International Journal of Women's Health最新文献

Objective: Moringa oleifera leaf extract can mediate green synthesis of metal oxide nanoparticles with potential antimicrobial properties. This study evaluated copper oxide nanoparticles (CuO NPs) synthesized using M. oleifera for antifungal, antibiofilm, and cytocompatibility effects in a vaginal-simulant medium.

Methods: CuO NPs were synthesized using M. oleifera leaf extract and characterized by FT-IR, XRD, UV-Vis, SEM, and EDX. 10 Candida albicans isolates and ATCC 90028 were screened for biofilm production; strong biofilm producers were selected for detailed testing. Antifungal activity (viability assays, MIC₅₀, MIC₉₀, MFC) and dose-response relationships were determined. Effects at sub-inhibitory concentrations on EPS production, cell-surface hydrophobicity, membrane permeability, ROS generation, germ tube formation, and biofilm formation/disruption were assessed. In vitro biocompatibility was evaluated by MTT assays on L929 fibroblasts, RAW 264.7 macrophages, MCF-12F epithelial cells, PBMCs, and by hemolysis assay.

Results: CuO NPs produced a concentration-dependent reduction in Candida viability with high dose-response correlation (R² = 0.967-0.9779). MIC₅₀, MIC₉₀, and MFC values ranged 44.5-103 µg/mL (ATCC 90028: MIC₅₀ 44.5 µg/mL, MIC₉₀ 86.5 µg/mL, MFC 91 µg/mL; C. albicans 6: MIC ₅₀ 51.5 µg/mL, MIC ₉₀ 79.5 µg/mL, MFC 103 µg/mL). At sub-inhibitory concentrations, CuO NPs reduced EPS production and cell-surface hydrophobicity, increased membrane permeability and ROS generation, inhibited germ tube formation, and limited biofilm formation and integrity. Biocompatibility testing showed concentration-dependent cytotoxicity in fibroblasts and macrophages at higher doses, relative tolerance of MCF-12F cells, low hemolysis, and acceptable PBMC viability at lower concentrations.

Conclusion: M. oleifera-mediated CuO NPs exhibit potent in vitro antifungal and antibiofilm activity against C. albicans and affect multiple virulence-related pathways, with a distinguishable therapeutic window based on cell-type-dependent cytotoxicity. These findings support further development and optimization of topical intravaginal formulations of green-synthesized CuO NPs for candidal biofilm-associated infections, with additional in vivo safety and efficacy studies needed.

Preeclampsia (PE) is a pregnancy-specific complication that typically occurs in the mid to late stages of gestation. Its main clinical features include gestational hypertension, proteinuria, and multiple organ dysfunction. In severe cases, it may progress to eclampsia, HELLP syndrome, and even pose life-threatening risks to both mother and fetus. Recent studies have found that serum uric acid (UA) levels are significantly elevated in patients with PE and closely correlated with disease severity, suggesting that UA may not only serve as a metabolic marker but also play an active role in the pathogenesis of PE. At the same time, coagulation dysfunction-an important pathological feature of PE-manifests as thrombocytopenia, consumption of coagulation factors, suppression of the fibrinolytic system, and microthrombus formation. These changes contribute significantly to organ damage and adverse pregnancy outcomes in PE. This review summarizes the dynamic changes in serum uric acid levels during PE and explores their relationship with coagulation abnormalities. Particular emphasis is placed on the potential mechanisms by which uric acid induces coagulation disorders, including endothelial cell injury, oxidative stress aggravation, and activation of inflammatory pathways. Additionally, the review discusses the clinical utility of various coagulation-related biomarkers (such as D-dimer, fibrinogen, PAI-1, and P-selectin) in the early prediction, severity assessment, and clinical management of PE. Current research indicates that combined monitoring of serum uric acid and coagulation markers-for instance, models integrating UA with the sFlt-1/PlGF ratio or with PAI-1, which have demonstrated high predictive accuracy (AUC >0.90) for early-onset PE-may improve early detection and risk stratification. However, the current evidence remains primarily observational and is limited by heterogeneity in study designs. Future studies should prioritize well-designed prospective cohorts to clarify causal relationships and explore more sensitive and specific combined predictive models to provide a stronger theoretical and clinical foundation for improving maternal and fetal outcomes.

Purpose: Health utility values (HUVs) are quantifiable metrics used to assess health-related quality of life and reflect individuals' overall physical, psychological, and social well-being. This study measured HUVs using the the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) among women in rural Yunnan, China, and identify their determinants to inform targeted interventions for improving maternal quality of life and promoting infant development in resource-limited settings.

Patients and methods: A cross-sectional study was conducted in May 2022 in a rural Yunnan Province, China, enrolling pregnant and postpartum women (within one year after delivery) across six reproductive stages, with a target sample of 50~100 per stage. The Tobit regression model was utilized to analyze the factors influencing the HUVs of pregnant and postpartum women.

Results: The analysis included 1,177 valid questionnaires (response rate 96.7%). The HUVs of pregnant and postpartum women in Yunnan ranged from 0.057 to 1.000, with a mean of 0.955 (SD = 0.102). This mean is somewhat lower than the HVUs recently reported in Chinese adults under 40, suggesting a potential decline in health-related quality of life during pregnancy and postpartum period. Depressive symptoms were prevalent in 22.9% of participants, with greater severity inversely associated with HUVs, indicating that mental health burdens may substantially impair health-related quality of life during this critical phase. Tobit regression analyses confirmed perinatal depressive symptoms as a significant predictor of reduced HUVs across all reproductive stages. Additional key factors influencing HUVs included social support, health behaviors, breastfeeding difficulties, postpartum recovery challenges, and infant health status.

Conclusion: This study provides novel quantitative evidence on health-related quality of life among pregnant and postpartum women in rural China. The findings demonstrate the impact of psychosocial and behavioral factors on maternal health outcomes. These insights can inform the development of targeted interventions and guide health policy decisions aimed at improving maternal and child well-being in resource-limited settings.

Purpose: Triple-negative breast cancer (TNBC) is an aggressive subtype with limited treatment options and a poor prognosis. Data on TNBC in Sudan are scarce. This study assessed the prevalence and predictors of TNBC and other molecular subtypes (Luminal A, Luminal B, and HER2-enriched) in relation to histopathological patterns, age at diagnosis, and sociodemographic risk factors.

Methods: A retrospective, single-center study was conducted of 1480 women diagnosed with breast cancer between 2016 and 2021. Histological subtypes included carcinoma in situ (CIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), or medullary carcinoma (MC). Estrogen receptor (ER), progesterone receptor (PR), and HER2 status were determined by immunohistochemistry. Multivariate logistic regression identified predictors of TNBC.

Results: TNBC accounted for 21% (n=307; mean age, 49 years) of all cases. Luminal A tumors represented 49% (n=722; mean age, 55), Luminal B 16% (n=237; mean age, 51), and HER2-enriched 14% (n=214; mean age, 50). TNBC was particularly frequent in MC (77%) compared to IDC (21%), CIS (20%), and ILC (15%). In multivariate analysis, younger age was a significant predictor of TNBC; each additional year of age reduced the odds by approximately 3% (Adjusted Odds Ratio [AOR]=0.97; 95% CI: 0.96-0.99; p<0.001). Histological subtype was also a significant determinant, with MC showing the strongest association with TNBC compared to other diagnoses.

Conclusion: TNBC is highly prevalent among Sudanese women, especially those younger than 50 years and those with MC. These findings underscore the importance of early diagnosis and wider access to molecular profiling to guide treatment in low-resource settings.

Purpose: To investigate the association between serum uric acid (SUA) levels and reproductive outcomes in non-polycystic ovary syndrome (PCOS) women undergoing intrauterine insemination (IUI) treatment.

Patients and methods: This retrospective study examined 2448 IUI cycles at a large reproductive health center from 2015 to 2024. They were categorized into four groups according to SUA quartiles. Differences in pregnancy and obstetric outcomes of women without PCOS were compared among these groups. Logistic regression analysis was applied to obtain the odds ratio (OR) and 95% confidence interval (CI) for outcomes with or without adjusting for confounding variables.

Results: There was no significant difference in the biochemical pregnancy rate from the lowest SUA quartile (Q1: 18.81%) to the highest (Q4: 17.81%) (adjusted OR 0.80, 95% CI: 0.58-1.09, P=0.455). Similarly, both the unadjusted and adjusted models indicated that SUA level had no significant effect on most reproductive outcomes including clinical pregnancy rate, miscarriage rate, and live birth rate (P>0.05). Notably, mean birth weight in Q3 (3376.93 ± 64.63 g) was the highest among the four groups (P=0.021). Consistent with this result, the low birth weight rate in Q3 was significantly lower than in Q1 in Model 3 (adjusted OR 0.21, 95% CI: 0.05-0.94, P=0.041) after adjusting for factors such as age, body mass index, menstrual cycle, and systolic blood pressure.

Conclusion: We conclude that pre-pregnancy SUA does not impair reproductive outcomes in women without PCOS undergoing IUI treatment. Fetal growth and subsequent birth weight would appear to benefit from an appropriate maternal SUA level. However, the precise efficacy and mechanism of action need to be further investigated.

Objective: To compare maternal outcomes between cesarean hysterectomy and wedge resection in pregnant women diagnosed with FIGO grade 2 placenta accrete spectrum (PAS).

Methods: This retrospective cohort study with a cross-sectional design included pregnant women diagnosed with FIGO grade 2 PAS by ultrasonography who underwent either cesarean hysterectomy or wedge resection at Hasan Sadikin General Hospital between 2022-2025. The maternal outcomes analyzed included the amount of bleeding, duration of surgery, and the need for transfusion. Statistical analyses were conducted using the chi-square test (p <0.05).

Results: A total of 83 patients were included, 49 patients underwent cesarean hysterectomy and 34 wedge resection. Based on the characteristics of the study participants, no significant differences were found in age or parity between the groups. Patients in the wedge resection group had significantly shorter operative duration and lower amount of bleeding compared with the hysterectomy group (p<0.05). Transfusion requirements of <4 units were comparable (63% vs 62%, x²=0.019, p=0.88).

Conclusion: Both WR and CH are viable surgical options for FIGO grade 2 PAS. The increasing incidence of PAS is associated with previous cesarean section and multiparity. WR was associated with a shorter duration of surgery than CH. However, differences in blood loss and transfusion requirements were not statistically significant. These findings highlight the importance of individualized surgical planning and the potential role of postoperative management in optimizing maternal outcomes.

Purpose: To suggest a potential causal role of gut microbiota in Postpartum depression (PPD) and identify susceptible microbiota-host genes.

Patients and methods: The two-sample Mendelian randomization (MR) study was carried out with the genome-wide association studies (GWAS) data of 196 gut microbial taxa and PPD. Causal relationships were evaluated with inverse variance weighted (IVW), MR‒Egger, weighted mode, and weighted median approaches. Cochran's Q test, the MR‒Egger intercept test, the MR-PRESSO test, and leave-one-out analysis were performed for assessing pleiotropy and heterogeneity. Additionally, false discovery rate (FDR) correction was completed via q-value method. A microarray dataset was carried out to identify susceptible microbiota-host genes.

Results: IVW suggested that the family Veillonellaceae [odds ratio (OR) = 0.82, 95% confidence interval (CI) = 0.71-0.94, p = 0.004, q = 0.030] decreased the PPD risk, but the class Alphaproteobacteria (OR = 1.22, 95% CI = 1.01-1.47, p = 0.041, q = 0.074) and the genus Family XIII AD3011 group (OR = 1.24, 95% CI = 1.04-1.48, p = 0.019, q = 0.065) increased the incidence of PPD. Additionally, we extracted SNP-related genes from the Family XIII AD3011 group and identified four gut microbe-host genes (AQP9, ALDH1A2, DGUOK, and STAMBP) in combination with the transcriptome dataset GSE45603.

Conclusion: The findings support the genetically predicted causal relationship of gut microbiota with PPD and identify susceptible microbiota-host genes as potential therapeutic targets or diagnostic biomarkers, providing new insights into the prevention and intervention of PPD.

Purpose: Gene signatures offer superior power on prognosis and survival of patients over traditional single-gene biomarker. This study aimed to develop a nomogram based on an immunogenic cell death (ICD) and endoplasmic reticulum (ER) stress-related gene signature to predict the overall survival (OS) of patients with ovarian cancer (OC).

Materials and methods: ICD- and ER stress-related genes were identified from public datasets and previous publications. Candidate genes were screened through differential expression and survival analyses. A prognostic risk score was established using Cox and LASSO regression. The model's predictive performance was evaluated by Kaplan-Meier and multivariate analyses, and a nomogram was constructed to estimate individual survival probabilities.

Results: A seven-gene signature related to ICD and ER stress was developed to generate a prognostic risk score. Patients with low risk scores had significantly longer OS compared to high-risk patients. The signature correlated with immune features and remained an independent prognostic factor for OS in multivariate analysis. The prediction performance was good, with AUC values of 0.61, 0.64, and 0.67 for 1-, 2-, and 3-year OS in the training set, and 0.60, 0.61, and 0.60 in the validation set. The calibration curve showed good consistency between predicted and actual results.

Conclusion: We established a clinically applicable nomogram integrating a seven-gene ICD/ER stress signature to provide individualized survival prediction for OC patients. This tool may assist clinicians in risk stratification and personalized treatment planning.

Background: Lipedema is a relatively unknown condition, often leading to misdiagnosis and a lack of proper treatment.

Purpose: To explore the experiences of seeking healthcare support and treatment among women with a physician-verified diagnosis of lipedema.

Methods: Twelve women with lipedema, verified by medical examination, were interviewed using semi-structured interviews. The transcribed data was analyzed using qualitative content analysis with an inductive approach and abstracted to visualize manifest and latent meanings.

Results: The theme "Pushing the barricaded doors to treatment and care while fighting to illuminate the shadows of lipedema" describes the experiences of women being denied subsidized treatment and disregarded by healthcare professionals. The theme is based on three categories "Experiencing societal injustice and gatekeeping in healthcare services", "Combating prejudice and stigmatization with increased awareness", and "Having a solid desire for improved and affordable treatment options". Women with lipedema described feelings of being abandoned by decision-makers and healthcare. When in need of symptom relief, women with lipedema searched and attempted different therapies, and when treatment were available, the women would have to pay for it themselves.

Conclusion: Lipedema remains an unknown disease with few available treatments in subsidized healthcare. Lack of experience regarding lipedema among healthcare professionals and their failure to assess the condition risks damaging the confidence of affected women. Therefore, increased awareness and education of healthcare personnel to increase the clinical recognition of lipedema are necessary first steps to reducing misdiagnosis, improve patient satisfaction, and the availability of care among patients with lipedema.

Objective: Asymptomatic bacteriuria (ASB) is common in pregnant women and can lead to serious complications. During pregnancy, routine screening for bacteriuria is often not standard in many developing countries, leading to underdiagnosis. In Jordan, there is limited data on ASB in pregnant women. This study aimed to determine the prevalence, causative organisms, antibiotic sensitivity, and associations with maternal conditions and diseases.

Methods: This cross-sectional, prospective study conducted at Jordan University Hospital assessed the prevalence of ASB in pregnant women. Pregnant women aged ≥18 years at any trimester, without symptoms of urinary tract infection, and who had not utilized antibiotics for two weeks, were included. Midstream urine samples were collected, analyzed, cultured, and tested for antibiotic susceptibility in the hospital's Microbiology laboratory.

Results: Out of 319 women, 23.5% (n=76) showed positive urine culture. The chi-square and logistic regression analysis revealed that gestational age and grand multipara were associated with ASB. Neither diabetes nor hypertension (true or gestational) was associated with ASB. Fifty-one of the bacteriuria cases (68%) were positive for pure culture of Escherichia coli, and 4% were mixed with Gram-positive organisms. ASB due to Gram-negative organisms was significantly associated with older age group (p = 0.025). Furthermore, the antibiotic sensitivities of the isolated E. coli showed high percentages (≥90%) to nitrofurantoin, aminoglycosides, and some types of cephalosporins, but low (56%) to amoxicillin-clavulanic acid.

Conclusion: The prevalence of ASB among Jordanian women was higher than in developed countries and some low-to-middle-income countries, and ASB was significantly associated with gestational age and parity. These findings emphasized the importance of routine screening for ASB during pregnancy, particularly in the third trimester and in grand multiparous women. Although no significant association was found with maternal age or common comorbidities such as diabetes and hypertension, further extensive studies are needed.