Przeglad Menopauzalny最新文献

Introduction: Treatment of refractory thin endometrium during IVF is a relatively challenging problem, considering that optimal endometrium thickness is one of the critical factors for successful implantation and pregnancy. Autologous intrauterine platelet-rich plasma (PRP) infusion is an adjuvant therapeutic alternative for enhancing the endometrial thickness (EMT) and echo pattern. It was shown that PRP could expand EMT and improve pregnancy outcomes with its high content of growth factors and cytokines, and its role in the regulation of the immunological interaction between the embryo and the endometrium. The aim of the study is to evaluate the effect of autologous PRP in improving the ongoing pregnancy rate in patients with refractory thin endometrium undergoing IVF.

Material and methods: A prospective study in Ain Shams University Hospital including 66 infertile women with a refractory thin endometrium below 7 mm by ultrasound on the day of human chorionic gonadotropin injection in fresh embryo transfer (ET) cycle, who did not respond to standard medical therapies after more than 2 cycles of previous medical therapy, and who were candidates for IVF cycle were given intrauterine PRP.

Results: A significant increase in EMT was noted and enhancement of endometrial pattern after intrauterine PRP infusion in the days of ovum pick-up and ET. There was also a significant increase in ongoing pregnancy, chemical pregnancy, clinical pregnancy, and implantation rates, while the miscarriage rate decreased after PRP infusion.

Conclusions: Intrauterine PRP infusion improved ongoing pregnancy, chemical pregnancy, clinical pregnancy, and implantation rates, in addition to EMT and pattern on the days of ovum pick-up and ET, while the miscarriage rate significantly decreased.

Introduction: Menopause is associated with disturbed cardiovascular health. The objective of the study was to compare the effect of hormonal replacement therapy (HRT) and its combination with diet, L-arginine, and xylitol solutions on metabolic processes and cardiovascular health in perimenopausal women.

Material and methods: In total 106 women were enrolled in the cross-sectional study. The 36 patients of Group II received HRT. 35 women who had been prescribed additionally to HRT a diet, L-arginine, and also xylitol were included in Group III. 35 healthy reproductive-aged women were included in Group I (control). The variables body mass index (BMI), heart rate (HR), blood pressure (BP), lipid and carbohydrate metabolism and C-reactive protein, and menopausal Cooperman's score were determined before and after the 3-month program.

Results: The obtained results showed the homogeneity of average age, BMI, HR, BP, and Cooperman's score in Group II and Group III before inclusion in the study. But several variables changed significantly after a 3-month period. The study showed the effect of the 3-month program on BMI and Cooperman's score. We also found the restoration of the lipid profiles in Group III. The patients of perimenopausal age featured elevated levels of insulin and C-RP (C-reactive protein). The restoration of levels of insulin and CRP occurred in the process of the 3-month program.

Conclusions: The use of a 3-month program including diet, xylitol, and L-arginine solutions contributed to the reduction of Cooperman's score, chronic inflammation, and restoration of lipid and carbohydrate metabolism.

Angiomyomatous hamartoma (AMH) of the lymph node is an extremely rare, benign vascular disease of unknown etiology. It is characterized by partial or complete replacement of the lymph node parenchyma by irregularly distributed, thick-walled blood vessels, smooth muscle bundles and adipose tissue in a fibrotic stroma. Angiomyomatous hamartoma occurs mainly in inguinal and femoral nodal regions, but there are a few reports of some other locations - submandibular, cervical, popliteal and paraaortic lymph nodes. We present a case of a 37-old female patient with AMH in the pelvic and paraaortic lymph nodes who presented with weight loss - 7 kg in 7 months. The differential diagnosis of AMH includes lymphangiomyomatosis, which, unlike AMH, involves primarily thoracic and intra-abdominal lymph nodes: nodal leiomyomatosis with less pronounced vascular proliferation and angiomyolipoma of the lymph node. The latter is composed of the same tissues as in AMH, but the smooth muscle component shows increased cellularity, polymorphism and increased mitotic activity, as well as a typical immune profile with coexpression of melanocyte markers and estrogen, which were negative in our case. The world literature references show that this is the first reported case in which the disease manifested itself with weight loss and affected paraaortic lymph nodes in a female patient.

Introduction: Atherosclerosis, cognitive impairment, and depression are common entities in postmenopausal patients. Our aim was to ascertain the relationship between the carotid intima-media thickness (IMT) and cognitive function and depression in postmenopausal women.

Material and methods: This was an observational, cross-sectional, comparative study among postmenopausal women. A carotid artery ultrasound was performed, and the IMT was measured. Mental function was assessed with the mini-mental state examination (MMSE), and the presence of depression with the Hamilton Depression Rating Scale (HDRS). For statistical analysis the Mann-Whitney U test and Spearman correlation were used. Sensitivity, specificity, positive predictive value, negative predictive value, and odds ratio (OR) were calculated.

Results: Seventy-five patients were studied. The median of age was 52 years (31-76), and the IMT was 1.1 mm (0.6-0.20). The HDRS score was 8.9 (1-21), and that of the MMSE was 29 (18-30). After dividing the group according to the presence or absence of depression, it was found that age and IMT were greater in the group with depression, and the MMSE score was greater in the group without depression. After dividing according to the MMSE score, age and HDRS score were significantly greater in the group with cognitive impairment. The intima-media thickness had an OR of 12.2 (2.6-58.0) for cognitive impairment and an OR of 5.2 (1.9-14.1) for depression.

Conclusions: The intima-media thickness is associated with greater risk of cognitive impairment and depression.

Introduction: The aim of this study is to assess the secretory-phase endometrial leucocytes in women with 2 or more unexplained abortions and in healthy controls.

Material and methods: This cross-sectional study was performed in 3 tertiary centres: Ain Shams University, Al-Azhar, and October 6 University Maternity Hospitals. The study included 50 women who consented to participate in this study. Women were divided in 2 groups; the first group consisted of 25 non-pregnant women with unexplained recurrent pregnancy loss, while the second group (n = 25) included non-pregnant women as a control group who had no history of recurrent pregnancy loss. Endometrial biopsies were taken from all participants around the expected time of implantation (one week after induction of ovulation by human chorionic gonadotrophins) to elucidate the T lymphocyte population, CD4+ (helper-T) and CD8+ (suppressor-T) markers.

Results: Women with 2 or more unexplained abortions had significantly less endometrial CD8+ (p < 0.05), and consequently their endometrial CD4/CD8 ratio was higher in relation to the controls. There was no significant difference in endometrial CD4+ in relation to controls (p > 0.05).

Conclusions: From the results we can conclude that CD8 is more valuable than CD4 in women with recurrent spontaneous miscarriage. CD8 is better positive than negative in such patients.

Introduction: This study aims to assess the attitude, knowledge, and behaviour of Jordanian women toward cervical cancer screening and its phenomenal role in preventing the disease, and to identify the defects and obstacles in the national screening programs for early detection of this manageable kind of malignancy.Material and methods: A prospective study via a questionnaire that included the demographic data, knowledge, behaviour, and attitude among Jordanian women about the cervical screening program using face-to-face interviews.

Results: Among 655 women who responded to the questionnaire, 340 (51.9%) reported having no idea about the smear, 350 (53.4%) had completed higher education, 84 (12.84%) were not happy to be screened, and 53 (8.09%) were afraid of the result being positive for malignancy. The shocking and scandalous upshots reported that 600 women (91.6%) had no idea about the role of vaccination against this threatening disease.

Conclusions: Screening programs occupy a limited space among the health care provider's priorities. The health education and national awareness strategy regarding cervical cancer should be adopted and implemented in primary health care units. The media with its different facets and platforms must take responsibility and share this national cancer education battle. The once-in-a-lifetime screening test should be adopted urgently, being the most important step, because it represents the minimum correct starting point to lessen the future burden on the national healthcare system and benefit the health of the target groups.

Introduction: To evaluate the efficacy of ferric carboxy maltose (FCM) in the treatment of iron deficiency/iron deficiency anaemia (ID/IDA) during pregnancy.

Material and methods: Pregnant women ≥ 20 years old diagnosed with ID (serum ferritin < 15 µg/l) and moderate IDA were included in this study for correction of their ID/IDA. The participants received an FCM infusion for correction of their ID/IDA. The pre-treatment ferritin, haemoglobin (Hb), and red blood cell (RBC) indices were compared with the 6- and 12-week post-treatment values to evaluate the efficacy of FCM in the treatment of ID/IDA during pregnancy.

Results: The pre-treatment ferritin and Hb significantly increased from 10.3 ±2.3 µg/l and 7.99 ±0.6 g/dl, respectively, to 139.5 ±1.9 and 14.04 ±0.45, respectively, 6-weeks after FCM infusion (p = 0.02 and 0.001, respectively), and to 128.9 ±1.7 and 13.02 ±0.5, respectively, 12-weeks after FCM infusion (p = 0.0008 and 0.02, respectively). In addition, the pre-treatment RBCs mean corpuscular volume and RBCs mean corpuscular haemoglobin (MCH) significantly increased from 72.02 ±3.5 fl and 23.9 ±1.9 pg, respectively, to 90.6 ± 2.8 fl and 29.98 ±1.5 pg, respectively, 6 weeks after FCM infusion (p = 0.01 and p = 0.007, respectively), and to 89.5 ±2.9 fl and 30.2 ±1.5 pg, respectively, 12 weeks after FCM infusion (p = 0.02 and 0.007 respectively).

Conclusions: The ferric carboxy maltose was safe and effective for the treatment of ID/IDA during pregnancy within 6 weeks. The serum ferritin and Hb levels and the RBC indices remained significantly high 12 weeks after FCM infusion compared to the pre-treatment values.

Introduction: To detect the accuracy of the risk of malignancy index-I (RMI-I) in diagnosing ovarian malignancy in menopausal women.

Material and methods: Eighty-two menopausal women with suspected ovarian masses (OMs) scheduled for surgery were included in this study. Blood samples were preoperatively collected from participants to measure the CA-125, followed by transvaginal sonography to evaluate the suspected OMs regarding the consistency, whether the OMs were unilateral or bilateral, unilocular or multilocular, and for extra-ovarian metastasis. The preoperative RMIs were compared to the postoperative histology of the excised OMs to detect the accuracy of RMI-I at a cut-off value of 200 in diagnosing ovarian malignancy. The receiver operating characteristic curve was also used to detect the cut-off value of RMI-I with the highest sensitivity and specificity in diagnosing ovarian malignancy in menopausal women.

Results: The incidence of benign and malignant OMs in the studied menopausal women was 59.8% and 40.2%, respectively. The risk of malignancy index-I at a cut-off value 200 in this study had 75.8% sensitivity, 91.8% specificity, 86.2% positive predictive value (PPV), and 84.9% negative predictive value (NPV) in diagnosing ovarian malignancy in menopausal women. The receiver operating characteristic curve showed that the RMI-I at a cut-off value of > 241.5 had 96% sensitivity and 94.74% specificity in diagnosing ovarian malignancy in menopausal women (AUC 0.98, 95% CI: 0.92-0.99, p < 0.001).

Conclusions: The risk of malignancy index I at a cut-off value of 200 had 75.8% sensitivity, 91.8% specificity, 86.2% PPV, and 84.9% NPV in diagnosing ovarian malignancy in menopausal women. The receiver operating characteristic curve showed that the RMI-I at a cut-off value > 241.5 had 96% sensitivity and 94.74% specificity in diagnosing ovarian malignancy in menopausal women.

Introduction: Gender medicine is an innovative medical approach that studies how some biological variables are influenced by the male or female sex and gender. This issue is under debate because it characterizes the impact of tailored or individual medicine. In this scenario, the aim of this study is to study the correlation between heavy metal exposure and pathologies of neurodevelopment, according to the sex of newborns. In particular, this is an observational study under the name of the Neurosviluppo Project, involving 217 mother-child couples.

Material and methods: The correlation with phenotype small for gestational age and congenital malformations were studied, but above all we focused on the pattern of placental permeability to heavy metals.

Results: Our results are specifically related to foetal medicine and investigate the impact of foetal sex in transplacental metal exposure. Our results did not show any significant differences related to foetal sex in terms of congenital malformations or the other variables taken into consideration. However, because these conclusions are the first related to the gender medicine in transplacental foetal medicine, they could be a marked background for further studies.

Conclusions: Considering the lack of data in literature regarding foetal sexual medicine and transplacental exposure, these study results are pioneering in terms of sexual foetal medicine. Possibly in the future, studies regarding the correlation between foetal sex and obstetrics outcomes will be performed.

Introduction: With the increase in expected life duration, the life expectancy increases, and so one-third or more of a woman's life will be after the menopause. As a result, menopause, aging physiology and process management carry great importance for women's health. This study was conducted to investigate the effect of menopausal symptoms on women's daily life activities.

Material and methods: The sample of the descriptive and relationship-seeking study consisted of 381 women aged 40-64 years who agreed to participate in the study. The data of the study were collected by Personal Information Form, Menopause Symptoms Rating Scale, and Daily Living Activities Schedule. Descriptive statistical techniques were used to evaluate the data. Differences in independent groups were evaluated with Student's t-test and one-way ANOVA. The relationship between continuous variables was evaluated with the Pearson correlation analysis test.

Results: Of women participating in the research, 67.5% had not had a period for more than one year, and 95.5% entered the menopause through natural routes. The daily life activities most affected by the menopausal symptoms experienced by women were sleep, concentration, physical and mental fatigue, mental state, general quality of life, and enjoyment of life. The least affected daily living activities were sexuality and interpersonal communication. Advanced level significant positive correlations were found between the menopause rating scale and its sub-dimension scores and daily living activities scores of women (p < 0.05).

Conclusions: The results of this study showed that menopausal symptoms in the menopausal period negatively affected the daily activities of women.