Przeglad Menopauzalny最新文献

The onset of menopause usually occurs between the ages of 48 and 52, leading to diverse symptoms in various body systems due to a decrease in estrogen level. Visceral obesity and diminished estrogen level during the menopausal phase are associated with unfavorable metabolic changes, resulting in insulin resistance and increased risk of type 2 diabetes mellitus (T2DM). Owing to the increase in the incidence and prevalence of T2DM in recent decades, it is important to identify predisposing factor such as menopausal age to improve T2DM prevention and management. We searched PubMed, Scopus, and Google Scholar databases to find all studies related to menopause and type 2 diabetes up to August 4, 2023. Studies were reviewed for compliance with the inclusion criteria. Sample size and number of post-menopausal T2DM cases were extracted from studies. Effect sizes and related confidence intervals were calculated for them. The combined analysis of 17 studies demonstrated a significant association between menopausal age and risk of T2DM. The calculated odds ratio (OR) demonstrated that women with menopausal age > 45 had significantly decreased risk of developing T2DM with OR of 0.13 (95% CI: 0.04, 0.22). This effect changed to OR = 0.44 (95% CI: -1.12, 2.00) and 0.21 (95% CI: -1.39, 1.82) for menopausal age > 50 and > 55, respectively. In conclusion, this present meta-analysis emphasizes the importance of the complex relationship between earlier menopausal age and risk of T2DM development.

The increase of the incidence of autoimmune diseases and, at the same time, a significant surge in the number of regenerative/anti-aging medicine treatments carried out, raises the need to systematise the current knowledge on the safety of the use of hyaluronic acid fillers in patients with autoimmune diseases and to frame management guidelines for aesthetic doctors. One of the most prevalent autoimmune diseases is chronic lymphocytic thyroiditis, so-called Hashimoto's disease, which affects one in every 5-10 women who visit a regenerative medicine doctor. Women in the perimenopausal and menopausal period, aged 40-54 years, were the single largest target group for aesthetic treatments. At the same time, Hashimoto's disease, similarly to other autoimmune disorders, constitutes a contraindication to most treatments with hyaluronic acid fillers and biostimulators. Due to the dysfunction of the immune system in this group of patients, there is a higher risk of adverse side effects, especially those of immunological nature. Based on the available literature, the incidence of adverse reactions after the use of hyaluronic acid-based fillers amounts to 0.01-1% and is undoubtedly underestimated. The most typical one is recurrent oedema and granulomas. The following paper reviews the existing literature on the safety of hyaluronic acid fillers in patients with autoimmune endocrinopathies.

Müllerianosis of the urinary bladder is a rare pathological condition involving ectopic Müllerian-derived tissues within the bladder. Despite its benign nature, due to its ability to mimic malignant conditions such as bladder carcinoma, diagnosis might be challenging. In this review, data from 36 cases across 32 studies were analyzed, focusing on patient demographics, symptomatology, diagnostic imaging, and histopathological features. The average patient age was 42.4 years. Common symptoms included dysuria, hematuria, and pelvic pain. Diagnostic challenges arise from the nonspecific nature of symptoms and imaging findings, making histopathological confirmation necessary. Surgical treatment is mainly involved, with transurethral resection being the most common approach. In some cases, hormonal therapy is also explored. While the prognosis is generally favorable, recurrence is possible, emphasizing the need for long-term follow-up. The review underscores the importance of early diagnosis and individualized management strategies to improve patient outcomes.

Small bowel obstruction (SBO) is a serious condition with distinct symptoms such as constipation, vomiting, and abdominal distension. It is commonly caused by well-recognised factors. Recent advancements in imaging techniques and minimally invasive procedures have significantly improved our ability to accurately select patients for surgical intervention and promptly identify common SBO causes. Nonetheless, it is crucial to recognise that diagnosing rare SBO causes remains a challenge. We present a rare case of mechanical bowel obstruction caused by massive uterine fibroids in a 44-year-old woman. Large uterine fibroids can cause mechanical small intestine obstruction, although this is not a common cause. Diagnostic imaging, particularly computed tomography, plays a crucial role in diagnosing and determining appropriate management plans. Accurate monitoring and imaging can lead to improved patient outcomes by avoiding unnecessary surgical intervention and reducing morbidity and mortality rates. Treatment options include both medical and surgical methods. Both approaches have proven effective, with surgical procedures being the last resort if medical treatments are unsuccessful. The accuracy and efficacy of these surgical methods have shown promising results and significant prognostic benefits. It is critical to identify and report rare causes of bowel obstruction to improve future recognition and enhance patient outcomes.

Introduction: Triple-negative breast cancer (TNBC) accounts for approximately 15-20% of all breast carcinomas. In the last two decades, both nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) with immediate reconstruction have been used in the surgical management. The aim of our study was to analyze the outcomes of the combined treatment of patients with TNBC treated with NSM or SSM.

Material and methods: A total of 114 women with TNBC were enrolled in this study. All diagnostic, therapeutic and follow-up procedures were conducted in one center of the Holycross Cancer Centre in Kielce. In all patients, subcutaneous mastectomy was performed. Overall survival was estimated by the Kaplan-Meier method. The influence of selected prognostic factors on the risk of death was analyzed using the Cox proportional hazards models.

Results: The probability of survival at 1, 3, and 5 years was 0.982, 0.894, 0.850, respectively. Based on the 5-factor Cox model, all included features had a significant relationship with the risk of death. In conclusion, the presence of a genetic mutation, adjuvant chemotherapy, complete pathological regression, and the absence of radiotherapy significantly reduced the risk of death.

Conclusions: The results of the treatment with subcutaneous mastectomy are good. The early stage of the cancer is associated with a better prognosis. Complete pathological regression after systemic treatment, particularly in patients with BRCA1 mutation, is a good prognostic factor and can help diminish the range of surgery in the axilla region.

Introduction: Ovarian cancer is a significant cause of death among females. MiRNAs, particularly the miR-196 family, can influence tumor progression by targeting specific pathways. Detecting ovarian cancer early is challenging, highlighting the need for additional biomarkers such as miRNAs to improve diagnosis and treatment strategies.

Material and methods: Healthy controls and patients with high-grade serous carcinoma (n = 50) were recruited for this study. Samples for testing were obtained from archival paraffin blocks obtained from intraoperative material.

Results: The study found that miRNA 196a expression was significantly elevated in ovarian cancer patients compared to the control group (p < 0.05). Higher miRNA 196a expression was also noted in patients with advanced FIGO stages (III, IV). Increased miRNA expression was significantly associated with higher mortality and chemoresistance (p < 0.05). Genotype analysis revealed differing distributions of SNPs (C/C, C/T, T/T) between the study and control groups, but no significant correlation with malignancy was observed.

Conclusions: This study supports the critical role of microRNA-196a in the progression of ovarian cancer.

Introduction: A decrease in bone mineral density (BMD) accompanied by muscle weakness during aging significantly increases the probability of low-energy fracture occurrence, but it can also happen in those with a non-osteoporotic score (treatment gap). To improve the identification process of those at risk, the authors proposed using the interconnectivity between bone mineral density and muscle tissue.

Material and methods: A total of 20,776 patient records were collected from the database in the period 2008-2021. After applying inclusion criteria, a total of 7159 records were used in the study. Questionnaires regarding patients' history were collected at admission. Patients underwent lumbar spine and/or femoral neck DXA examination and handgrip testing with a handheld dynamometer. Statistical analysis was conducted using tests suitable for the distribution of the data.

Results: Osteoporosis was diagnosed in a total of 1914 patients. Depending on the diagnosis there was a significant (p < 0.001) difference in handgrip strength (HGS) between the BMD statuses (norm-osteopenia-osteoporosis). HGS was significantly (p < 0.001) correlated with both BMD neck (r = 0.2) and spine (r = 0.1) in females, and with BMD neck (r = 0.11) in the male population. In our study group HGS was significantly (p < 0.001) higher for all the analysed fractures in the no-fracture group of women. There was no such relationship in reference to the male population.

Conclusions: Due to its relationship with BMD, its low cost, and availability, HGS might prove useful in identifying women at risk of a fragility fracture.

Introduction: Breast cancer is the predominant form of malignancy among women. Polymorphisms in DNA repair genes, such as X-ray repair cross complementing 3 (XRCC3), can influence an individual's capability to repair damaged DNA. This can result in genetic instability and potentially contribute to the development of cancer. This study investigates the correlation between the XRCC3 Thr241Met genetic variants and the risk of breast cancer.

Material and methods: This study is considered the first study in Iraq that sheds light on studying the effect of the XRCC3 Thr241Met genotype variants and their relationship with increased risk of breast cancer. The blood of 75 Iraqi women who had been diagnosed with breast cancer was used in this study to extract DNA, in addition to using 50 blood samples from women who appeared to be healthy and without a family history of any other cancer, as a control group. Genotyping of the XRCC3 Thr241Met gene was studied by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The single nucleotide polymorphism (SNP) genotypes were determined in all participants.

Results: The findings of this study demonstrated that the Met/Met allele occurred more frequently in patients than controls (OR = 3.3, 95% CI: 1.8-6.04; p = 0.0001), particularly in patients with positive lymph node metastases, grade II and III, and stages III/IV.

Conclusions: These findings established the association of the Thr241Met genotype with breast cancer among Iraqi women; specifically, the homozygous (Met/Met) genotype appeared to be correlated with risk of breast cancer and cancer prognosis. This genotype was notably more prevalent among women diagnosed with high-grade tumours, as well as advanced stage and metastatic breast cancer.

Introduction: To correlate the direct and indirect morphological uterus sonographic assessment (MUSA) features of adenomyosis with clinical symptoms severity.

Material and methods: This observational prospective study was conducted at a tertiary care institute from April 2023 to March 2024, involving 254 women aged 18 to 45 years with a regular menstrual cycle and ultrasound-confirmed diagnosis of adenomyosis. Detailed clinicodemographic data were collected, including symptoms such as painful menses, heavy menstrual bleeding (HMB), chronic pelvic pain (CPP), and bowel/bladder symptoms. Severity of symptoms was graded using a visual analogue scale and pictorial blood loss analysis chart. All participants underwent a 2D transvaginal ultrasound during the secretory phase, performed by blinded sonographers. Diagnosis of adenomyosis was based on the presence of direct or indirect MUSA features.

Results: The study's primary findings showed that 94.4% of participants had at least one direct feature, with myometrial cysts being the most common (83.75%). Statistical analysis revealed significant associations between clinical symptoms and specific MUSA features. Heavy menstrual bleeding was linked with asymmetrical myometrial thickening, interrupted junctional zone, and globular uterus. Chronic pelvic pain was significantly associated with myometrial cysts, and dysmenorrhoea was linked with myometrial cysts and hyperechogenic islands. On stepwise logistic regression, HMB was found to be significantly associated with asymmetrical myometrial thickening, interrupted JZ, and globular uterus with odds ratios (OR) of 2.84, 2.01, and 4.03, respectively. Chronic pelvic pain was significantly associated with myometrial cyst (OR = 3.07), as was dysmenorrhoea (OR = 1.13).

Conclusions: The findings of the study highlight that few sonographic direct and indirect signs of adenomyosis are linearly associated with the severity of disease symptoms.

Introduction: The thyroid gland has a significant impact on the morphofunctional state of the organs of the female reproductive system, the regulation of the ovarian-menstrual cycle, as well as the age-related decline of the generative and endocrine function of the ovaries.

Material and methods: The study involved 102 women aged 49-62 years, who were divided into 2 groups. Group I included 54 patients who suffered from manifestations of the menopausal syndrome, and the control group comprised 48 patients whose menopausal period proceeded physiologically. All patients underwent clinical, laboratory, and instrumental examinations in accordance with the requirements of modern protocols.

Results: A thyroid dysfunction has a significant impact on the course of menopause. In women who suffered from manifestations of pathological menopause, the thyroid dysfunction was detected in 64.81% of patients, with the most frequently diagnosed being hypothyroid state (61.11%). Among thyroid diseases, chronic autoimmune thyroiditis prevailed (37.04%), and diffuse focal and focal changes were observed in 24.07% of cases. In patients with uncomplicated menopause, thyroid pathology was diagnosed 3.9 times less frequently. No autoimmune thyropathies were identified among the patients in the control group; focal pathology (category TI-RADS1 and TI-RADS2) was detected in 14.58% of cases.

Conclusions: Thyroid dysfunction accompanied by hypothyroidism can be considered as a risk-stratification factor for the development of pathological menopause.