Medicine and Pharmacology

Abstract: Recent advances in artificial intelligence (AI), especially machine learning (ML), deep learning (DL), natural language processing (NLP) and computer vision have rapidly impacted obstetric care. Key applications include automated ultrasound interpretation (biometry, anomaly detection), AI-enhanced fetal monitoring (cardiotocography), risk stratification (preeclampsia, preterm birth, hemorrhage), labor management (delivery mode prediction), genomic screening (NIPT interpretation), and remote/telehealth tools for monitoring especially in underserved areas. For example, DL models now attain accuracy comparable to experts for fetal ultrasound biometry[1], and FDA-cleared AI tools have achieved >97% detection of congenital heart defects during prenatal screening[2]. However, clinical readiness varies: some technologies (e.g. ultrasound AI tools) are already FDA-cleared[2,3], whereas others remain at proof-of-concept. Across studies, performance metrics (AUC, R2, accuracy) are generally high (often >0.85) but depend on data quality and label definitions[4,5]. Crucial issues include dataset biases, lack of standardization, explainability, and regulatory oversight. This review synthesizes AI technologies, applications, validation (metrics, datasets), deployment (trials, approval, integration), and ethical considerations, and identifies knowledge gaps. Overall, AI shows promise to improve prenatal diagnosis and individualized care, but requires rigorous validation, transparent algorithms, and clinician oversight to ensure safety, equity and trust.

Abstract: Background: Vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection are among the most frequent infectious conditions encountered in gynecological practice and are commonly associated with substantial impairment in quality of life, sexual health, emotional well-being, and daily functioning. Dequalinium chloride is a locally administered broad-spectrum anti-infective agent with activity against bacterial and fungal pathogens; however, longitudinal real-world data integrating clinical, physiological, and fresh microscopic evolution across heterogeneous infectious phenotypes remain limited, particularly in Latin American populations Objectives: To evaluate the longitudinal clinical, physiological, and fresh microscopic evolution associated with intravaginal dequalinium chloride therapy in women with vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection during routine gynecological practice. Methods: A retrospective longitudinal real-world study was conducted in non-pregnant women diagnosed with vulvovaginal candidiasis, bacterial vaginosis, or mixed vaginal infection who received intravaginal dequalinium chloride therapy. Patients were evaluated at baseline, treatment completion, and post-treatment follow-up. Longitudinal assessment integrated patient-reported symptoms, physician-assessed gynecological findings, vaginal pH, and direct fresh wet-mount microscopic examination. Exploratory integrated clinical–microscopic assessment frameworks were used to characterize multidimensional longitudinal therapeutic evolution. Repeated-measures non-parametric analyses were performed across follow-up evaluations. Results: A total of 69 women were included in the final longitudinal analysis, including vulvovaginal candidiasis (n = 24), bacterial vaginosis (n = 31), and mixed vaginal infection (n = 14). Significant longitudinal improvement was observed across all evaluated clinical, physiological, and fresh microscopic domains throughout follow-up (all p < 0.0001). Median integrated clinical–microscopic assessment values decreased from 8 (IQR 6–10) at baseline to 3 (IQR 1–5) at treatment completion and to 1 (IQR 0–3) during post-treatment follow-up. Progressive normalization of vaginal pH occurred concomitantly with reduction of inflammatory-suggestive microscopic findings, improvement of infectious microscopic markers, and partial restoration of Döderlein bacillary predominance. Patients with mixed vaginal infection demonstrated the greatest baseline multidimensional disease burden but also exhibited substantial longitudinal improvement throughout follow-up. Clinically meaningful longitudinal therapeutic response was observed in 95.7% of patients at treatment completion and in 100% during post-treatment evaluation. Intravaginal dequalinium chloride demonstrated favorable overall tolerability, with only mild transient adverse events reported and no severe treatment-related complications identified Conclusions: Intravaginal dequalinium chloride therapy was associated with consistent longitudinal clinical, physiological, and fresh microscopic improvement across women with vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection in a real-world gynecological setting. The observed concordance between clinical symptom improvement, vaginal physiological normalization, and objective fresh microscopic evolution supports the potential clinical utility of dequalinium chloride as a locally administered therapeutic approach in heterogeneous vulvovaginal infectious disorders. Larger prospective controlled studies incorporating molecular microbiological evaluation and longer-term follow-up remain necessary to further validate these findings.

Abstract: Background: The incidence of placenta accreta spectrum (PAS) with placenta previa has been previously reported. However, the incidence varies across reports, suggesting that unknown risk factors may be involved. This study aimed to reevaluate the risk of PAS in patients with placenta previa. Methods: This multicenter retrospective study was conducted from 2015 to 2024 in patients with placenta previa who underwent cesarean section (CS). PAS was defined based on pathological or clinical findings, such as manual removal of the placenta or obvious retention of the placenta if a hysterectomy was not performed. The incidence of PAS and associated risk factors were analyzed using multivariable logistic regression. Results: PAS was observed in 26% of women with placenta previa. The incidence of PAS increased significantly with the number of prior CSs: 13.2% in women with no prior CS, 41.9% in those with one prior CS, and 66.7% in those with two or more prior cesarean sections. Multivariate analysis identified major placenta previa (aOR 2.69, 95% CI 1.11–6.54), including complete and partial placenta previa, and number of prior CSs (one prior: aOR 4.35, 95% CI 1.94-9.73; two or more prior: aOR 9.48, 95% CI 2.55-35.2) as independent risk factors. Conclusions: The incidence of PAS with placenta previa was higher than that previously reported, and major placenta previa was shown to be an independent risk factor, regardless of prior CS history. Comprehensive evaluation, including prior CS and placenta previa classification, is crucial for accurate risk stratification and perinatal management.

Abstract: Pregnancy involves profound metabolic, hormonal, and immunological adaptations essential for fetal development; however, disturbances may lead to complications such as preeclampsia (PE), pre-gestational diabetes, and gestational diabetes mellitus (GDM). These conditions are closely linked to oxidative stress, inflammation, endothelial dysfunction, impaired placentation, and metabolic dysregulation. Consequently, dietary strategies capable of modulating these pathways are of increasing interest. Edible and medicinal mushrooms have emerged as functional foods rich in bioactive compounds with antioxidant, anti-inflammatory, immunomodulatory, and metabolic regulatory effects. This review summarizes the nutritional composition of mushrooms and highlights key bioactive constituents, such as ergothioneine, which may influence redox balance, immune responses, glucose metabolism, endothelial function, and placental development. Experimental evidence suggests that these compounds modulate pathways involved in PE and GDM pathogenesis. Mushroom consumption has additionally been associated with improved glycemic control, enhanced antioxidant defenses, and reduced risk of hypertensive and metabolic pregnancy complications. Although preclinical findings are promising, clinical evidence remains limited. Further well-designed prospective studies and randomized controlled trials are required to determine efficacy, safety, optimal intake, and active compounds responsible for these effects. Nevertheless, current evidence supports edible and medicinal mushrooms as potential dietary modulators of key mechanisms involved in PE and GDM, with relevance for improving maternal-fetal health outcomes.

Abstract: Stress urinary incontinence (SUI) is conventionally viewed as a peripheral mechanical disorder, but the growing evidence has highlighted the significant psychological burden. This kind of narrative integrative review has examined SUI through a chronic stress framework and this has linked clinical outcomes with epigenetic and neuroendocrine mechanisms. Evidence has suggested that SUI-related experiences can activate the HPA axis and contribute to allostatic load, and might also induce an epigenetic alteration in stress-related genes such as FKBP5 and NR3C1. These are linked with consistent effective symptoms even after the treatment. In addition to this, the review has highlighted the important function of anticipatory anxiety, behavioural avoidance, and social evaluative threat in the sustenance of chronic stress exposure among individuals who have SUI. These psychosocial mechanisms have interacted dynamically with other biological processes, and it has reinforced a feedback loop which has contributed to psychological vulnerability and persistence. The evidence has highlighted the heterogeneity of patient outcomes, and it has suggested the presence of distinctive vulnerability and resilience profiles which are shaped by individualistic differences in the responsivity to stress and coping strategies. Collectively, this thorough integrative perspective has highlighted the requirement of moving beyond solely biomedical models towards a more interdisciplinary approach that can incorporate biological and psychological assessment. Such a framework has crucial implications for targeted interventions, early identification, and the development of more exhaustive management strategies for SUI. This review has proposed a stress-epigenetic model which integrates psychosocial and biological pathways, thereby offering new types of insights into SUI as a condition with translational and systemic relevance to psychiatry.

Abstract: Background/Objectives: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine-metabolic disorder, and Rotterdam-defined phenotypes may require more refined non-invasive adjunctive signals for phenotypic stratification. Saliva is a practical diagnostic matrix, but genus-level qPCR findings must be interpreted cautiously. This study evaluated whether salivary qPCR signals for Lactobacillus, Prevotella, and Bifidobacterium differ across Rotterdam-defined PCOS phenotypes and controls, with emphasis on the exploratory diagnostic relevance of Prevotella. Methods: This cross-sectional study included 110 women: 87 with PCOS and 23 controls. PCOS phenotypes were classified according to the Rotterdam criteria. Salivary microbial targets were assessed using SYBR Green-based genus-specific qPCR on a MyGo Mini S platform. Because the available standard-curve outputs did not support robust absolute CFU/mL conversion across all targets, inferential analyses were reported using Cq-based microbial signals; lower Cq values indicate higher target DNA signal. Group differences were evaluated using non-parametric tests, followed by Bonferroni-corrected post-hoc comparisons. Exploratory ROC and correlation analyses were retained only as hypothesis-generating diagnostic adjunct analyses. Results: Prevotella Cq values differed significantly across groups (p < 0.001), with lower median Cq values in selected hyperandrogenic and PCOM-related PCOS phenotypes compared with phenotype D and controls. Lactobacillus Cq values did not differ significantly across groups (p = 0.249), whereas Bifidobacterium showed an overall between-group difference (p < 0.001) with a less consistent post-hoc pattern. Among women with PCOS, Prevotella Cq values were associated with Ferriman-Gallwey score and polycystic ovarian morphology. Conclusions: Salivary Prevotella showed the clearest exploratory genus-level qPCR signal across Rotterdam-defined PCOS phenotypes. The findings support further evaluation of saliva-based microbial profiling as a non-invasive diagnostic adjunct for PCOS phenotype stratification, but they do not establish Prevotella as a validated standalone diagnostic biomarker or absolute bacterial load estimate.

Abstract: Background: Endometriosis is a chronic inflammatory disease commonly associated with pelvic pain and infertility. Increasing evidence suggests that women with endometriosis may also experience lower urinary tract symptoms (LUTS), even without direct urinary tract involvement. Aim: This study aimed to evaluate LUTS in women with endometriosis and determine whether these symptoms are associated with urethral ultrasonographic parameters or the localization of endometriotic lesions. Materials and Methods: This prospective case–control study included 166 women aged 17–49 years: 83 with confirmed endometriosis and 83 controls without endometriosis. Endometriosis was confirmed laparoscopically, except in patients with cesarean scar endometriosis, where diagnosis was based on imaging and histopathological confirmation. Clinical assessment included standardized questionnaires and transvaginal pelvic floor sonography. Urinary symptoms were assessed using the Urogenital Distress Inventory short form (UDI-6). Urethral length and mobility were evaluated at rest, during contraction, and during the Valsalva maneuver. Results: Women with endometriosis demonstrated significantly higher total UDI scores than controls (27.8 vs. 16.7; p = 0.002), with the greatest differences in pain/discomfort and urine leakage symptoms. No significant differences in urethral anatomy were observed. Among symptomatic patients, urethral mobility during Valsalva was significantly lower in the endometriosis group (p = 0.041). Lesion localization was not associated with symptom severity. Conclusions: Women with endometriosis experience a greater burden of LUTS, particularly bladder storage dysfunction and pain, likely related to functional and neuroinflammatory mechanisms rather than structural abnormalities.

Abstract: We report a rare case of simultaneous well-differentiated papillary mesothelial tumor (WDPMT) and multicystic mesothelioma. The concurrent occurrence of these entities is exceptionally uncommon and may pose challenges during surgical intervention. Both tumors are variants of epithelioid mesothelioma and are most frequently identified incidentally during surgical procedures. A 41-year-old patient was admitted for laparoscopic surgery due to a left adnexal mass. Ultrasound examination revealed a 5 cm lesion adjacent to the left ovary, exhibiting central vascularization. Intraoperatively, the mass appeared as a solid, soft, and nodular tumor. Frozen section analysis confirmed the diagnosis of WDPMT involving the left adnexa. Recognition of well-differentiated papillary mesothelial tumor and multicystic mesothelioma is critical for accurate differential diagnosis from malignant mesothelioma. Awareness of these entities informs appropriate surgical management and follow-up protocols.

Abstract: Background/Objectives: Electromagnetic pelvic floor stimulation is an emerging non-invasive treatment for urinary incontinence (UI), yet direct comparisons between devices of differing magnetic field strengths are lacking. This quality improvement study compared the clinical effectiveness of a 3 Tesla and an 8 Tesla electromagnetic device for the treatment of stress and mixed UI. Methods: In this prospective, single-blinded comparative quality improvement study with randomized allocation, 103 women (aged 35–77) with stress or mixed UI were randomly allocated to treatment with either a 3 Tesla device (Chair A, n = 52) or an 8 Tesla device (Chair B, n = 51). Each participant received six sessions over three weeks. Symptoms were assessed using a modified International Consultation on Incontinence Questionnaire (ICIQ) instrument at baseline, after each session, and at 2- and 4-week follow-up. Statistical analysis was performed independently by a biostatistician using SPSS v30. Results: Both devices produced statistically significant within-group improvements across all ICIQ domains (p < 0.001 to p < 0.05). Chair B demonstrated earlier onset of significant improvement (after 2 sessions vs. 3 sessions for Chair A) and significantly greater reduction in leakage frequency at 4-week follow-up (mean 1.02 ± 0.96 vs. 1.54 ± 1.19; p = 0.020; Cohen’s d = 0.48). One minor, self-limited adverse event was reported (transient low back pain, Chair A group). Conclusions: Both electromagnetic devices effectively reduced UI symptoms. The 8 Tesla device showed faster onset and greater sustained symptom reduction at 4 weeks, suggesting that higher magnetic field strength may enhance clinical outcomes for pelvic floor rehabilitation. Findings are reported in alignment with SQUIRE 2.0 guidelines for quality improvement research.

Abstract: Obesity is a multifactorial condition that profoundly affects female reproductive health through endocrine, metabolic, and inflammatory mechanisms that disrupt the hypothalamic–pituitary–gonadal (HPG) axis. Women with obesity frequently develop menstrual irregularities, anovulation, amenorrhea, infertility, polycystic ovary syndrome (PCOS), impaired endometrial receptivity, and adverse pregnancy outcomes. Central obesity and insulin resistance contribute to hyperinsulinemia, reduced sex hormone-binding globulin (SHBG) levels, hyperandrogenism, altered gonadotropin secretion, and impaired folliculogenesis, while adipokines such as leptin and chronic inflammation further impair ovarian steroidogenesis and ovulatory function. Obesity-related oxidative stress and lipotoxicity also negatively affect oocyte quality, embryo development, implantation, and assisted reproductive technology outcomes, increasing the risk of gestational diabetes, preeclampsia, miscarriage, and preterm birth. This review evaluates the therapeutic potential of pharmacological weight-loss therapies in obesity-associated female reproductive dysfunction. A comprehensive literature review was conducted using Medline, and Google Scholar, focusing on obesity, infertility, fertility, and anti-obesity pharmacotherapy in reproductive-aged women. Evidence suggests that several FDA-approved and off-label anti-obesity agents, including orlistat, liraglutide, semaglutide, phentermine/topiramate, bupropion/ naltrexone, metformin, exenatide, and tirzepatide, may improve reproductive outcomes primarily through weight reduction and metabolic improvement. GLP-1 receptor agonists, particularly liraglutide, semaglutide, and exenatide, appear especially promising, demonstrating beneficial effects on insulin sensitivity, menstrual regularity, ovulation, androgen levels, and pregnancy rates in women with PCOS. Tirzepatide, a dual GLP-1/GIP receptor agonist, has shown potent weight-loss and metabolic effects with potential indirect fertility benefits. Metformin improves insulin sensitivity and is widely used in PCOS to regulate androgen levels and restore ovulation, although its effects on pregnancy and live birth rates remain controversial. However, evidence for several agents remains limited, and concerns persist regarding reproductive safety during pregnancy. Overall, anti-obesity pharmacotherapy may represent an important adjunctive strategy for improving reproductive and metabolic health in women with obesity, although larger randomized clinical trials are still required.

Abstract: Background/Objectives: Abnormal vaginal discharge (AVD) is a common complaint among women of reproductive age often involving multiple, overlapping etiologies, most commonly bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), aerobic vaginitis (AV), and sexually transmitted infections (STIs). We aimed to evaluate a syndromic diagnostic approach by developing qPCR-derived dysbiosis indices for BV, VVC, and AV, subsequently comparing their performance against established reference methods and clinician-assigned diagnoses. Methods: Vaginal swabs were collected in a case-control design from 74 symptomatic and 64 asymptomatic women at two clinics in Slovenia. Commercial qPCR assays quantified microbial species associated with AVD. Relative abundances were integrated into novel dysbiosis indices. Diagnostic performance was validated against Nugent scoring (BV), semiquantitative Candida culture with clinical symptoms (VVC), and Hay–Ison criteria (AV). Results: The dysbiosis indices demonstrated significantly higher agreement with their respective reference tests compared to clinician-assigned diagnoses across all three conditions. The syndromic approach further revealed that mixed etiologies were frequent, providing diagnostic resolution for this patient subset. Conclusions: qPCR-based microbial dysbiosis indices offer a robust alternative to microscopy, particularly in settings where microscopy is not routinely performed. This syndromic testing improves the accuracy of AVD evaluation and supports more targeted clinical management.

Abstract: Embryo implantation is a highly regulated, multistep process requiring precise synchronization between a developmentally competent blastocyst and a receptive endometrium. This article outlines the fundamental stages of implantation (apposition, adhesion, and invasion) and highlights the molecular, cellular, and immunological mechanisms underlying successful embryo–endometrial interaction. Uterine receptivity, occurring during the temporally restricted window of implantation, is governed by hormonal regulation and coordinated gene expression, and its disruption represents a key factor in infertility and recurrent implantation failure (RIF). The article further examines the multifactorial etiology of implantation failure, including genetic abnormalities, maternal age, lifestyle influences, immunological imbalance, uterine pathology, and chronic endometrial conditions. Current and emerging therapeutic strategies in assisted reproductive technology (ART) are critically reviewed, with emphasis on their efficacy and limitations. In addition, the paper explores innovative technologies aimed at improving implantation outcomes, including time-lapse imaging, artificial intelligence-based embryo selection, and transcriptomic tools such as endometrial receptivity analysis. Advanced experimental models, particularly microfluidic “womb-on-a-chip” systems and three-dimensional in vitro embryo–endometrial platforms, are highlighted as transformative tools for studying implantation dynamics and enabling personalized therapeutic approaches. Collectively, these advances offer promising avenues for improving reproductive outcomes, although further research and standardization are required to translate these innovations into routine clinical practice.

Abstract: The human placenta, a transient but vital organ, governs fetal development and maternal-fetal interactions, yet its study has been stymied by ethical and accessibility constraints. Stem cell biology has now revolutionized the capacity to model human placental development, in particular with the derivation of human trophoblast stem cells (hTSCs) and organoids. Classically, hTSCs have been derived from pluripotent stem cells (PSCs) such as ESCs or iPSCs, which, under defined culture signals, can be directed into trophoblast lineages by manipulation of master regulatory pathways including GATA3, TFAP2C, and BMP4. However, a quantum leap has come with pluripotency-independent reprogramming, where somatic cells (e.g., fibroblasts) are reprogrammed directly into hTSCs. By bypassing the pluripotent stage with these specific transcription factors and trophoblast-supporting conditions, this approach enhances the efficiency, safety, and disease modeling potential of hTSC derivation. An important advance underlying these improvements is the mapping of a global reprogramming roadmap. Multi-omic and lineage-tracing experiments have mapped the stepwise transcriptional and epigenetic conversions of fibroblasts to hTSCs, including sequential chromatin reconfiguration, trophoblast gene network activation, and repression of somatic signatures. These results identify major regulatory bottlenecks and intermediate states, improving reprogramming fidelity. The derivation of stem-cell-based trophoblast organoids now enables complex modeling of placental architecture, function, and disease susceptibility in vitro. These organoids accurately recapitulate placental barrier functions and immunological features, allowing for examinations of maternal-fetal health, pregnancy disorders, and placental infection response to viruses like cytomegalovirus and SARS-CoV-2. Looking ahead, the integration of reprogramming and organoid technologies will propel patient-specific and tailor-made models for personalized diagnostics, drug screening, and mechanism studies. As we unravel the molecular ballet of trophoblast induction, such discoveries have the potential to bridge basic translational gaps in reproductive biology and maternal-fetal medicine.

Abstract: Cesarean section (CS) rates have been steadily increasing worldwide beyond medical needs. Globally, CS rates have surpassed the World Health Organization's recommended 10–15% range, with potential implications for maternal and neonatal health. The first mode of delivery influences future pregnancies. This study aimed to determine the prevalence, indications, and immediate fetal and maternal outcomes of cesarean section among primigravida women delivered at Bugando Medical Centre (BMC), Mwanza, Tanzania, from January 2022 to 2025. A retrospective cross-sectional study reviewed the medical records of 868 primigravida women who underwent CS during the study period. Data was extracted from the Electronic Health Management System and analyzed using descriptive statistics and inferential tests in SPSS version 26. The prevalence of CS among primigravida deliveries was 25% (868/3,515). Most women were aged 20–34 years (87.3%), delivered at term (83.9%), and underwent emergency CS (94.6%). The leading maternal indication was prolonged/obstructed/poor progress of labor (63.4%), while fetal indications included fetal distress/non-reassuring fetal status (14.2%). Maternal outcomes showed no complications in 75.7% of cases, with PPH (12.7%) as the most common issue. Neonatal outcomes included normal birth weight in 86.0%, NICU admission in 15.8% (primarily due to respiratory distress syndrome [37%]). Prevalence of CS in primigravida at BMC is higher than WHO range, mainly driven by labor-related maternal indications. No immediate complications to mother and child highlight the safe nature of CS.

Abstract: Objective: To evaluate the efficacy of a black raspberry extract-containing composite gel in treating persistent cervical high-risk human papillomavirus (hrHPV) infection and to analyze the clinical factors influencing treatment outcomes, with the goal of informing precision treatment strategies for this population.Methods: This was a prospective cohort study that enrolled 161 patients with persistent hrHPV infection. Participants received vaginal applications of a black raspberry gel every other day (discontinued during menstruation) for three consecutive months, followed by a three-month off-treatment period before re-examination. The primary efficacy endpoint was the viral clearance rate, defined as the clearance of any high-risk HPV subtype that was positive at baseline. Univariate analysis was performed to evaluate the correlation between clinical characteristics and efficacy. Additionally, data from 121 contemporaneous patients who received other treatments were retrospectively collected, and after propensity score matching, the efficacy was compared between the two groups.Results: The response rate among 161 patients who received black raspberry gel intervention was 50.9% (82/161). Univariate analysis showed that significantly higher response rates were observed in younger patients (P=0.011) and those who were premenopausal (P=0.003). Patients with multiple HPV infections had a significantly higher response rate compared to those with single infections (P=0.043). The clearance rates for HPV16 and HPV18 were 66.7% and 70.0%, respectively. No serious adverse events were reported during the intervention period. After propensity score matching, 99 patients were matched in the black raspberry gel group and 99 in the concurrent alternative treatment group. The response rate in the black raspberry gel group (57.6%, 57/99) was non-inferior to that in the concurrent alternative treatment group (55.6%, 55/99). Subtype analysis revealed that the black raspberry gel achieved a significantly higher clearance rate for hrHPV types 16, 18, 33, 39, 51, and 59 compared to the concurrent alternative treatment group (61.5% vs. 31.3%, P=0.011). For hrHPV types 52, 53, 58, and 68, the overall clearance rate was comparable between the black raspberry gel group and the concurrent alternative treatment group (51.0% vs. 50.0%, P=1.000). However, for hrHPV types 31, 35, 56, 66, and 73, the overall clearance rate was significantly lower in the black raspberry gel group than in the concurrent alternative treatment group (39.1% vs. 69.6%, P=0.038).Conclusion: The black raspberry extract-containing composite gel demonstrated a favorable safety profile and certain clinical efficacy in patients with persistent hrHPV infection, particularly showing enhanced effectiveness in younger, premenopausal women and exhibiting potential advantages in clearing high-risk subtypes such as HPV16/18. This study provides new real-world evidence for topical pharmacotherapy in persistent hrHPV infection and offers a preliminary theoretical basis for developing individualized, subtype-specific precision intervention strategies in the future.

Abstract: The role of human leukocyte antigen F (HLA-F) at the maternal-fetal interface (MFI) during viral infection and its regulation by interferon signaling remains poorly understood. Here, we investigated HLA-F expression and regulation in first-trimester trophoblast cells following activation of the type I interferon pathway and viral infection. We demonstrate that HLA-F is significantly upregulated at both mRNA and protein levels in response to Poly(I:C) and IFN-β in a dose- and time-dependent manner, suggesting its regulation as an interferon-stimulated gene (ISG). Zika virus (ZIKV) infection similarly induced HLA-F upregulation over time. In contrast, HSV-2 infection downregulated HLA-F mRNA while maintaining steady protein levels, indicative of virus-specific regulatory mechanisms. Moreover, we identified a soluble HLA-F secreted following Poly(I:C) stimulation. These findings reveal that HLA-F is dynamically regulated in trophoblasts during viral challenge and type I IFN signaling activation, supporting its broader immunomodulatory role in antiviral defense and immune tolerance at the MFI.

Abstract: Background: Cervical cancer is the fourth most common cancer among women globally, with the highest burden in low- and middle-income countries. Limited access to screening and treatment contributes to high mortality, despite effective screening methods like HPV testing and cervical cytology. Objectives: To establish the degree of correlation between cervical cytology, colposcopy, and histological features among patients with abnormal cytological smears seen at Nelson Mandela Academic Hospital and MthathaRegional Hospital. Methods: This was an analytical cross-sectional study conducted from June 1, 2024, to June 30, 2025. Two hundred twenty-five participants were enrolled through a convenience sampling method. Demographic and clinical data were collected using a structured questionnaire. Categorical data were expressed as frequencies and proportions, and continuous data were summarized into means ± SD or medians (IQR). X² was used to determine the correlation, and a p-value of <0.05 was significant. Results: The mean age was of the participants was 45.5 years, with 72% being HIV positive. Most cytology results showed high-grade squamous intraepithelial lesions (HSIL). Colposcopy classified 77% of participants as CIN II or III. Both cytology and colposcopy correlated positively with histology p< 0.05. Cytology showed 92% sensitivity and 33% specificity for detecting CIN 2+ lesions, while colposcopy had 87.4% sensitivity and 49% specificity. Micro-invasive cervical cancer was prevalent in 4% of the participants and was associated with age ≥ 50 years and treatment delay of > 4months. Conclusion: Both colposcopy and cytology demonstrated good sensitivity but poor specificity for the diagnosis of CIN 2 or higher dysplastic lesions of the cervix. Early colposcopic evaluation and treatment of women with HSIL can help prevent incident cervical cancer.

Abstract: Background: Pregnancy-related transient osteoporosis of the hip (PR-TOH) is a rare and often underdiagnosed condition presenting with acute hip pain in late pregnancy or postpartum. Due to its nonspecific clinical presentation, it is frequently misinterpreted as common musculoskeletal or pelvic girdle pain, leading to delayed diagnosis and suboptimal management. Case Presentation: We report a rare case of bilateral PR-TOH in a 35-year-old primigravida diagnosed at 31+6 weeks of gestation. The patient presented with progressively worsening hip pain leading to severe mobility impairment. Initial investigations, including ultrasound and laboratory testing, were inconclusive. Definitive diagnosis was established by magnetic resonance imaging (MRI), demonstrating characteristic bone marrow oedema in both femoral heads. The patient was managed conservatively with analgesia, restricted weight bearing, and multidisciplinary care involving obstetrics, endocrinology, and orthopaedics. Pregnancy was successfully prolonged until 37+4 weeks, when caesarean section was performed due to clinical deterioration. Postpartum management included calcium and vitamin D supplementation and rehabilitation. Follow-up demonstrated significant improvement in bone mineral density on DEXA and complete clinical recovery at 12 months. Conclusions: PR-TOH should be considered in pregnant or postpartum women presenting with persistent hip pain and progressive functional limitation. Early use of MRI is essential for accurate diagnosis and differentiation from more common pregnancy-related conditions. Prompt recognition and multidisciplinary management are crucial to prevent complications and optimize maternal and obstetric outcomes.

Abstract: Background/Objectives: Clinical management of uterine fibroids in the context of infertility is characterised by significant heterogeneity. The aim of our study was to record the participants’ views and clinical practices regarding minimally invasive, fertility-sparing management of fibroids, focusing on fertility outcomes. Methods: Online survey distributed to members of the European Society of Gynecology (ESG), using a questionnaire comprising 27 questions. Questions 1 to 5 related to the participants’ background, while questions 6 to 27 related to the clinical management of fibroids. Results: 98 participants completed the survey, 83% (n=82) of which practice in European countries. 43% (n=42) had completed specialist training in minimally invasive gynecological surgery. For FIGO 0–II fibroids, 94% of participants recommended hysteroscopic removal in infertile patients. 50% may use anti-adhesion agents after hysteroscopic removal of FIGO 0–II fibroids. For FIGO III fibroids, 57% of participants (n=56) believe they have a detrimental impact on fertility while, for FIGO IV fibroids, 51% (n=50) believe the same. 48% of participants (n=49) stated that the distance between the inner portion of an intramural, non-cavity distorting fibroid and the junctional zone does not affect their decision for removal in infertile patients, and 51% (n=50) stated that it does, with variable cut-off values given. The majority of participants favour minimal access approaches over traditional laparotomy; however, the use of robot-assisted laparoscopy was limited. Conclusions: Our results confirm the significant variation in clinical practice associated with fibroid management and underline the need for standardised care, based on high-quality evidence.

Abstract: Introduction: Ovarian cancer remains the most lethal gynecological malignancy worldwide, primarily due to late-stage diagnosis, extensive molecular heterogeneity, and the development of therapeutic resistance. Although advances in cytoreductive surgery and platinum-based chemotherapy have improved short-term disease control, durable long-term survival improvements remain modest, particularly in patients with recurrent or platinum-resistant disease. Rapid progress in molecular profiling, targeted therapeutics, and artificial intelligence–based diagnostic tools has transformed the understanding and management of ovarian cancer. However, translating these scientific advances into consistent clinical benefit remains challenging due to therapeutic resistance, limited validation of emerging biomarkers, and disparities in access to precision oncology. Methods: This narrative review synthesizes current evidence from peer-reviewed clinical trials, translational studies, and systematic reviews examining molecular pathogenesis, early detection strategies, and therapeutic developments in ovarian cancer. Literature was identified through structured searches of major biomedical databases, focusing on studies evaluating molecular biomarkers, artificial intelligence–driven diagnostic approaches, targeted therapies—including poly (ADP-ribose) polymerase inhibitors and anti-angiogenic agents—and emerging treatment modalities such as immunotherapy, antibody–drug conjugates, and cellular therapies. Particular emphasis was placed on identifying conflicting findings, methodological limitations, and translational barriers affecting clinical implementation. Results: Advances in genomic and molecular characterization have established ovarian cancer as a biologically heterogeneous disease comprising multiple histological and molecular subtypes with distinct clinical behavior and therapeutic responsiveness. Targeted therapies, particularly PARP inhibitors, have significantly improved progression-free survival in patients with homologous recombination deficiency; however, long-term efficacy is frequently limited by acquired resistance mechanisms, including restoration of homologous recombination function and activation of alternative DNA repair pathways. Emerging diagnostic technologies—including circulating tumor DNA, multi-omics biomarker panels, and artificial intelligence–based predictive models—demonstrate promising diagnostic accuracy for early-stage disease detection. Nevertheless, many of these technologies remain in early clinical development and require large-scale prospective validation before routine adoption in clinical practice. Discussion: Despite substantial scientific progress, several translational gaps continue to limit the real-world impact of precision oncology in ovarian cancer. Variability in biomarker performance across populations, heterogeneity in study design, and reliance on retrospective datasets complicate interpretation of current evidence. In addition, the relatively modest response rates observed with immunotherapy highlight the importance of understanding tumor immune evasion mechanisms and optimizing combination treatment strategies. Emerging therapies, including antibody–drug conjugates and chimeric antigen receptor T-cell therapies, show encouraging early clinical activity but remain under active investigation. Addressing these challenges will require interdisciplinary collaboration, standardized biomarker validation frameworks, and integration of computational tools into routine clinical workflows. Conclusion: Ovarian cancer management is undergoing a paradigm shift toward precision oncology driven by advances in molecular biology, biomarker discovery, and targeted therapeutics. However, durable improvements in survival will depend on overcoming therapeutic resistance, validating early detection strategies in diverse populations, and ensuring equitable access to advanced diagnostics and personalized treatments. Future research should prioritize prospective validation of emerging technologies, development of biomarker-guided treatment strategies, and translation of scientific innovation into sustainable clinical outcomes.