Przeglad Menopauzalny最新文献

Introduction: Weight loss after bariatric surgery is attributed, at least in part, to the altered gastrointestinal (GI) hormone secretion, which is thought to be responsible for a number of beneficial metabolic effects.

Material and methods: We conducted a cross-sectional study. Twelve patients who underwent laparoscopic sleeve gastrectomy (SG) and 20 patients who underwent a variant of biliopancreatic diversion with Roux-en-Y gastric bypass and long limbs (BPD/RYGB-LL) were evaluated ≥ 7 years postoperatively. Ghrelin, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY) secretion were compared between patients with successful weight loss maintenance (WM group) and patients with weight regain (WR group).

Results: In both types of surgery, standard liquid mixed meal (SLMM) ingestion did not result in significant changes in fasting GI hormone levels. Fasting ghrelin levels did not differ between the WM group and the WR group in both types of surgery. In SG patients, SLMM ingestion elicited greater suppression of ghrelin levels in the WM group (p = 0.032). No difference in GLP-1 secretion was observed between the 2 groups of patients in both types of surgery. When patients were examined, regardless of the type of bariatric surgery they had undergone, postprandial PYY levels were lower in the WM group (p < 0.05), while fasting and postprandial PYY levels were correlated positively with an increase in body mass index (BMI) in the evaluation (Spearman's rho ≥ 0.395, p < 0.03).

Conclusions: Our data do not support the hypothesis that long-term weight regain after bariatric surgery is associated with an unfavourable GI hormone secretion pattern.

Introduction: The activities of daily living (ADLs) are a set of basic skills necessary for self-care. The inability of elderly people to perform ADLs leads to dependence, insecure conditions, and poor quality of life. The COVID-19 pandemic has affected all aspects of the daily life of the elderly. This study aimed to determine the factors associated with ADLs among elderly people during the COVID-19 pandemic using structural equation modelling/path analysis.

Material and methods: It was a descriptive-analytical study which had conducted on 487 elderly people who were selected randomly to participate in the study. Data collection tools included a demographic information questionnaire, an activities of daily living questionnaire, a knee pain and personal performance questionnaire Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and the falls efficacy scale, which were completed by interview and self-report methods. SPSS-22 and AMOS software were used for data analysis.

Results: Two structures of the fear of falling (FOF) and knee pain and personal performance questionnaire WOMAC had a significant role in explaining the ADL variance among the studied elderly people (p < 0.001, root mean square error of approximation = 0.063). These variables explained 64% of the ADL variance.

Conclusions: The structures of this model (FOF and WOMAC) can be used as a reference framework to design effective interventions for improving ADLs among elderly people during the COVID-19 epidemic. It is also recommended that a multi-component program be provided, which includes exercise and psychological strategies for this population during the COVID-19 pandemic through online videos, distance health programs, etc.

Recently, a dramatic increase in the average life expectancy has been noted, regarded as the one of the greatest achievements of the last decades, but in consequence osteoporosis affects millions of people all over the world. Currently osteoporosis is defined as a skeletal disorder characterized by compromised bone strength which leads to an increased risk of fractures. The most commonly used tool to evaluate the 10-year risk of fractures is the fracture risk assessment tool validated in many independent cohorts. Osteoporosis itself has no symptoms, but fractures are common symptoms of osteoporosis which can result in disability and mortality. Hence, osteoporosis is called a silent epidemic as well as a silent killer. The best way to assess patients with osteoporosis is by using the most widely employed techniques - dual-energy X-ray absorptiometry or quantitative computed tomography. There are a lot of precisely documented risk factors of osteoporosis - e.g. cigarette smoking, alcohol use, getting little or no exercise, being small-framed or thin, a diet low in foods containing calcium and vitamin D - and their limitation or elimination is the best way for prophylactics of this dangerous disease. Some other risk factors such as age and sex of patients should not be omitted in the decision making process. In the literature there are numerous therapeutic proposals and different guidelines. In this review we present the recent advances in the prophylactics and treatment of osteoporosis.

Endometriosis is a chronic inflammatory disorder with a prevalence of six to ten percent in women of childbearing age. As long as the aetiology of endometriosis is not fully understood and the disease has no definitive treatment, an examination of the environmental factors or interventions that could modify or cure endometriosis would greatly benefit women suffering from this chronic condition. This literature review utilized the electronic databases PubMed, EMBASE, and MEDLINE until February 2021. Studies indicate that fish oil may have a positive effect on reducing endometriosis-related pain due to the effects of pro-inflammatory prostaglandins derived from omega-3 fatty acids. The same effect was seen with the introduction of antioxidant vitamins C, D, and E. There is clinical viability of a low fermentable oligo-, di-, and mono-saccharides and polyols diet to successfully reduce the symptoms of patients who suffer from both endometriosis and irritable bowel syndrome. Despite the low level of evidence, there are frequent associations between endometriosis and gastrointestinal conditions in addition to the influence of various nutritional factors on the disease. The management of endometriosis requires a holistic approach focused on reducing overall inflammation, increasing detoxification, and attenuating troublesome symptoms. A dietician may provide great benefit in the management of these patients, especially at younger ages and in early stages. High-level evidence and well-designed randomized studies are lacking when it comes to studying the effect of lifestyle and dietary intake on endometriosis. Inarguably, further research with a more extensive focus is needed.

Introduction: Isolation and self-quarantine can expose individuals, particularly older people, to cognitive and physical decline. Due to a reduction in their musculoskeletal and neural flexibility, older adults are more likely to be affected by quarantine limitations. This study aimed to investigate the effect of self-quarantine on cognitive and balance performance of older women during the COVID-19 outbreak.

Material and methods: In a convenience sampling method, a total of 75 older adult women were recruited in this ex post facto study. The mini-mental state exam, single leg stance test, and timed up and go test were used to assess cognitive functions, static, and dynamic balance, respectively. Fall risk was measured by the Johns Hopkins assessment tool. Evaluations were performed before and after 7 months of quarantine due to the COVID-19 outbreak (November 2019 - June 2020), in which volunteers were at the lowest level of physical and social interaction.

Results: No significant difference was observed in the mean static balance performance of the older adult women between the baseline and quarantine phases [p = 0.095, t (df) = -1.69]. The dynamic balance performance [p < 0.001, t (df) = 5.6] and cognitive status (p < 0.001, t = -7.4) decreased and the fall rate increased [p < 0.001, t (df) = 7.35] after 7 months of quarantine.

Conclusions: It seems that self-quarantine can cause a decline in cognitive functions and dynamic balance performance of older women. It implies that the decrease in social interactions and physical activities caused by the limitations of self-quarantine put individuals at greater risk of cognitive impairment and increase their falling rate by impairing dynamic balance.

Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder and is one of the most common causes of infertility. The study aimed to investigate the association between endometrial polyp and infertility in PCOS in a high-incidence region such as the Middle East. Also, to identify the most common risk factors for endometrial polyp(s) in PCOS patients with infertility.

Material and methods: We conducted a retrospective cohort study on a total of 250 patients with a confirmed diagnosis of a PCOS. Eighty patients out of the 250 were finally included in the study after a high suspicion of endometrial polyp by 2-D transvaginal ultrasound at the early follicular phase, and they underwent an office hysteroscopy at the late follicular phase after proper counselling.

Results: Out of 80 patients enrolled in the study, 62 were confirmed to have endometrial polyp(s) by office hysteroscopy; 6 patients had a polypoid endometrium, 10 patients had an isolated increased endometrial thickness, and 2 patients had a small submucosal fibroid (less than 1.5 cm). The most observed co-factors in patients with PCOS and endometrial polyps are obesity, followed by oligomenorrhoea and amenorrhoea (hyperoestrogenic status).

Conclusions: Our study found that there is an association between PCOS with infertility and endometrial polyp(s). The most common associated factor is obesity, followed by oligomenorrhoea and amenorrhoea (hyperoestrogenic status). We hope that our study will raise global awareness about the unwanted effects of obesity in PCOS on general and reproductive health. A large study in the future is needed to confirm our results.

Gestational trophoblastic disease (GTD) covers a range of proliferative disorders from non-neoplastic hydatid moles to malignant neoplastic conditions such as choriocarcinoma. The incidence of these diseases is low and often challenging to diagnose. Placental site trophoblastic tumour (PSTT) is the rarest form of GTD, accounting for up to 3% of all cases. We present a case of a 35-year-old patient diagnosed with PSTT mimicking an intramural pregnancy. Placental site trophoblastic tumour occurred after pregnancy, which ended as a blighted ovum. β-hCG was not very high, and the patient had no complaints. The diagnosis was made after resection of formation which was accepted for intramural pregnancy. To our knowledge, this is the first such case described in the literature. A hysterectomy performed later confirmed the absence of a residual tumour after conservative intervention. The lack of distant metastases, confirmed by positron emission tomography-computed tomography scan, allowed for only hysterectomy with bilateral salpingo-oophorectomy to be performed. The patient was classified as low risk according to the World Health Organization (WHO) scoring system. Placental site trophoblastic tumour is a rare malignant tumour (despite its WHO coding) from the group of GTDs. It is not presented with a classic clinical picture, and its clinical diagnosis is challenging. However, clinicians should consider it in the case of unclear events after any type of pregnancy.

Introduction: It has become imperative to revisit facilitating factors of dysmenorrheal painful menstruation in order to further understand contributory habits common in the affected population. Hence, the present study aimed to explore lifestyles common among female students experiencing dysmenorrhea.

Material and methods: The survey was carried out among 358 female students. Data were obtained using a researcher-administered questionnaire from a sample size of 208 that was derived using the multistage sampling method. The descriptive method of analysis was used to analyze responses from respondents.

Results: It was revealed that 175 (89.7%) experience dysmenorrhea, which is higher than the number of respondents (42.6%) with a family history of dysmenorrhea, and dysmenorrheal symptoms of 106 (60.6%) of respondents are aggravated by excessive intake of sweet drinks/snacks. On a 5-point Likert scale with criterion mean 3, management of dysmenorrhea among respondents shows that they likely needed medication (3.93 ±0.72), used prescribed medications from varying sources (3.31 ±1.47), with an increased likelihood to use any home remedies or self-care such as herbal mixtures and assuming a comfortable body position (3.42 ±1.35) to ease period pain.

Conclusions: Critical empirical consideration is needed to review non-pharmacological interventions to relieve painful menstruation following a rise in the incidence of dysmenorrhea.

The incidence of ectopic pregnancy (EP) is about 1.3-2.4%. Approximately 6% of maternal deaths in the first trimester occur following ruptured EP. A 35-year-old lady, G4, P3, pregnant 7 weeks + 2 days, presented with left iliac pain, after positive pregnancy test, and β-human chorionic gonadotropin (β-hCG) 3614 mIU/ml. The transvaginal sonography showed an empty uterus, with a well-defined left adnexal echogenic structure measuring 38×32 mm (left adnexal gestational sac - GS) with foetal pole (bagel sign). The colour Doppler examination showed foetal cardiac activity with circumferential Doppler flow around the GS (ring of fire). She was diagnosed as left undisturbed tubal pregnancy with foetal cardiac activity. She refused the option of laparoscopic surgery. Therefore, she was counselled for medical treatment using methotrexate (MTX). She was also informed that the MTX treatment may fail due to the presence of foetal cardiac activity, and she may need more than one MTX dose. She received the first MTX dose at an initial β-hCG 3614 mIU/ml. The fourth day β-hCG after the first MTX dose was 5421 mIU/ml, while the seventh day β-hCG was 5055 mIU/ml [< 15% decrease of β-hCG (6.75%)]; therefore, she was given a second MTX dose. The fourth day β-hCG after the second MTX dose was 3851 mIU/ml, while the seventh day β-hCG was 2218 mIU/ml [> 15% decrease of β-hCG (42.4%)]; therefore, she was discharged home for follow-up in the outpatient department. This report represents the treatment of left undisturbed tubal pregnancy with foetal cardiac activity using a two-dose MTX regimen.

Introduction: The purpose of this study was to investigate the analgesic effect of 3 different regimens of combination analgesics administered to patients undergoing thyroidectomy.

Material and methods: A total of 152 patients undergoing total or subtotal thyroidectomy were enrolled. Patients allocated to group A received a combination of intravenous (IV) paracetamol and intramuscular (IM) pethidine, patients in group B received a combination of IV paracetamol and IV parecoxib, while patients in group C received IV paracetamol monotherapy.

Results: The analgesic regimens of groups A and B were found to be of equivalent efficacy (p-value = 1.000). In contrast, patients in group C (paracetamol monotherapy) had higher numerical rating scale scores, compared to both patients in groups A (p-value < 0.001) and B (p-value < 0.001).

Conclusions: The combinations of IV paracetamol with either IM pethidine or IV parecoxib are superior to IV paracetamol monotherapy in achieving pain control in patients undergoing thyroid surgery.