Przeglad Menopauzalny最新文献

Triple-negative breast cancer accounts for approximately 15% of all diagnosed breast cancers and is characterized by an aggressive clinical course resulting from rapid proliferation of tumor cells poses a huge therapeutic challenge. The shortened, in comparison with other subtypes of breast cancer, progression free survival or the limited influence of the chemotherapy used on the overall survival imply the necessity of searching for new therapies. The use of monoclonal antibodies conjugated with a cytostatic initially allowed selective introduction of the drug into tumor cells showing expression of strictly defined receptor proteins on the cell membrane surface. Modification of the linkers binding the cytostatic to the antibody, on the other hand, allowed activation of the by-stander effect, allowing effective destruction of tumor cells lacking expression of specific antigens on their surface. Sacituzumab govitecan (anti-TROP2 antibody conjugated with inhibitor of topoisomerase I) improve median progression-free survival and overall survival in patients with advanced, metastatic triple-negative breast cancer. Similarly, a beneficial effect from the use of ADCs (trastuzumab deruxtecan) was observed in patients with low HER2 expression. These therapeutic advances are reflected in clinical guidelines from leading organizations such as ASCO and ESMO, and have become the basis for ongoing clinical trials evaluating new ADCs with different molecular targets and cytotoxic mechanisms. This paper reviews the most important studies evaluating the clinical effect of ADCs in the treatment of triple-negative breast cancer.

Introduction: To determine whether the need for hospitalization is more frequent in patients with both frailty and functional dependence compared to patients with only frailty or functional dependence. We also performed an analysis stratified by sex.

Material and methods: An observational, analytical, retrospective cohort study that analyzed a secondary database of a study including a population of 1896 older adults cared for by the Geriatric Service of the "Naval Medical Center" of Peru from 2010 to 2015. The analysis of the data was done using the program STATA version 15.0.

Results: There was a statistically significant association between age (p = 0.001), education (p = 0.003), number of comorbidities (p = 0.01), frailty (p = 0.001), coexistence between frailty and functional dependence (p = 0.001) and the number of hospitalizations. The mean number of hospitalization days was greater among the older adults with both frailty and functional dependence compared to those who were only frail or functionally dependent (2.6 ±1.6 vs. 2.3 ±1.5 vs. 0.7 ±0.7; p = 0.001, respectively). This association was maintained in women and men.

Conclusions: The coexistence of functional dependence and frailty is associated with a greater number of hospitalizations in older male and female adults. This is relevant because frailty can be avoided by implementing promotional and preventive interventions of active aging and at the same time, it is potentially reversible with an early detection and adequate measures such as physical activity, diet, and cognitive training.

Introduction: The term steatotic liver disease (SLD) has replaced fatty liver disease following the Delphi consensus process. Recent trends indicate an increasing prevalence of SLD among women, particularly postmenopausal women. This study evaluates the prevalence of SLD in pre- and postmenopausal women and identifies risk factors contributing to its development.

Material and methods: We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Adults aged ≥18 years with available controlled attenuation parameter (CAP) and liver stiffness measures (LSM) from vibration-controlled transient elastography were included. SLD and its subtypes - metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic-alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD) - were classified according to the consensus definitions. Menopausal status was determined via self-reported reproductive health data. Multivariate logistic regression identified risk factors for SLD and liver fibrosis, adjusting for demographic and metabolic variables.

Results: Steatotic liver disease prevalence was significantly higher in postmenopausal women (34.57% vs. 23.49%, p < 0.001), driven by MASLD (32.79% vs. 21.70%, p < 0.001). MetALD was more common in postmenopausal women (17.04% vs. 13.52%), while ALD was more frequent in premenopausal women (0.44% vs. 0.07%, p = 0.045). Advanced fibrosis (LSM ≥ 11.7 kPa) was also more prevalent in postmenopausal women (3.4% vs. 2.63%). Key predictors of SLD included higher BMI (OR = 1.94, 95% CI: 1.68-2.23, p < 0.001) and diabetes (OR = 1.52, 95% CI: 1.28-1.81, p < 0.001).

Conclusions: Postmenopausal women face an increased burden of SLD, likely due to metabolic risk factors and estrogen loss. Preventive interventions are needed to reduce SLD-related morbidity in this population.

Statins are the first-line treatment for dyslipidemia, which is a major modifiable risk factor for cardiovascular disease. One of the main problems in the dyslipidemia treatment is the frequently reported discontinuation of statins, mainly due to side effects of statins. The aim of the study was to summarize current knowledge on, and comprehensively discuss, the lower adherence to statins among women than men, and to assess whether gender is associated with the incidence of statin side effects. A narrative review was performed using data from articles found in a search of PubMed and Scopus databases using the terms related to statin adherence and statin adverse events by gender. Women are less adherent to statin therapy than men. Statin adverse events and statin intolerance appear to be the main cause of poor adherence to statin treatment. Women have been found to be more likely than men to stop or switch their statin therapy because of side effects, were less likely than men to perceive statins as safe or effective, and were more likely to report discontinuing statins because of adverse effects. Female sex has also been identified as a risk factor for statin intolerance. The reports reviewed in the manuscript indicate a higher prevalence of SAMS and new-onset diabetes among women than men. The risk also increases with age and is dose-dependent. Women have also been found to be more susceptible to the nocebo and drucebo effects of statins. Greater awareness of gender-specific side effects may lead to better tailoring of therapy and consequently to better adherence to statins among women, and thus the achievement of therapeutic goals in finally reducing cardiovascular risk.

Introduction: HIV/AIDS remains a major public health issue, with social and cultural dimensions often underestimated. Middle-aged women, particularly in rural settings, represent a vulnerable and frequently overlooked population in prevention strategies, despite remaining sexually active during this life stage.

Material and methods: A quantitative, cross-sectional, and analytical study was conducted using data from Peru's 2024 Demographic and Health Survey (ENDES). A total of 6,314 women aged 40 to 49 years with complete data were included: 4,176 from urban areas and 2,138 from rural areas. An additive index of adequate HIV/AIDS knowledge and beliefs was constructed (range: 0-9), along with sociodemographic and health information access variables. Statistical analysis was performed using Stata v17, and geographic visualization using RStudio.

Results: Rural women reported lower exposure to HIV/AIDS information and less awareness of vertical transmission and asymptomatic HIV transmission (p < 0.001). Preventive beliefs were more frequent in urban areas, while misbeliefs, such as mosquito transmission, were more common in rural areas. Geographic analysis revealed a clear territorial gap, with higher index scores in urban zones. Nevertheless, some rural regions exhibited unexpectedly high scores.

Discussion: Findings highlight informational and cultural disparities that hinder HIV prevention among rural women. These disparities underscore the need for tailored interventions that consider sociocultural and territorial specificities.

Conclusions: Middle-aged women should be explicitly targeted by sexual health strategies. Regionalized interventions are essential to address territorial and sociocultural inequities in HIV/AIDS knowledge and beliefs.

Introduction: The use of contraceptive methods (CM) in women aged 40 to 49 years is often underestimated, despite the risk of unplanned pregnancies. This study aimed to estimate the prevalence and associated factors of CM use among Peruvian women in this age group.

Material and methods: An analytical, cross-sectional study was conducted based on secondary data from the 2023 Demographic and Family Health Survey (ENDES). Women aged 40 to 49 years who were neither pregnant nor menopausal were included. Sociodemographic, gynecologic-obstetric, and intimate partner violence variables were analyzed with adjustments for complex survey design.

Results: The prevalence of CM use was 63.06%. The most commonly used methods were female sterilization (26.73%) and injectable contraceptives (15.46%). Contraceptive method use was higher among women aged 40-44 years, those who were married or cohabiting, and those with more children. Lower use was associated with the desire for more children, lack of knowledge about the ovulatory cycle, and a history of intimate partner violence. Among women not using CM, 54.22% expressed an intention to use them in the future, mainly favoring injectable methods or condoms. The most frequent reasons for non-use were infrequent sexual activity, perceived infertility, and not being in a relationship.

Discussion: Contraceptive methods used in this group are influenced by personal, relational, and contextual factors. Violence and limited partner involvement negatively affect its adoption.

Conclusions: It is necessary to strengthen personalized counseling strategies, reduce gender inequalities, and promote shared contraceptive responsibility among women of advanced reproductive age.

Introduction: Breast cancer (BC), the most prevalent cancer amongst women globally, exhibits a complex relationship with obesity and its associated factors. Chemerin, an adipokine linked to both inflammatory and metabolic processes, has emerged as a potential player in tumor development and progression. This study delves into the potential role of chemerin in breast cancer by analyzing its expression patterns in tumor cells, fibroblasts, and adipocytes alongside corresponding clinico-pathological parameters.

Material and methods: Encompassing 77 patients with invasive ductal carcinoma, the study revealed an interesting interplay between chemerin and disease characteristics.

Results: While chemerin expression itself did not associate with established markers like BC stage, oestrogen receptor, or progesterone receptor status, its presence is elevated in patients with lymph node metastasis. Despite these insightful findings, the study acknowledges limitations inherent to its design. The absence of a healthy control group necessitates further controlled studies to solidify the observed associations. Additionally, external factors like diet and exercise, known to influence chemerin levels, were not accounted for, requiring more comprehensive patient history and examination data in future investigations.

Conclusions: While chemerin expression did not correlate with traditional BC markers, its apparent associations with lymph node metastasis, c-ERB2 expression, and involvement within the tumour microenvironment warrant further exploration. This study paves the way for future research to elucidate the precise role of chemerin in BC development and progression, potentially paving the path for the development of novel diagnostic and prognostic tools.

Introduction: Adnexal masses in postmenopausal women often present a diagnostic challenge, especially when imaging reveals complex features such as solid components, papillary projections, and ascites. Accurate preoperative characterization is crucial to guide surgical management and avoid unnecessary extensive procedures. Multimodal imaging combined with serum tumor markers and validated risk prediction models such as the IOTA ADNEX (International Ovarian Tumor Analysis) model, enhances diagnostic accuracy in differentiating benign from malignant ovarian lesions.

Case presentation: A 49-year-old postmenopausal woman presented to the Emergency Department with severe pelvic pain. Initial evaluation revealed a left adnexal mass with a total size of 13 cm, composed of an 8 cm cystic portion and a 5 cm solid component. Transvaginal ultrasound demonstrated three vascularized papillary projections. Computed tomography and magnetic resonance imaging confirmed the suspicious morphology and ascitic fluid. The preoperative risk of malignancy, calculated using the IOTA ADNEX model via freely accessible online tools, was 81.2%. Due to the severity of symptoms and high suspicion of malignancy, the patient underwent urgent diagnostic laparoscopy. Intraoperatively, the mass appeared partially torsed with external surface papillary excrescences. A left salpingo-oophorectomy was performed, and peritoneal and cystic fluids were collected for cytological analysis.

Results: The final histopathology revealed a benign serous cystadenofibroma. Cytological evaluation of the fluids was negative for malignant cells. Postoperative recovery was uneventful.

Conclusions: This case highlights the importance of comprehensive diagnostic evaluation in adnexal masses. Even when multimodal imaging and risk models suggest malignancy, benign lesions may mimic malignant features. Integrating clinical, radiologic, and intraoperative findings is essential to avoid overtreatment.

The aim of the study was to review publications on the early, most accurate diagnosis of pathological changes in the endometrium, which occur during and after tamoxifen (TAM) therapy for breast cancer (BC). Accurate diagnosis of potential endometrial lesions is essential to make correct decisions regarding the necessity of adjuvant therapy with TAM. MEDLINE (http://www.ncbi.nlm.nih.gov/pubmed), EMBASE (http://www.embase.com) and Scopus (http://www.scopus.com) databases were searched using the following MeSH terms in titles and abstracts: ("tamoxifen endometrial hyperplasia" OR "tamoxifen endometrial pathology" OR "endometrial pathology tamoxifen"). No language restriction was used in the literature search. The search was limited to studies in humans. The results of an ultrasound investigation of the endometrium in asymptomatic BC patients receiving TAM should be interpreted with caution. An overdiagnosis of endometrial abnormalities, and the consequent unnecessary invasive diagnostic procedures could discourage some patients from continuing the adjuvant treatment with TAM, putting them at increased risk of recurrent BC. There is no evidence that patients receiving adjuvant TAM therapy could benefit from a screening program based on the ultrasound examination alone. Asymptomatic BC patients on adjuvant TAM-treatment should not be submitted routinely to ultrasound examination or biopsy, but encouraged to report any abnormal vaginal bleeding promptly.

Introduction: Menopause significantly impacts a woman's life, marked by changes in sex hormone levels. Many perimenopausal women experience weight gain and other physical changes affecting their mental state and body image. The aim of the study was to evaluate the association between postmenopausal women's body image and the severity of menopausal symptoms.

Material and methods: This survey-based study involved 271 postmenopausal female residents of the West Pomeranian Voivodeship. It was performed using the author questionnaire and Menopause Rating Scale, the Body Image Questionnaire by Alicja Głębocka, the Body Parts Satisfaction Scale and the Patient Health Questionnaire-9.

Results: The participants had moderate menopause severity and were generally neutral about their appearance. No depressive symptoms were found in 31.37% of the women. Factors such as place of residence, education, onset of menopausal symptoms, and hormone replacement therapy influenced body image criticism scores. Education and employment status significantly affected depressive symptoms severity. The severity of menopausal symptoms was closely related to depressive symptoms and body image dissatisfaction.

Conclusions: The severity of menopausal symptoms had a significant effect on body image and the level of depressive symptoms among the postmenopausal women.