Correlation of plasma osteopontin and neutrophil gelatinase-associated lipocalin levels with the severity and clinical outcome of pelvic inflammatory disease

Pelvic inflammatory disease in the adolescent and young adult: An update

Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).

Protective effects of Asiatic acid against pelvic inflammatory disease in rats

Asiatic acid (AA) is one of the major components of the Chinese herb Centella asiatica and exerts a variety of pharmacological activities. However, the pharmacological effects of AA on pelvic inflammatory disease (PID) remain unknown. The purpose of the present study was to investigate the therapeutic efficacy and potential mechanisms of AA on PID in rats. A total of 75 female Sprague Dawley rats were randomly divided into the following five groups: A control group; a PID group; a PID + AA 5 mg/kg group; a PID + AA 35 mg/kg group; and a PID + AA 75 mg/kg group. Changes in cytokine and chemokine levels, myeloperoxidase (MPO) activity, nucleotide-binding domain-like receptor protein 3 (NLRP3) inflammasome and nuclear factor-κB (NF-κB) activation, oxidative stress and cleaved caspase-3 were measured. AA treatment significantly decreased the excessive production of cytokines and chemokines and suppressed MPO activity and the activation of NLRP3 inflammasome, NF-κB and caspase-3, as well as oxidative stress. These results suggest that AA exhibits potent anti-inflammatory and antioxidant effects in rats with pathogen-induced PID and that the mechanism of these anti-inflammatory effects may be associated with the suppression of NLRP3 inflammasome activation and the NF-κB pathway.

Middlemore Hospital experience with tubo-ovarian abscesses: an observational retrospective study

AIM

The aim of this paper was to study the characteristics of patients presenting to Middlemore Hospital with tubo-ovarian abscess (TOA) and to compare the outcomes of conservative medical management versus medical management with surgical drainage and medical management with radiological drainage.

METHODS

All patients admitted with a radiologically or surgically proven TOA between January 01, 2008 and December 31, 2010, were included and followed up until June 30, 2011. The total number of patient/index admission was 174.

RESULTS

The mean age of patients was 37.8 years. One hundred thirty patients had medical treatment only with hospitalization and antibiotics, and 44 patients were managed with antibiotics and surgical drainage. Complete resolution of TOA was 77.3% (99/128) for patients managed medically and 93.2% (41/44) for patients managed surgically. When the two groups were compared, patients who were managed surgically were more likely to have complete resolution of TOA within 6 months of index admission with an odds ratio (OR) of 4 and a P-value of 0.029. There was no statistically significant difference in the secondary outcomes namely of readmission with TOA (OR: 0.47) and the need for repeat surgical or radiological drainage (OR: 1.48). Nonetheless, the relative duration of hospitalization was longer for the surgical group with a P-value of <0.0001. The C-reactive protein and the size of TOA were the significant factors involved in the resolution of TOA.

CONCLUSION

The results of this study confirmed our initial hypothesis that we should consider surgical drainage more often, probably earlier, especially for the younger patients still desiring fertility preservation and for larger abscesses. Laparoscopic surgical drainage is safe and could be used as the procedure of choice. Conservative medical management is still acceptable with good cure rates of 77%. C-reactive protein and the size of the abscess were the important factors to consider when managing patients with TOA.

Neutrophil gelatinase-associated lipocalin and innate immune responses to bacterial infections

Neutrophil gelatinase-associated lipocalin (NGAL), an essential component of the antimicrobial innate immune system, is present in neutrophils and multiple other tissues. It prevents iron acquisition by microorganisms by sequestering iron-loaded bacterial siderophores. NGAL also modulates neutrophil functions. Its production is inducible following Toll-like receptor 4 activation and release of pro-inflammatory cytokines. NGAL is employed clinically in the diagnosis of acute kidney injury and may be useful in general in the differential diagnosis of a bacterial-mediated infectious process. Elevated levels of NGAL have been detected in the blood of patients with bacterial urinary tract infection, community-acquired pneumonia, sepsis, as well as in the cerebrospinal fluid and peritoneal fluid of patients with bacterial meningitis and peritonitis. Some bacteria have developed resistance to NGAL-mediated iron sequestration by production of modified siderophores that are not recognized by NGAL.