were determined in all subjects.
 Results of the research. In the follicular phase of menstrual cycle after the standard treatment there is a positive dynamics of progesterone and FSH levels in the patients in the I and II groups whose concentrations reached the control group. However, LH level in patients in both groups and estradiol amount in the II group differed significantly from those in healthy women. After optimized treatment, the levels of prolactin and cortisol reached the amount of healthy women, while after the standard treatment the prolactin concentration was increased by 17.22 % (p=0.049), cortisol – by 43.84 % (p<0.001) compared with controls. In the luteal phase, the greatest correction of estradiol and progesterone concentrations in the I and II groups and prolactin level in women in the I group were determined. However, the amount of prolactin in patients of the II group remained high, exceeding the rate of healthy women by 33.64 % (p=0.007), while in the I group it corresponded to the control value. No significant changes in the concentration of FSH, LH and testosterone on the background of treatment in women of the two groups were observed, as their levels corresponded to the control group. FSH and LH levels in patients before and after the standard and optimized treatment were at the lower limit of healthy persons.
 Conclusions. The use of standard and optimized approaches in the management of patients with abnormal uterine bleeding and chronic psycho-emotional stress has been successful in normalizing in female sex hormones, but the standard approach has demonstrated an insufficient correction of stress-induced hormone levels, in contrast, the optimized treatment led to a more effective correction of all hormonal disorders.

Different Outcomes of Pelvic Inflammatory Disease after Transvaginal Oocyte Retrieval in Patients with and without Endometriosis and the Factors Influencing Its Treatment: A Retrospective Study of 66 Cases

Background: Even though endometriosis is an important risk factor for pelvic inflammatory disease (PID), it is still not clear whether endometriosis influences PID after ultrasound-guided transvaginal oocyte retrieval (TVOR). Therefore, this work was designed to explore whether endometriosis will influence PID after TVOR and study the influencing factors of receiving drainage treatment to improve the outcomes of patients with PID. Methods: A retrospective study was conducted between 2004 and 2017. Data were collected from Women’s Hospital, Zhejiang University School of Medicine, China. This study included 66 patients with acute PID symptoms after TVOR with or without endometriosis. The independent factors predicting drainage treatment were determined using univariate and multivariate logistic regression analyses, and their optimal cut-off points were ascertained using a receiver operating characteristic curve. Results: Among 66 cases, there were 53 women without endometriosis and 13 women with stage III or IV endometriosis. The significantly higher maximum body temperature (p = 0.047), longer days of fever (p = 0.043) and duration of intravenous (IV) antibiotic use (p = 0.001), and more receiving drainage treatment (p = 0.002) were found in the patients with endometriosis. In vitro fertilization (IVF) cycles (odds ratio [OR] = 6.055, 95% confidence interval [CI] = 1.360–26.961, p = 0.018), puncture cyst during TVOR (OR = 60.167, 95% CI = 2.477–1461.619, p = 0.012), and pre-treatment C-reactive protein (CRP; OR = 1.022, 95% CI = 1.003–1.041, p = 0.022) were significant independent risk factors for drainage treatment. The optimal cut-off for IVF cycles and pre-treatment CRP for patients receiving drainage treatment were 2 and 40.3 mg/L, respectively. Conclusions: Patients with endometriosis had more severe PID outcomes after TVOR, requiring more attention during treatment. Early drainage treatment is recommended for patients with pre-treatment CRP levels higher than 40.3 mg/L, puncture cyst during TVOR, and those receiving more than 2 IVF cycles.

Cervical Power Doppler Angiography with Micro Vessel Blood Flow Indices in the Auxiliary Diagnosis of Acute Cervicitis.

We have conducted cervical imaging of uterine and micro-vessel flow velocity waveforms in acute pelvic inflammatory disease (PID) by transvaginal power Doppler ultrasound (TVPDU) in order to explore the associations of sonographic parameters with simple and complex cervicitis. Thirty-eight patients with acute PID (26 with acute simple cervicitis and 12 with complex cervicitis) were enrolled for an assessment of vascular grading of cervix and micro-vessel flow velocity using TVPDU before treatment. Seven parameters, including vascular grading (VG), lowest pulsatility index (PI), resistance index (RI), peak systolic velocity (PS), end diastolic velocity (ED), time average maximum velocity (TAMV), and vascular index (VI = PS/ED), were measured and recorded. Forty-one healthy patients were assessed as the control group. Vascular grading (VG) was significantly higher in the study group than the control group (p < 0.0001). The PI, RI, and VI were significantly lower in the study group than control group (p < 0.0001). No significant associations were observed between seven sonographic parameters and acute simple or/and complex cervicitis. For acute simple cervicitis, a PI cutoff of 1.1 had a sensitivity of 85.4% and a specificity of 92.1% (area under ROC curve [AUC], 93.2%). A RI of 0.6 had a sensitivity of 85.4% and a specificity of 78.9% (AUC, 86.1%). A VI of 2.6 had a sensitivity of 85.4% and a specificity of 78.9% (AUC, 84.9%). Power Doppler angiography of micro-vessel flow velocity waveforms in the cervix could represent a practical method to assist the diagnosis of pelvic inflammatory disease presented as acute cervicitis detected on transvaginal ultrasound before medical or surgical treatment. Cervical PI may be a useful index to detect micro-vessel flow velocity waveforms in acute cervicitis and differentiate acute simple cervicitis from complex cervicitis.

Irisin Activates M1 Macrophage and Suppresses Th2-Type Immune Response in Rats with Pelvic Inflammatory Disease.

Objective To investigate the mechanism of irisin to treat rats with acute pelvic inflammatory disease (APID). Methods Female rats were established as APID. Firstly, the content of IL-6, IL-8, TNF-α, and NF-kB was tested in rats' serum by enzyme linked immunosorbent assay (ELISA). Interferon-γ (IFN-γ) and IL-4 in the supernatant of pelvic homogenates were also detected. The mRNA expression of the inducible nitric oxide synthase (iNOS), TNF-α, chemokine ligand 1 (CXCL1), arginase-1(Arg1), and chitinase-3-like-3 (Chi313) genes in the pelvic cavity was detected by quantitative reverse transcription polymerase chain reaction (RT-qPCR). IFN-γ and IL-4 secreted by spleen CD4+T cells and CD8+T cells were counted by flow cytometry, and the ratio of IFN-γ/IL-4 in CD4+T cells and CD8+T cells in the spleen was also detected by flow cytometry. Results Irisin reduced the levels of IL-6, IL-8, TNF-α, and NF-kB in serum. Compared with the APID group, the expression level of IL-4 in the APID + Irisin group was reduced in the homogenate. At the same time, Irisin promotes the activation of M1 macrophages in the uterus, ovaries, and uterine tubes of rats with APID. Irisin also inhibited Th2-type immune response. Conclusions Irisin activates M1 macrophage and suppresses Th2-type immune response in APID rats.

Emergency treatment in gynecology using different methods of surgery

The aim. Improving surgical treatment of urgent genital pathology based on comparing the effectiveness of different methods of surgery.&#x0D; Materials and methods. 170 women were selected and divided into three groups. Group 1 included women with acute pelvic inflammatory disease (aPID); to 2nd group – 60 women with intra-abdominal bleeding (IAB); to 3rd group - 50 women with impaired blood supply to tumors of the internal genitalia (uterus and ovaries) (IBSTIG). Each group was divided into two equivalent subgroups depending on the method of treatment: laparoscopic or laparotomy.&#x0D; During the study, all examined patients had a medical history, gynecological examination, ultrasound examination, surgical treatment by laparoscopy or laparotomy.&#x0D; Results. The average duration of laparoscopic operations in patients in subgroup 1.1 was 50.4±7.2 minutes and 80.3±10.1 minutes in subgroup 1.2 – with laparotomy method. Intraoperative blood loss was significantly lower in subgroup 1.1 compared with subgroup 1.2 (210.7±31.4 ml and 375.9±44.5 ml) (p &lt;0.01). In the postoperative period in subgroup 1.1, which included women with emergencies due to aPID and in which operations were performed laparoscopically, the maximum temperature rise after surgery was 37.6±0.04 °C, which was significantly lower than in subgroup 1.2, which included women with emergencies due to aPID and in which operations were performed by laparotomy, this figure was 38.0±0.08 °C (p &lt;0.001). The mean duration of the postoperative period in patients of subgroup 1.1 was significantly shorter compared to subgroup 1.2 (7.2±0.6 and 10.2±1.0 days) (p &lt;0.05).&#x0D; The average duration of operations in subgroup 2.1 was significantly shorter than in subgroup 2.1 (39.8±2.1 and 59.1±2.5 minutes, respectively) (p &lt;0.001). Intraoperative blood loss was on average significantly lower in subgroup 2.1 (189.1±19.8 and 388.5±37.2 ml, respectively) (p &lt;0.05).&#x0D; In subgroup 3.1, which included women with IBSTIG and underwent surgical treatment by laparoscopy, the average duration of operations was significantly shorter than in subgroup 3.2, where such women with such pathology received surgical treatment by laparotomy (62.1±4.9 and 89.6±7.8 minutes, respectively) (p &lt;0.01). Blood loss was significantly lower in subgroup 3.1 in contrast to subgroup 3.2 (101.7±10.1 ml and 283.3±12.9 ml, respectively) (p &lt;0.001).&#x0D; Conclusions. The use of laparoscopy for the treatment of urgent genital pathology could increase the effectiveness of surgical treatment. In addition, this method reduces the duration of surgery and surgical blood loss. As a result, it makes it possible to improve the postoperative period.

Diagnostic accuracy of pelvic imaging for acute pelvic inflammatory disease in an emergency care setting: a systematic review and meta-analysis.

The aim of this review is to investigate the diagnostic accuracy or performance of contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) for acute pelvic inflammatory disease (PID) in an emergency care setting. We searched for studies on the diagnostic test accuracy of contrast-enhanced CT or MRI for women of reproductive age with acute abdominal pain using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, and ClinicalTrials.gov. The reference standard was gynecological examinations by gynecologists using standard diagnostic criteria with or without laparoscopy or transcervical endometrial biopsy. Two reviewers undertook screening of records, data extraction, and assessment of the risk of bias in each included study using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate model was used for the meta-analysis. Of 2,619 screened studies, three studies investigating contrast-enhanced CT and one study investigating MRI were eligible, including a total 635 patients and with a median prevalence of acute PID of 29%. All of the included studies had a high risk of bias for a reference standard and had some applicability concerns. Contrast-enhanced CT had a pooled sensitivity of 0.79 (95% confidence interval [CI], 0.52-0.93) and specificity of 0.99 (95% CI, 0.94-1.00). Magnetic resonance imaging had a sensitivity of 0.95 (95% CI, 0.76-1.00) and specificity of 0.89 (95% CI, 0.52-1.00). Contrast-enhanced CT might serve as a practical alternative to gynecological examination in the diagnosis of acute PID in an emergency care setting, however, the evidence was uncertain. The evidence on MRI was also very uncertain.

Diagnosis and Analysis of Transabdominal and Intracavitary Ultrasound in Gynecological Acute Abdomen.

In order to explore the effective diagnosis method of gynecological acute abdomen, this paper takes hospital gynecological acute abdomen patients as samples and selects gynecological acute abdomen patients admitted to the hospital to be included in this study. They are divided into transabdominal ultrasound group, intracavitary ultrasound group, and combined group. Moreover, this paper uses mathematical statistics to carry out sample statistics. The statistical data mainly include ectopic pregnancy, torsion of ovarian tumor pedicle, acute suppurative salpingitis, torsion of fallopian tube, hemorrhagic salpingitis, acute pelvic inflammatory disease, rupture of corpus luteum cyst, and diagnosis accuracy rate. In addition, this paper compares the diagnostic accuracy of the abdominal ultrasound group, the intracavitary ultrasound group, and the combined group. The experimental research shows that the combined ultrasound diagnosis method can effectively improve the accuracy of the diagnosis of gynecological acute abdomen.

Identifying the clinical presentations, progression, and sequela of pelvic inflammatory disease through physiological, histological and ultrastructural evaluation of a rat animal model.

BackgroundPatients with pelvic inflammatory disease (PID) are at an increased risk of ectopic pregnancy, infertility, and varying degrees of chronic pelvic pain. The aims of this study were to establish a rat model of PID and characterize its progression in order to assist in the study of pathophysiological mechanisms and to provide animal model for future studies of PID treatments.MethodsFifty Sprague-Dawley rats (female, 6-weeks-old) were divided into a model group (n=28) and a control group (n=22). The rat endometrium was mechanically injured by a needle which moved back and forth 3 times on the endometrial tissue, and a mixed bacterial solution (6×108 CFU) of equal concentrations of Escherichia coli and Staphylococcus aureus was injected into both horns of the rat uterus. Physiological characteristics including weight, temperature, blood, and inflammatory factors were compared, and immunohistochemistry and transmission electron microscopy were used to evaluate the progress and sequela of PID.ResultsThe model rats experienced acute PID in the first 14 days and exhibited higher body temperatures and decreased body weight. Infection-related factors in the blood were also significantly changed compared with the normal group, with obviously increased serum levels of C-reactive protein (CRP), interferon gamma (IFN-γ), and interleukin-4 (IL-4). Congestion and edema were observed in the uteri of the model rats, followed by infiltration of numerous inflammatory cells and ultrastructural morphology changes. Histological examination of the uterus showed that adhesion initially appeared at approximately 21 days. In addition to the increased collagen fibers biomass, the expression of transforming growth factor-beta 1 (TGF-β1) was elevated, which might have contributed to pelvic tissue adhesion formation in the PID sequela.ConclusionsThis study clearly described the characteristics and progression of PID in a rat model. The detailed evidence increased our understanding of the pathogenesis and progression of PID and may be useful for future studies of PID treatments.

S2884 Pelvic Inflammatory Disease as an Unusual Cause of Ascites

Introduction: Pelvic inflammatory disease (PID) is an infection of the upper genital tract, including the uterus, fallopian tubes, and/or ovaries. Neisseria gonorrhea, Chlamydia trachomatis, and Mycoplasma genitalium are the most frequently isolated pathogens. Case Description/Methods: A 25-year-old female presented with an 8-day history of lower abdominal pain associated with fevers, chills, vomiting, and non-bloody diarrhea. Patient denied recent travel, changes in her diet, family history of Inflammatory Bowel Disease. Her abdomen was diffusely tender. Routine laboratory testing was unremarkable. CT scan of the abdomen and pelvis (Figure 1) showed focal small bowel mural thickening, concerning for gastroenteritis. COVID PCR, HIV antigen/antibody, blood cultures, Clostridium difficile toxin and stool pathogen PCR panel were all negative. Patient was presumed to have viral gastroenteritis and was discharged home. She was readmitted two days later for worsening nausea and vomiting. Laboratory testing was significant for WBC 12.7 x 109/L, potassium of 2.8 mEq, INR 1.7, CRP 19.24 mg/dL. A repeat CT abdomen and pelvis (Figure 2) showed a re-demonstration of marked wall thickening of the small bowel most consistent with enteritis, and the development of large loculated ascites in the mid abdomen and pelvis with peritoneal thickening and enhancement. Diagnostic paracentesis showed PMNs 990, RBCs 4000, SAAG < 1.1, total protein 3.7 g/dl, glucose 29 mg/dl, and LDH 1609 U/L. Peritoneal cultures grew Neisseria gonorrhea. Patient was discharged home on a two-week course of IV ceftriaxone, metronidazole and doxycycline with improvement in clinical symptoms. Repeat diagnostic imaging showed interval improvement and resolution of ascites. Discussion: Acute symptomatic PID presents with lower abdominal pain associated with fevers, chills, nausea, vomiting, vaginal discharge and/or intermenstrual bleeding. PID may present with RUQ pain in the setting of liver capsular inflammation, also known as perihepatitis i.e. Fitz-Hugh Curtis Syndrome. Perihepatitis occurs in about 10% of woman with acute PID. However, the development of ascites as a presenting complication of PID is very rare. In this case, the ascites fluid studies were not consistent with portal hypertension with a SAAG < 1.1. In addition, PMNs > 250 cells suggested bacterial peritonitis. Furthermore, per the Runyon’s criteria, this pattern resembled secondary bacterial peritonitis with a total protein >1 g/dL, glucose < 50 mg/dL, and LDH > upper limit of normal serum.Figure 1.: CT abdomen and pelvis on presentation showing small bowel mural thickening and enhancement.Figure 2.: CT abdomen and pelvis on representation showing large volume ascites with continued small bowel mural thickening and enhancement.

Features of condition of hemodynamic and homeostasis at acute gynecologic diseases

In recent years, there has been a significant increase in urgent conditions in gynecology. The use of inadequate and sometimes unjustified surgical interventions due to the peculiarities of the clinical course of the disease, the difficulties of early diagnosis, uncertainty of treatment tactics can lead to complications and even death of the patient. Therefore, improving early diagnosis and emergency care is one of the priorities of modern medicine. The objective: to improve the early diagnosis and comprehensive treatment of acute gynecological conditions to study the structure and features of urgent gynecological diseases in modern conditions; analyze indicators of hemodynamics and homeostasis (including immune) to reduce possible complications in patients with acute gynecological diseases. Materials and methods. A 5-year retrospective clinical and anamnestic analysis of 1261 case histories of patients with various acute gynecological diseases, the most common of which are acute pelvic inflammatory disease (PID), uterine and intraperitoneal bleeding, impaired blood supply to internal tumors. Patients in the comparative groups were comparable in age and course of the pathological process in the genitals. Results. The study found that among acute gynecological diseases dominated by acute PID (41,4%), uterine bleeding (31,6%), intra-abdominal bleeding (20,8%), impaired blood supply to tumors of the internal genitalia (6,2%), and in the last two groups the incidence increased. The age of patients varied significantly depending on the type of pathology. Clinical manifestations of acute PID and impaired blood supply to tumors of the internal genitalia in most cases were characterized by a predominance of pain and intoxication syndromes. Intra-abdominal and uterine bleeding was dominated by symptoms associated with hemodynamic disturbances and posthemorrhagic anemia. A high frequency of anemia of toxic genesis was observed in patients with acute PID and impaired blood supply to tumors of the internal genitalia. Conclusion. In modern conditions, the percentage of patients in need of emergency care is increasing, mainly due to an increase in the number of patients with intraperitoneal bleeding and impaired blood supply to tumors of the uterus and ovaries. The course of urgent gynecological diseases is accompanied by a violation of the adaptive-regulatory mechanisms of detoxification, indicators of homeostasis, immune system, hemodynamics, acid-base state of the blood. Given the clinical picture of the disease and the established diagnosis, it is necessary to develop individual management tactics for each patient.

Using Innovation to Address Adolescent and Young Adult Health Disparities in Pelvic Inflammatory Disease: Design of the Technology Enhanced Community Health Precision Nursing (TECH-PN) Trial.

New approaches to pelvic inflammatory disease (PID) care among adolescents and young adults (AYAs) that optimize self-care and personalize treatment are warranted to address age and racial-ethnic PID-related health disparities. Here we describe the 13-month preliminary feasibility and acceptability outcomes of recruitment, retention, and intervention delivery for Technology Enhanced Community Health Precision Nursing (TECH-PN) randomized controlled trial. Urban AYAs 13-25 years assigned female sex at birth with acute mild-moderate PID provided baseline and follow-up interview data and vaginal specimens for sexually transmitted infection (STI), cytokine, and microbiota assessment. All participants received medications and text-messaging support. Participants were block randomized to either control or intervention. Control participants received 1 community nursing visit with self-management for interim care per national guidelines. Intervention participants received unlimited precision care services driven by interim STI and macrolide resistance testing results by an advanced practice provider. In the first 13 months, 75.2% patients were eligible, and 76.1% of eligible patients enrolled. Of the participants, 94% completed the intervention and 96%, 91%, and 89%, respectively, completed their 14-, 30-, and 90-day visits. Baseline laboratory results revealed infection rates that were highest for Mycoplasma genitalium (45%) followed by Chlamydia trachomatis (31%). Preliminary enrollment, STI, intervention delivery, and retention data demonstrate the feasibility and acceptability of the TECH-PN intervention and support rationale for precision care for PID among urban AYAs. ClinicalTrials.gov Identifier. NCT03828994.

The Continued Challenges in the Diagnosis of Acute Pelvic Inflammatory Disease: Focus on Clinically Mild Disease.

Many women with lower genital tract infections associated with sexually transmitted pathogens have evidence of upper genital tract inflammation despite the absence of symptoms and signs traditionally associated with pelvic inflammatory disease (PID). New biomarkers are needed to identify these women with clinically mild PID or subclinical PID (silent salpingitis) to facilitate initiation of early treatment and ameliorate the sequelae associated with upper genital tract infection and inflammation.

Systematic Review and Meta-Analysis of Randomized Controlled Trials of Fuke Qianjin Tablet.

Purpose The aim of the research was to evaluate the efficacy and safety associated with Fuke Qianjin tablet combined with conventional therapy in the treatment of pelvic inflammatory diseases and associated complications (endometritis) using a meta-analysis approach. Patients and Methods. We searched 8 electronic databases up to December 31, 2019, including PubMed, the Cochrane Library, Embase, Web of Science, CNKI, WanFang, VIP, and SinoMed. Eligible studies were clinical trials of Fuke Qianjin tablet combined with conventional therapy used in the treatment of acute pelvic inflammatory disease, chronic pelvic inflammatory disease, and endometritis. The meta-analysis was performed using STATA15 software. Results A total of 125 RCTs (n = 14,494) were shortlisted for the meta-analysis, which included 23 trials for acute pelvic inflammatory disease, 69 trials for chronic pelvic inflammatory disease, and 33 trials for endometritis. The overall analysis illustrated Fuke Qianjin tablet combined with conventional therapy was significantly more efficacious than conventional therapy alone across all types of antibiotics treatment for acute pelvic inflammatory disease (OR = 5.57, 95% CI 4.09–7.58, Z = 10.90, p=0.001), chronic pelvic inflammatory disease (OR = 4.70, 95% CI 4.07–5.42, Z = 21.21, p=0.001) and endometritis (OR = 5.09, 95% CI 4.03–6.43; Z = 13.63, p=0.001) in both primary endpoints and secondary endpoints. There is also a trend that Fuke Qianjin tablet combined with conventional therapy has lower adverse reaction rates than conventional therapy alone. Conclusion Fuke Qianjin tablet combined with conventional therapy showed better clinical efficacy in the treatment of acute pelvic inflammatory disease, chronic pelvic inflammatory disease, and endometritis. There were no obvious drug-related adverse reactions. Fuke Qianjin tablet presented advantages in shortening the remission time of clinical symptoms, reducing the concentration of serum inflammatory factors, improving endometrial thickness, menstruation, and reducing relapse rate.

Diagnostic Value of Ultrasound Imaging in Obstetrics and Gynecology Acute Abdomen

Common types of gynecological acute abdomen include ovarian cyst pedicle torsion, ectopic pregnancy, luteal rupture, and acute pelvic inflammatory disease. Make accurate diagnosis and surgical treatment of acute abdomen patients in obstetrics and gynecology in time, otherwise it will cause life danger or loss of organ function, therefore, accurate and timely diagnosis and treatment of gynecological acute abdomen is very important for the prognosis of patients. Ultrasound imaging has important clinical value for the diagnosis of acute abdomen in obstetrics and gynecology. Ultrasound imaging has the advantages of simple examination, rapid reporting, and no pain in the subject, which is one of the best methods for diagnosing acute abdomen in obstetrics and gynecology. This study analysed and summarized the imaging principles of ultrasound imaging in acute obstetrics and gynecology and the imaging characteristics of various acute abdomen. A retrospective analysis of patients with acute obstetrics and gynaecology performed in our hospital from December 2017 to June 2019 was performed. The diagnostic analysis of ultrasound imaging in acute obstetrics and gynaecology was performed. The results showed that the ultrasound imaging diagnosis results of 202 obstetric and gynecological acute abdomen patients were compared with the results of surgery and pathological diagnosis. Among the 182 cases with correct ultrasound imaging diagnosis, the coincidence rate was 90.1%, and 20 cases were misdiagnosed, accounting for 9.9%. The research of this study shows that the ultrasound examination technique for patients with acute obstetrics and gynaecology is simple, fast, non-invasive, and has high accuracy. Ultrasound imaging can provide reliable objective evidence for the diagnosis and differential diagnosis of most acute abdominal diseases, in order to improve the diagnosis rate and reduce the misdiagnosis rate.

A Probe into Application Value of Ultrasonography in Clinical Diagnosis of Gynecologic Acute Abdomen

This paper aims to observe and analyze application value of ultrasonography in clinical diagnosis of gynecologic acute abdomen. The 180 cases of gynecologic acute abdomen were selected as the subjects. All the cases were examined by ultrasonography. The results of ultrasonography were compared with those of clinical diagnosis and then application effect and practical value of ultrasonography were analyzed. Among the 180 patients, ultrasonography revealed 80 cases, 6 cases, 4 cases, 10 cases, 12 cases, 40 cases, 24 cases of ectopic pregnancy, corpus luteum rupture, ovarian tumor torsion, acute uterine perforation, acute pelvic inflammatory disease, placenta previa and miscarriage, respectively. 176 cases were detected by ultrasonography, with coincidence rate of 97.78 % compared to results of clinical examination. Ultrasonography is of great application value for gynecologic acute abdomen. During operation, ultrasonography is convenient and non-invasive, safe and reliable. It features high coincidence rate in examination, worthy of promotion in practice.https://sekabet.fun/https://asyabahis.fun/https://asyabahis.xyz/https://tipobet.fun/https://olabahis.fun/https://betist.fun/