Updates in the Diagnosis of Gestational Trophoblast Disease

GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis of the pathology results in inadequate classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to point out updated national and international practice protocols of diagnosis of GTD, through an integrative review. Seven articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized (usually one month for Partial Hydatidiform Mole six months for Complete Hydatidiform Mole and one year for Gestational Trophoblastic Neoplasia). Unfortunately, regarding the diagnosis of MH, the guidelines of some countries show the absence or difficulty of access to the karyotype test and ploid p57 or pelvic ultrasound accompanying the uterine curettage, contrary to what is proposed by the IFGO guideline. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of recurrence, morbidity and mortality, especially in less developed countries.

Management of Gestational Trophoblast Disease: A Review Integrative National and International Guidelines

GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis and treatment of the aforementioned pathology results in inadequate risk classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to compare the different national and international guidelines in the management of GTD, through an integrative review. Nine articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized;in low-risk GTN (Gestational Trophoblastic Neoplasm): chemotherapy with methotrexate or actinomycin D, in high-risk: EMA/CO protocol, in ultra-high-risk EMA/PE, methotrexate with radiotherapy for brain metastases. All medical societies recommend the registration of these patients in GTD screening centers, endorse the use of the IFGO scoring system (2000) and recommend the surgical management of placental site trophoblastic or epithelioid tumors, as chemotherapy is less effective in these cases. The controversies are in the proper follow-up after the treatment of HM, use of ultrasound to evacuate the uterus, administration of anti-D immunoglobulin, time of oxytocin infusion and rescue regimens that can be used in cases of resistant or recurrent GTN. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of recurrence, morbidity and mortality, especially in less developed countries.

Evaluation of Different Parasitological Techniques for Diagnosing Intestinal Parasites in Dogs

Intestinal nematodes are among the most common parasites of dogs, being Toxocara spp. and Ancylostoma spp. threats to public health due to their zoonotic potential. In this study, three parasitological diagnostic techniques for detecting the eggs/oocysts of canine intestinal parasites were evaluated. Fecal samples (n = 285) were collected from the environment (i.e. public streets, squares and homes) in Garanhuns, Pernambuco, Brazil. Samples were analyzed using the Willis-Mollay simple flotation technique, spontaneous sedimentation (Hoffman, Pons and Janer) and modified centrifugal flotation. Among the samples analyzed, 56.49% (161/285) showed eggs and/or oocysts of intestinal parasites. In particular, 44.21% (126/285) were detected by the Willis technique, 45.14% (121/268) by centrifugal flotation and 31.57% (90/285) by the Hoffmann technique. The kappa index indicated good concordance between the centrifugal flotation and Willis techniques (κ = 0.625), whereas fair concordance was observed between Hoffmann and Willis (κ = 0.480), and between Hoffman and centrifugal flotation (κ = 0.433). In conclusion, the centrifugal flotation technique showed high sensitivity towards detecting Ancylostoma spp. and Toxocara spp. (the most common parasites in this study) and could be used in association with the Willis technique to obtain safe diagnoses within routine laboratory analysis.