Life | Special Issue : Diagnosis and Treatment of Obstetrics and Gynecology Diseases

Research

12 pages, 2874 KiB

Open AccessArticle

Clinicopathological Aspects of Dilation and Curettage (D&C) Biopsies Taken from Patients Living at High Altitude in Taif, KSA, with a Special Emphasis on Chronic Endometritis

by Howaida M. Hagag, Khadiga A. Ismail, Mashael M. Almutairi, Bushra I. Alnefaie, Seham H. Alajmani, Ashwaq M. Altalhi, Abdulaziz H. Alkhamash, Naif S. Althobaiti, Mohammed Awadh Alhumaidi, Ahmed Abdulwahab Bawahab and Abdulkarim Hasan

Life 2024, 14(8), 1021; https://doi.org/10.3390/life14081021 - 16 Aug 2024

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Abstract

Background: Chronic endometritis (CE) is a persistent inflammation of the uterine lining. Although it has a minimal clinical presentation, CE adversely affects the reproductive ability of women. The aims of this study were to detect pathological endometrial patterns in D&C biopsies and to [...] Read more.

Background: Chronic endometritis (CE) is a persistent inflammation of the uterine lining. Although it has a minimal clinical presentation, CE adversely affects the reproductive ability of women. The aims of this study were to detect pathological endometrial patterns in D&C biopsies and to evaluate chronic endometritis in patients living in a high-altitude area (1800 m above sea level) in order to determine the clinical pathological features and prevalence. Materials and methods: A cross-sectional study conducted at King Faisal Maternity Hospital included 100 samples of D&C biopsies from women complaining of various gynecological symptoms not due to gestational causes. The biopsies underwent tissue processing, H&E staining, and CD138 detection. Blood samples were taken for serological detection of infectious diseases, complete blood count, and chemical parameters. Results: The mean age of women in the study with CE was 48.5 ± 8.5 years, and that of those without CE was 46.9 ± 9.7 years. The most common complaints were abnormal uterine bleeding, accounting for 83%. CE was present in 8% of cases, and there was a nonsignificant difference in hematological parameters between women with CE and those with other pathological diagnoses. There were also nonsignificant differences in chemical parameters, except for FSH and LH levels, which showed a significant difference, with p-values of 0.05 and 0.02, respectively. It can be concluded that the most common gynecological complaint of women in this study was abnormal uterine bleeding. Conclusions: The most commonly diagnosed pathological endometrial disorder in D&C biopsies was disordered proliferative endometrium, followed by endometrial polyps and endometrial hyperplasia. All of these are usually associated with hormonal disturbance, which appeared to be very common in the women in this study. The prevalence of chronic endometritis detected in our study was 8%, which is relatively high. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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12 pages, 910 KiB

Open AccessArticle

Optimal Dietary Intake of Riboflavin Associated with Lower Risk of Cervical Cancer in Korea: Korean National Health and Nutrition Examination Survey 2010–2021

by Seon-Mi Lee, Aeran Seol, Hyun-Woong Cho, Kyung-Jin Min, Sanghoon Lee, Jin-Hwa Hong, Jae-Yun Song, Jae-Kwan Lee and Nak-Woo Lee

Life 2024, 14(4), 529; https://doi.org/10.3390/life14040529 - 20 Apr 2024

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Abstract

Background: This study aimed to evaluate the association between the dietary intake of vitamin B complex (thiamine, riboflavin, and niacin) and cervical cancer in Korea. Methods: The data from the Korean National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2021 were [...] Read more.

Background: This study aimed to evaluate the association between the dietary intake of vitamin B complex (thiamine, riboflavin, and niacin) and cervical cancer in Korea. Methods: The data from the Korean National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2021 were analyzed, which included 28,306 participants who were categorized into non-cervical cancer and cervical cancer groups. The following dietary intake threshold levels of thiamine, riboflavin, and niacin were identified based on the recommended daily allowances (RDAs): thiamine, 1.1 mg/day; riboflavin, 1.2 mg/day; and niacin, 14 mg/day. Results: Among 28,306 participants, 27,976 were in the non-cervical cancer group and 330 were in the cervical cancer group. Riboflavin intakes of more than 1.2 mg/day but less than 2.4 mg/day were associated with a significantly reduced risk of cervical cancer, whereas intakes of above 2.4 mg/day were not associated with cervical cancer. Thiamine and niacin intakes were not significantly related to the risk of cervical cancer. Conclusions: The results of this study suggest that an intake of riboflavin of 1.2–2.4 mg/day may contribute to a lower risk of cervical cancer. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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14 pages, 2581 KiB

Open AccessArticle

Evaluating Patient Preferences and Clinical Outcomes for Modified Laparoscopic Burch Colposuspension and Transobturator Tape Procedures in Stress Urinary Incontinence Treatment

by Simona Brasoveanu, Ligia Balulescu, Dorin Grigoraș, Dragos Erdelean, Flavius Olaru, Răzvan Bardan, Oana Balint, Mădălin-Marius Margan, Alexandru Alexandru, Ivan Cristiana-Smaranda and Laurențiu Pirtea

Life 2024, 14(3), 380; https://doi.org/10.3390/life14030380 - 14 Mar 2024

Cited by 1 | Viewed by 1063

Abstract

Objective: This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two prominent surgical techniques for treating Stress Urinary Incontinence (SUI): the modified laparoscopic Burch colposuspension and the transobturator tape (TOT) procedure. Material and Methods: A prospective [...] Read more.

Objective: This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two prominent surgical techniques for treating Stress Urinary Incontinence (SUI): the modified laparoscopic Burch colposuspension and the transobturator tape (TOT) procedure. Material and Methods: A prospective cohort study was conducted on 145 patients who recieved surgical treatment for SUI, of which 71 patients (49%) underwent the modified laparoscopic Burch procedure, while 74 patients (51%) received the TOT procedure. Data on clinical characteristics, treatment success rates, and postoperative outcomes were collected and analyzed to understand patient preferences and real-world clinical effectiveness. Results: This study revealed notable differences in patient demographics and clinical characteristics between the two groups. At the 2-year follow-up, a success rate of 100% was reported in the modified laparoscopic Burch group and 86.48% in the TOT group. A total of 99 patients (68.28%) were considered cured postoperatively, with 47 (66.20%) in the modified laparoscopic Burch group and 52 (70.27%) in the TOT group (p = 0.598). A significant difference was found in the incidence of dyspareunia, with six cases (8.10%) reported in the TOT group, compared to none reported in the modified laparoscopic Burch group (p = 0.028). The median operation time was significantly shorter in the TOT group, namely 15 min, compared to the modified laparoscopic Burch group, which had a median equal to 27 min (p < 0.001). Despite these differences, patient preference for either surgical technique was observed, along with similar success rates and varied postoperative outcomes. Conclusions: The findings provide a comprehensive overview of patient preferences and factual clinical outcomes for the two surgical techniques in SUI treatment. This study contributes to understanding the factors influencing patient choice and offers valuable insights into the real-world application of these techniques, enhancing patient-centered care in SUI management. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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13 pages, 821 KiB

Open AccessArticle

Women’s Sexual Dysfunctions Following Stem Cell Transplant and the Impact on Couple Relationship

by Mihaela Plotogea, Anca Zgura, Claudia Mehedințu, Francesca Scurtu, Aida Petca, Valentin Nicolae Varlas, Roxana Georgiana Bors, Antoine Edu, Oana-Maria Ionescu, Mihaela Andreescu, Radu Nicolae Mateescu and Al Jashi Isam

Life 2024, 14(1), 35; https://doi.org/10.3390/life14010035 - 25 Dec 2023

Cited by 1 | Viewed by 1099

Abstract

Stem cell transplant proved its efficacy in increasing the survival rate among young patients diagnosed with hematological malignancies. A transplant conditioning regimen is particularly destructive on the genital system, often determining premature ovarian failure, accompanied by vulvovaginal atrophy and sexual dysfunctions. The aims [...] Read more.

Stem cell transplant proved its efficacy in increasing the survival rate among young patients diagnosed with hematological malignancies. A transplant conditioning regimen is particularly destructive on the genital system, often determining premature ovarian failure, accompanied by vulvovaginal atrophy and sexual dysfunctions. The aims of the present study were, first, to evaluate sexual dysfunctions among transplanted women, using clinical examination and the female sexual function index (FSFI), and second, to determine their impact on a couple’s relationship. A prospective observational comparative study was performed and included 38 patients who underwent allogenic stem cell transplant (SCT) procedures for different hematological malignancies and 38 healthy patients (control group). This study included baseline evaluation, one-year, and three-year follow-up visits. In addition to anamnesis and medically obtained information, FSFI was evaluated to determine the impact of gynecological damage in a subjective manner. In the study group, vulvovaginal atrophy was diagnosed in 76.32%, with subsequent sexual dysfunctions in 92.10% of patients, based on FSFI scoring. Even though the results improved throughout the study, at the last visit, mild vulvovaginal atrophy was diagnosed in 81.58% of patients, and the FSFI score was abnormal for 21.05%. When compared to the control group, both sexual dysfunctions and FSFI results were considerably impaired, with statistical significance. There is a confirmed negative impact of sexual dysfunctions and self-declared FSFI on couple/marital status and couple relationships, with statistical significance, at the last visit. In conclusion, anatomical, functional, and psychological difficulties are a reality of long-term survivors after a stem cell transplant. They should be addressed and assessed equally to other medical conditions, as they may determine serious consequences and impact the sexual quality of life and the couple’s relationship. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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14 pages, 1784 KiB

Open AccessArticle

Detection of High-Grade Cervical Intraepithelial Neoplasia by Electrical Impedance Spectroscopy in Women Diagnosed with Low-Grade Cervical Intraepithelial Neoplasia in Cytology

by Georgios Panagakis, Ioannis K. Papapanagiotou, Charalampos Theofanakis, Paraskevi Tsetsa, Adamantia Kontogeorgi, Nikolaos Thomakos, Alexandros Rodolakis and Dimitrios Haidopoulos

Life 2023, 13(11), 2139; https://doi.org/10.3390/life13112139 - 31 Oct 2023

Cited by 2 | Viewed by 1438

Abstract

The authors attempt to address the importance of timely detection and management of cervical intraepithelial neoplasia (CIN) to prevent cervical cancer. The study focused on the potential of electrical impedance spectroscopy (EIS) as an adjunct to colposcopy, aiming to enhance the accuracy of [...] Read more.

The authors attempt to address the importance of timely detection and management of cervical intraepithelial neoplasia (CIN) to prevent cervical cancer. The study focused on the potential of electrical impedance spectroscopy (EIS) as an adjunct to colposcopy, aiming to enhance the accuracy of identifying high-grade cervical lesions. Colposcopy, a widely used technique, exhibited variable sensitivity in detecting high-grade lesions, which relies on the expertise of the operator. The study’s primary objective is to evaluate the effectiveness of combining colposcopy with EIS in detecting high-grade cervical lesions among patients initially diagnosed with low-grade CIN based on cytology. We employed a cross-sectional observational design, recruiting 101 women with abnormal cervical cytology results. The participants underwent colposcopy with acetic acid and subsequent EIS using the ZedScan device. The ZedScan results are categorized into color-coded probability levels, with red indicating the highest likelihood of high-grade squamous intraepithelial lesions (HSIL) occurrence. Results revealed that ZedScan exhibits a sensitivity rate of 89.5% and a specificity rate of 84% for detecting high-grade lesions. Colposcopy, on the other hand, recorded a sensitivity rate of 85.5% and a specificity rate of 92%. The agreement rate between ZedScan and biopsy is 79.2%, as indicated by a kappa coefficient of 0.71, while the agreement rate between colposcopy and biopsy is 74.3%, with a kappa coefficient of 0.71. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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12 pages, 619 KiB

Open AccessArticle

Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative Study

by Grigorios Karampas, Martin Witkowski, Dimitra Metallinou, Margareta Steinwall, Alkis Matsas, Theodoros Panoskaltsis and Panagiotis Christopoulos

Life 2023, 13(10), 2016; https://doi.org/10.3390/life13102016 - 5 Oct 2023

Viewed by 1640

Abstract

Trial of labor after cesarean (TOLAC) is an alternative to repeated cesarean for women with singleton pregnancy and one previous transverse lower segment cesarean section (LSCS), resulting in most cases being a successful vaginal birth after cesarean section (VBAC). The primary objective of [...] Read more.

Trial of labor after cesarean (TOLAC) is an alternative to repeated cesarean for women with singleton pregnancy and one previous transverse lower segment cesarean section (LSCS), resulting in most cases being a successful vaginal birth after cesarean section (VBAC). The primary objective of this study was to examine if the progress and the duration of the active first stage and the second stage of labor in nulliparous women with singleton pregnancy, spontaneous start of labor and vaginal birth differ from primiparous women succeeding VBAC after one previous elective LSCS in a country with a low cesarean section and high VBAC rate. Secondary objectives were to compare labor interventions and maternal–neonatal outcomes between the two groups. Methods: This is a retrospective comparative study. Data were collected in a four-year period at the departments of Obstetrics and Gynecology at Kristianstad and Ystad hospitals in Sweden. Out of 14,925 deliveries, 106 primipara women with one previous elective LSCS and a spontaneous labor onset in the subsequent singleton pregnancy were identified. Of these women, 94 (88.7%) delivered vaginally and were included in the study (VBAC group). The comparison group included 212 randomly selected nulliparous women that had a normal singleton pregnancy, spontaneous labor onset and delivered vaginally. Results: The rate of cervical dilation during the active first stage of labor as well as the duration of the second stage did not differ between the two groups. When adjusting for cervical dilation at admission, there was no significant difference between the two groups regarding the duration of the active phase of the first stage of labor. No significant differences were found in maternal–neonatal outcomes between the two groups except for higher birth weight in the VBAC group. The use of epidural analgesia was associated with slower dilation rhythm over the duration of the active phase and second stage of labor, need for labor augmentation, postpartum bleeding and need for transfusion at higher rates, irrespective of parity when epidural was used. Conclusions: Our study provides evidence that in women with one previous elective LSCS undergoing TOLAC in the subsequent pregnancy resulting in vaginal birth, the progress and duration of labor are not different from those in nulliparous women when labor is spontaneous and the it is a singleton pregnancy. The use of epidural was associated with prolonged labor, need for labor augmentation and higher postpartum bleeding, irrespective of parity. This information may be useful in patient counseling and labor management in TOLAC. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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11 pages, 686 KiB

Open AccessArticle

The Therapy of Vulvar Carcinoma—Evaluation of Surgical Options in a Retrospective Monocentric Study

by Peter Jankowski, Sebastian Findeklee, Mihai-Teodor Georgescu, Romina Marina Sima, Meletios P. Nigdelis, Erich-Franz Solomayer, Gilbert Georg Klamminger and Bashar Haj Hamoud

Life 2023, 13(10), 1973; https://doi.org/10.3390/life13101973 - 27 Sep 2023

Viewed by 3109

Abstract

(1) Background: Surgical-oncological treatment methods are continuously put to the test in times of evidence-based medicine—notably, a constant reevaluation remains key, especially for tumor entities with increasing incidence such as vulvar carcinoma. (2) Methods: In order to determine the postoperative clinical course of [...] Read more.

(1) Background: Surgical-oncological treatment methods are continuously put to the test in times of evidence-based medicine—notably, a constant reevaluation remains key, especially for tumor entities with increasing incidence such as vulvar carcinoma. (2) Methods: In order to determine the postoperative clinical course of different methods of vulvar excision (vulvectomy, hemivulvectomy) as well as inguinal lymph node removal (lymphadenectomy, sentinel lymph node biopsy) with regard to postoperative wound-healingprocess, perioperative hemorrhage, and re-resection rates, we retrospectively analyzed surgical, morphological and laboratory data of 76 patients with a pathological diagnosed vulvar cancer. (3) Results: Analysis of our data from a single center revealed a comparable perioperative clinical course regardless of the chosen method of vulvar excision and inguinal lymph node removal. (4) Conclusions: Thus, our results emphasize the current multimodality in surgical therapy of vulvar carcinoma, in which consideration of known prognostic factors together with the individual patient’s clinical situation allow guideline-based therapy aimed at maximizing surgical safety. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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13 pages, 3529 KiB

Open AccessArticle

Laparoscopic Pectopexy versus Vaginal Sacrospinous Ligament Fixation in the Treatment of Apical Prolapse

by Simona Brasoveanu, Razvan Ilina, Ligia Balulescu, Marilena Pirtea, Cristina Secosan, Dorin Grigoraș, Daniela Chiriac, Răzvan Bardan, Mădălin-Marius Margan, Alexandru Alexandru and Laurențiu Pirtea

Life 2023, 13(10), 1951; https://doi.org/10.3390/life13101951 - 23 Sep 2023

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Abstract

Objectives: To compare the follow-up results of a sacrospinous ligament fixation (SSLF) technique for laparoscopic bilateral fixation of the vagina to the iliopectineal ligament via a PVDF-mesh (laparoscopic pectopexy technique, LP) in terms of cure rate and postoperative complications rate. Material and methods: [...] Read more.

Objectives: To compare the follow-up results of a sacrospinous ligament fixation (SSLF) technique for laparoscopic bilateral fixation of the vagina to the iliopectineal ligament via a PVDF-mesh (laparoscopic pectopexy technique, LP) in terms of cure rate and postoperative complications rate. Material and methods: This prospective study included 160 patients diagnosed with pelvic organ prolapse stage II–IV according to the POP-Q system. Eighty-two patients (51.25%) underwent vaginal sacrospinous ligament fixation and seventy-eight patients (48.75%) underwent the laparoscopic pectopexy procedure. Results: The cure rate was high in both groups, 95.12% of the patients (78 out of 82) in the SSLF group and 93.59% of the patients (73 out of 78) in the LP group were cured post surgery, leading to an overall cure rate of 151 out of 160 patients. Pelvic pain was present in 5.00% of all patients, but was notably more frequent in the SSLF group (7, 8.54%) than in the LP group (1, 1.28%). Dyspareunia occurred in 4.37% of all patients, slightly more frequently in the SSLF group (6, 7.32%) than the LP group (1, 1.28%), but without significant difference. Conclusions: The laparoscopic pectopexy procedure has comparably positive follow-up results with the conventional sacrospinous ligament fixation procedure. Both SSLF and LP are effective in the treatment of pelvic organ prolapse, with favorable anatomical and subjective results, a high cure rate and low rates of serious postoperative complications. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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11 pages, 559 KiB

Open AccessArticle

Maternal and Neonatal Outcomes in Women with Metabolic Syndrome and Substance Use Disorder

by Vijaya Lakshmi Sundaram, Rajan Lamichhane, Alfred Cecchetti, Subha Arthur and Usha Murughiyan

Life 2023, 13(9), 1933; https://doi.org/10.3390/life13091933 - 19 Sep 2023

Viewed by 1534

Abstract

Introduction: Metabolic syndrome amplifies the risk of gestational diabetes, preeclampsia, and preterm labor in pregnant women. Similarly, women with substance use disorder have worsened obstetric and birth outcomes. Despite these two conditions being major healthcare disparities in Appalachia, the health outcomes of this [...] Read more.

Introduction: Metabolic syndrome amplifies the risk of gestational diabetes, preeclampsia, and preterm labor in pregnant women. Similarly, women with substance use disorder have worsened obstetric and birth outcomes. Despite these two conditions being major healthcare disparities in Appalachia, the health outcomes of this cohort have not been studied thus far. This study looks at the health outcomes of this cohort. Method and Results: In this retrospective cohort study, we analyzed 27,955 mothers who delivered at Cabell Huntington Hospital between January 2010 and November 2021. We implemented Chi-square tests to determine the associations and multiple logistic regression methods for comparison after controlling for other factors, and found that MetS, together with SUD, significantly increases the risk as well as the number of pregnancy complications such as gestational diabetes (p-value < 0.001), preeclampsia (p-value < 0.001), premature rupture (p-value < 0.001), preterm labor (p-value < 0.001), and newborn disorder (p-value < 0.001) compared to the women who had none or had either MetS or SUD alone. Conclusion: Women with both metabolic syndrome and substance abuse had worsened pregnancy and neonatal outcomes compared to women with metabolic syndrome or SUD alone. In conclusion, analysis of all the variables is crucial to strategically planning and implementing health interventions that will positively influence the health outcome of the pregnant woman as well as the child. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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11 pages, 752 KiB

Open AccessArticle

The Impact of the Microbiological Vaginal Swab on the Reproductive Outcome in Infertile Women

by Sebastian Findeklee, Lena Urban, Romina-Marina Sima, Simona Lucia Baus, Alexander Halfmann, Gudrun Wagenpfeil, Erich-Franz Solomayer and Bashar Haj Hamoud

Life 2023, 13(6), 1251; https://doi.org/10.3390/life13061251 - 25 May 2023

Cited by 1 | Viewed by 2016

Abstract

Background: The thesis on which this paper is based intended to investigate whether the result of the microbiological vaginal swab has an influence on the outcome of the fertility treatment. Methods: The microbiological vaginal swabs of patients who received fertility treatment at Saarland [...] Read more.

Background: The thesis on which this paper is based intended to investigate whether the result of the microbiological vaginal swab has an influence on the outcome of the fertility treatment. Methods: The microbiological vaginal swabs of patients who received fertility treatment at Saarland University Hospital were evaluated. Depending on the microorganisms detected, the swab result was classified as inconspicuous, intermediate, or conspicuous. The SPSS software was used to determine the correlation between the swab result and the outcome of the fertility treatment. Results: Dysbiosis was associated with a worse outcome of fertility treatment. The pregnancy rate with a conspicuous swab was 8.6%, whereas it was 13.4% with an inconspicuous swab. However, this association was not statistically significant. Furthermore, an association of endometriosis with dysbiosis was found. Endometriosis was more frequent with a conspicuous swab result than with an inconspicuous result (21.1% vs. 17.7%), yet the correlation was not statistically significant. However, the absence of lactobacilli was significantly associated with endometriosis (p = 0.021). The association between endometriosis and a lower pregnancy rate was also statistically significant (p = 0.006). Conclusion: The microbiological vaginal and cervical swabs can be used as predictors for the success of fertility treatments. Further studies are needed to assess the impact of transforming a dysbiotic flora into a eubiotic environment on the success of fertility treatments. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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Review

Jump to: Research, Other

22 pages, 4953 KiB

Open AccessReview

Stem-Cell-Derived Extracellular Vesicles: Unlocking New Possibilities for Treating Diminished Ovarian Reserve and Premature Ovarian Insufficiency

by Yana O. Martirosyan, Denis N. Silachev, Tatiana A. Nazarenko, Almina M. Birukova, Polina A. Vishnyakova and Gennadiy T. Sukhikh

Life 2023, 13(12), 2247; https://doi.org/10.3390/life13122247 - 23 Nov 2023

Cited by 6 | Viewed by 2714

Abstract

Despite advancements in assisted reproductive technology (ART), achieving successful pregnancy rates remains challenging. Diminished ovarian reserve and premature ovarian insufficiency hinder IVF success—about 20% of in vitro fertilization (IVF) patients face a poor prognosis due to a low response, leading to higher cancellations [...] Read more.

Despite advancements in assisted reproductive technology (ART), achieving successful pregnancy rates remains challenging. Diminished ovarian reserve and premature ovarian insufficiency hinder IVF success—about 20% of in vitro fertilization (IVF) patients face a poor prognosis due to a low response, leading to higher cancellations and reduced birth rates. In an attempt to address the issue of premature ovarian insufficiency (POI), we conducted systematic PubMed and Web of Science research, using keywords “stem cells”, “extracellular vesicles”, “premature ovarian insufficiency”, “diminished ovarian reserve” and “exosomes”. Amid the complex ovarian dynamics and challenges like POI, stem cell therapy and particularly the use of extracellular vesicles (EVs), a great potential is shown. EVs trigger paracrine mechanisms via microRNAs and bioactive molecules, suppressing apoptosis, stimulating angiogenesis and activating latent regenerative potential. Key microRNAs influence estrogen secretion, proliferation and apoptosis resistance. Extracellular vesicles present a lot of possibilities for treating infertility, and understanding their molecular mechanisms is crucial for maximizing EVs’ therapeutic potential in addressing ovarian disorders and promoting reproductive health. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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19 pages, 670 KiB

Open AccessReview

Prolactin in Polycystic Ovary Syndrome: Metabolic Effects and Therapeutic Prospects

by Lara Mastnak, Rok Herman, Simona Ferjan, Andrej Janež and Mojca Jensterle

Life 2023, 13(11), 2124; https://doi.org/10.3390/life13112124 - 26 Oct 2023

Cited by 3 | Viewed by 7047

Abstract

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine and metabolic disorder in premenopausal women, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. Patients frequently present comorbidities, including obesity, insulin resistance, and impaired glucose and lipid metabolism. The diverse clinical presentation may mimic [...] Read more.

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine and metabolic disorder in premenopausal women, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. Patients frequently present comorbidities, including obesity, insulin resistance, and impaired glucose and lipid metabolism. The diverse clinical presentation may mimic various endocrine disorders, making the diagnosis challenging in some clinical circumstances. Prolactin (PRL) is a recommended biomarker in the initial diagnostic workup to rule out hyperprolactinemia (HPRL). The traditional role of PRL is linked to lactation and the reproductive system. Recent research highlights PRL’s emerging role in metabolic homeostasis. PRL influences metabolism directly by interacting with the pancreas, liver, hypothalamus, and adipose tissue. Its influence on an individual’s metabolism is intricately tied to its serum concentration. While deficient and very high levels of PRL can negatively affect metabolism, intermediate–normal to moderately high levels may promote metabolic health. In women with PCOS, PRL levels may be altered. Research results on different aspects of the relationship between PCOS and the impact of various levels of PRL on metabolic homeostasis are limited and inconsistent. In this narrative literature review, we comprehensively examined data on serum PRL levels in PCOS patients. We investigated the correlation between a favorable metabolic profile and serum PRL levels in this population. Furthermore, we explored the concept of beneficial PRL effects on metabolism and discussed the potential therapeutic application of dopamine agonists in PCOS treatment. Lastly, we emphasized several promising avenues for future research in this field. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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18 pages, 896 KiB

Open AccessReview

Tumor Markers and Their Diagnostic Significance in Ovarian Cancer

by Alkis Matsas, Dimitrios Stefanoudakis, Theodore Troupis, Konstantinos Kontzoglou, Makarios Eleftheriades, Panagiotis Christopoulos, Theodoros Panoskaltsis, Eleni Stamoula and Dimitrios C. Iliopoulos

Life 2023, 13(8), 1689; https://doi.org/10.3390/life13081689 - 5 Aug 2023

Cited by 17 | Viewed by 8060

Abstract

Ovarian cancer (OC) is characterized by silent progression and late-stage diagnosis. It is critical to detect and accurately diagnose the disease early to improve survival rates. Tumor markers have emerged as valuable tools in the diagnosis and management of OC, offering non-invasive and [...] Read more.

Ovarian cancer (OC) is characterized by silent progression and late-stage diagnosis. It is critical to detect and accurately diagnose the disease early to improve survival rates. Tumor markers have emerged as valuable tools in the diagnosis and management of OC, offering non-invasive and cost-effective options for screening, monitoring, and prognosis. Purpose: This paper explores the diagnostic importance of various tumor markers including CA-125, CA15-3, CA 19-9, HE4,hCG, inhibin, AFP, and LDH, and their impact on disease monitoring and treatment response assessment. Methods: Article searches were performed on PubMed, Scopus, and Google Scholar. Keywords used for the searching process were “Ovarian cancer”, “Cancer biomarkers”, “Early detection”, “Cancer diagnosis”, “CA-125”,“CA 15-3”,“CA 19-9”, “HE4”,“hCG”, “inhibin”, “AFP”, “LDH”, and others. Results: HE4, when combined with CA-125, shows improved sensitivity and specificity, particularly in early-stage detection. Additionally, hCG holds promise as a prognostic marker, aiding treatment response prediction and outcome assessment. Novel markers like microRNAs, DNA methylation patterns, and circulating tumor cells offer potential for enhanced diagnostic accuracy and personalized management. Integrating these markers into a comprehensive panel may improve sensitivity and specificity in ovarian cancer diagnosis. However, careful interpretation of tumor marker results is necessary, considering factors such as age, menopausal status, and comorbidities. Further research is needed to validate and refine diagnostic algorithms, optimizing the clinical significance of tumor markers in ovarian cancer management. In conclusion, tumor markers such as CA-125, CA15-3, CA 19-9, HE4, and hCG provide valuable insights into ovarian cancer diagnosis, monitoring, and prognosis, with the potential to enhance early detection. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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11 pages, 591 KiB

Open AccessReview

The Evolving Landscape of Immunotherapy in Uterine Cancer: A Comprehensive Review

by Bashar Haj Hamoud, Romina Marina Sima, Ileana Adela Vacaroiu, Mihai-Teodor Georgescu, Anca Bobirca, Alexandra Gaube, Florin Bobirca and Dragos-Eugen Georgescu

Life 2023, 13(7), 1502; https://doi.org/10.3390/life13071502 - 3 Jul 2023

Cited by 6 | Viewed by 2828

Abstract

Endometrial cancer affects the uterus and is becoming increasingly common and deadly. Although surgery and adjuvant pelvic radiotherapy can often cure the disease when it is contained in the uterus, patients with metastatic or recurrent disease have limited response rates to chemotherapy, targeted [...] Read more.

Endometrial cancer affects the uterus and is becoming increasingly common and deadly. Although surgery and adjuvant pelvic radiotherapy can often cure the disease when it is contained in the uterus, patients with metastatic or recurrent disease have limited response rates to chemotherapy, targeted agents, and hormonal therapy. To address this unmet clinical need, innovative treatment strategies are needed, and a growing focus on the immunomodulation of the tumor microenvironment has arisen. Current data suggest that active and/or passive immunotherapy may be promising for the treatment of endometrial cancer. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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Other

Jump to: Research, Review

6 pages, 195 KiB

Open AccessBrief Report

Pregnant Patients with COVID-19 Admitted to an ICU: A Comparison with a Historical Cohort of Critical Pregnant Patients without COVID-19

by Carmine Iacovazzo, Letizia Capasso, Carola Visani, Serena Salomè and Maria Vargas

Life 2024, 14(2), 165; https://doi.org/10.3390/life14020165 - 23 Jan 2024

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Abstract

Aim of the study: Maternal mortality and ICU admissions have increased during the COVID-19 pandemic. We reported a case-series of pregnant patients with COVID-19 admitted to an ICU and we compared them with a historical cohort of pregnant patients admitted to an ICU [...] Read more.

Aim of the study: Maternal mortality and ICU admissions have increased during the COVID-19 pandemic. We reported a case-series of pregnant patients with COVID-19 admitted to an ICU and we compared them with a historical cohort of pregnant patients admitted to an ICU without COVID-19. Methods: We included all pregnant patients with laboratory-confirmed COVID-19 infection admitted to our ICU in 2021. As a historical control group, we included all pregnant women who were admitted to our ICU between 1 January 2008 and 31 December 2013. Results: In 2021, 11 pregnant patients (pts) with COVID-19 were admitted to an ICU, representing 2.87% of ICU admissions. We found that pregnant patients with COVID-19 (1) had a higher BMI (34.6 vs. 28.8, p = 0.04) and a lower gestational age (30.6 vs. 34 weeks, p = 0.03), (2) were mainly admitted for respiratory failure (100% vs. 2.7%; p = 0.001) and (3) required more days of invasive and non-invasive ventilations (54.5% vs. 5.2%, p = 0.002), a longer duration of stay at the ICU (21.9 vs. 4.8 days, p < 0.0001) and had a higher mortality rate (27.3% vs. 0%, p = 0.0192). Conclusions: Pregnant patients with COVID-19 represent a challenge for ICU physicians due to their different characteristics and outcomes when compared to pregnant patients without COVID-19. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

11 pages, 4202 KiB

Open AccessCase Report

Prolapsed Atypical Polypoid Adenomyoma—A Case Report and Literature Review

by Tudor Butureanu, Ana-Maria Haliciu, Ana-Maria Apetrei, Ioana Pavaleanu, Razvan Vladimir Socolov and Raluca Anca Balan

Life 2023, 13(12), 2352; https://doi.org/10.3390/life13122352 - 15 Dec 2023

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Abstract

Atypical polypoid adenomyoma (APAM) is a rare polypoid benign tumor of the uterus that causes irregular vaginal bleeding in women of reproductive age. It has the potential for malignant transformation, but it does not metastasize. APAM may coexist with endometrial hyperplasia and adenocarcinoma, [...] Read more.

Atypical polypoid adenomyoma (APAM) is a rare polypoid benign tumor of the uterus that causes irregular vaginal bleeding in women of reproductive age. It has the potential for malignant transformation, but it does not metastasize. APAM may coexist with endometrial hyperplasia and adenocarcinoma, usually leading to misdiagnosis. Histopathologically, it is a biphasic tumor, represented by the endometrioid glands with a complex histoarchitecture, with sometimes squamous morular metaplasia or cytologic atypia, interspersed with a fibromyomatous stroma. This tumor has a high incidence of recurrence. We present a very rare case of a 21-year-old patient, a virgin, without a significant medical history, with a bleeding mass occupying the vagina. The mass was excised using forceps, scissors, and a suture of the visible pedicle. After a four-year follow-up and no additional medical treatment, no relapse was observed. Given the risk of recurrence and progression, APAM might be treated via a hysterectomy in patients with no desire for pregnancy. Due to a lower recurrence rate, the conservative treatment of atypical polypoid adenomyoma performed via an operative hysteroscopy represents the best choice. Previously diagnosed in hysterectomy specimens, with the introduction of better-performing indirect imaging techniques, adenomyosis is a clinical entity that has the possibility of being diagnosed in the presurgical stage. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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8 pages, 952 KiB

Open AccessCase Report

The Successful Management of Primary Amenorrhea in Woodhouse–Sakati Syndrome: A Case Report and a Literature Review

by Hanadi Bakhsh, Norah Alqntash and Ebtesam Almajed

Life 2023, 13(10), 2022; https://doi.org/10.3390/life13102022 - 7 Oct 2023

Cited by 1 | Viewed by 1788

Abstract

Background: Woodhouse–Sakati syndrome (WSS) is a rare multisystemic disease resulting from an autosomal recessive gene mutation characterized by distinctive facial appearance, alopecia, impaired HbA1c, and hypogonadism. Purpose: To present the successful management of primary amenorrhea in a WSS patient. Case Presentation: We report [...] Read more.

Background: Woodhouse–Sakati syndrome (WSS) is a rare multisystemic disease resulting from an autosomal recessive gene mutation characterized by distinctive facial appearance, alopecia, impaired HbA1c, and hypogonadism. Purpose: To present the successful management of primary amenorrhea in a WSS patient. Case Presentation: We report a 19-year-old Saudi female referred to the gynecology clinic at the age of 16 as a case of primary amenorrhea. The patient underwent a genetic analysis, which revealed mutations in the DCAF17 gene, confirming the diagnosis of WSS. Treatment includes hormonal replacement therapy for the induction of puberty. Conclusions: Careful and detailed medical and physical examination led to appropriate testing confirming the WSS diagnosis. Genetic tests for family members and the offspring of the patient are strongly recommended. Treatment timing and dosage are determined by the patient’s individual needs, which take into consideration the patient’s potential for growth, the family’s readiness, and any comorbidities. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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10 pages, 525 KiB

Open AccessSystematic Review

Surgical Treatments for Women with Stress Urinary Incontinence: A Systematic Review

by Bogdan Cristian Călinescu, Adrian Neacșu, Ana Elena Martiniuc, Dan Dumitrescu, Catalina Diana Stănică, George-Alexandru Roșu, Laura Ioana Chivu and Raluca Gabriela Ioan

Life 2023, 13(7), 1480; https://doi.org/10.3390/life13071480 - 30 Jun 2023

Cited by 4 | Viewed by 2096

Abstract

Stress urinary incontinence affects a large proportion of women in their lifetime. The objective of this review was to describe and compare the latest surgical trends in urinary incontinence and focus on the literature advantages, disadvantages, complications and efficacy of surgical procedures regarding [...] Read more.

Stress urinary incontinence affects a large proportion of women in their lifetime. The objective of this review was to describe and compare the latest surgical trends in urinary incontinence and focus on the literature advantages, disadvantages, complications and efficacy of surgical procedures regarding this pathology. Using network meta-analysis, we have identified the most frequently used procedures (Burch surgery, midurethral sling and pubovaginal sling), and we have described and characterized them in terms of effectiveness and safety. Midurethral procedures remain the gold standard for surgical treatment of stress urinary incontinence, although the potential of serious complications following this procedure should be taken into consideration always. There is a clear need for a much more unified evaluation of possible complications and postoperative evolution. This process will help practitioners to adapt and individualize their strategy for each patient. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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7 pages, 1370 KiB

Open AccessCase Report

Acute Promyelocytic Leukemia and Severe Differentiation Syndrome in Pregnancy—A Management Challenge

by Gabriela Droc, Maria Camelia Stancioaica, Corina Gabriela Soare, Mihai-Gabriel Stefan, Daiana Ingustu, Cristina Martac, Daniel Coriu, Sebastian Isac, Nicolae Suciu and Stefan Andrei

Life 2023, 13(5), 1141; https://doi.org/10.3390/life13051141 - 8 May 2023

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Abstract

Acute promyelocytic leukemia (APL) is generated by the PML-RARA fusion gene. In patients suffering from APL, the early diagnosis and treatment are essential in the successful management. We reported a case of a 27-year-old 17th-week pregnant patient diagnosed with APL. After an extensive [...] Read more.

Acute promyelocytic leukemia (APL) is generated by the PML-RARA fusion gene. In patients suffering from APL, the early diagnosis and treatment are essential in the successful management. We reported a case of a 27-year-old 17th-week pregnant patient diagnosed with APL. After an extensive hematological diagnostic panel, the acute promyelocytic leukemia was confirmed, and the patient received all-trans retinoic acid (ATRA), idarubicin (IDA), and dexamethasone, following national guidelines. Due to ATRA-related differentiation syndrome, the therapy was adjusted, and hydroxycarbamide was added with a good outcome. The patient was admitted to the ICU secondary to hypoxemic respiratory failure on the 2nd day after hospital admission. Our patient received an individualized drug combination, adjusted by the clinical response. Furthermore, the drugs used in APL treatment are all teratogenic. Despite various major complications, including severe acute respiratory distress syndrome (ARDS), which needed mechanical ventilation; ICU-acquired myopathy; and spontaneous abortion, the patient had a good outcome and was transferred from the ICU after a total stay of 40 days. APL during pregnancy is a rare entity of intermediate-risk APL. Our study emphasized the need for individualized therapy in a rare case of a pregnant woman diagnosed with a potentially fatal hematologic disease. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstetrics and Gynecology Diseases)

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