Emotional dysregulation in women with endometriosis with cyclical and non-cyclical chronic pelvic pain.

BACKGROUND: Endometriosis is a pathophysiological condition characterized by glands and stroma outside the uterus in regions such as the bladder, ureter, fallopian tubes, peritoneum, ovaries, and even in extra pelvic sites. One of the main clinical problems of endometriosis is chronic pelvic pain (CPP), which considerably affects the patients' quality of life. Patients with endometriosis may, cyclically or non-cyclically (80% of cases) experience CPP. High levels of anxiety and depression have been described in patients with endometriosis related to CPP; however, this has not been evaluated in endometriosis women with different types of CPP. Therefore, the research question of this study was whether there is a difference in the emotional dysregulation due to the type of pain experienced by women with endometriosis? METHODS: This work was performed in the National Institute of Perinatology (INPer) in Mexico City from January 2019 to March 2020 and aimed to determine if there are differences in emotional dysregulation in patients with cyclical and non-cyclical CPP. 49 women from 18 to 52 years-old diagnosed with endometriosis presenting cyclical and non-cyclical CPP answered several batteries made up of Mini-Mental State Examination, Visual Analog Scale, Beck's Depression Inventory, State Trait-Anxiety Inventory, and Generalized Anxiety Inventory. Mann-Whitney U and Student's t-test for independent samples to compare the difference between groups was used. Relative risk estimation was performed to determine the association between non-cyclical and cyclical CPP with probability of presenting emotional dysregulation. RESULTS: We observed that patients with non-cyclical CPP exhibited higher levels of depression and anxiety (trait-state and generalized anxiety) than patients with cyclical pain, p < 0.05 was considered significant. No differences were observed in pain intensity, but there was a higher probability of developing emotional dysregulation (anxiety or depression) in patients with non-cyclical CPP. No differences were observed in cognitive impairment. CONCLUSIONS: Our data suggest that patients with non-cyclical (persistent) CPP present a higher emotional dysregulation than those with cyclical pain.

Expression of Membrane Progesterone Receptors in Eutopic and Ectopic Endometrium of Women with Endometriosis.

Endometriosis is one of the most frequent gynecological diseases in reproductive age women, but its etiology is not completely understood. Endometriosis is characterized by progesterone resistance, which has been explained in part by a decrease in the expression of the intracellular progesterone receptor in the ectopic endometrium. Progesterone action is also mediated by nongenomic mechanisms via membrane progesterone receptors (mPRs) that belong to the class II members of the progesterone and adipoQ receptor (PAQR) family. The aim of the present study was to evaluate the expression at mRNA and protein levels of mPR members in the eutopic and ectopic endometrium of women with endometriosis. Total RNA and total protein were isolated from control endometrium (17 samples), eutopic endometrium (17 samples), and ectopic endometrium (9 samples). The expression of PAQR7 (mPRα), PAQR8 (mPRß), and PAQR6 (mPRδ) at mRNA and protein levels was evaluated by RT-qPCR and Western blot, whereas PAQR5 (mPRγ) gene expression was evaluated by RT-qPCR. Statistical analysis between comparable groups was performed using one-way ANOVA followed by Tukey's multiple comparisons test with a confidence interval of 95 %. The analysis of gene expression showed that PAQR7 and PAQR5 expression was lower in both eutopic and ectopic endometrium as compared to the endometrium of women without endometriosis, whereas the expression of PAQR8 and PAQR6 was only reduced in eutopic endometrium. Furthermore, mPRα and mPRß protein content was decreased in the ectopic endometrium of women with endometriosis. Our results demonstrate a decrease in the expression and protein content of mPRs in eutopic and ectopic endometrium of patients with endometriosis, which could contribute to the progesterone resistance observed in patients with this disease.

Abordaje diagnóstico del cáncer de mama en el Instituto Nacional de Perinatología / Diagnostic approach of breast cancer in the National Institute of Perinatology

El cáncer de mama en la mujer ocupa el primer lugar como causa de muerte por cáncer en México, desde 2006. El diagnóstico tardío implica que el tratamiento sea más costoso, doloroso y con menor posibilidad de curación. Objetivo: Analizar el abordaje diagnóstico utilizado en el Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, en pacientes con diagnóstico de cáncer de mama. Material y métodos: Se realizó un estudio observacional, retrolectivo, transversal y descriptivo, de enero de 2004 a diciembre de 2010. Se incluyeron 54 pacientes de entre 29 y 85 años de edad; el motivo de la consulta fue presentar algún síntoma. El principal síntoma fue la tumoración mamaria, con un promedio de evolución de 8.4 meses; 84% presentaba lesión palpable; en 82.4% de los casos se realizó mastografía, y en 80.4%, ultrasonido. El diagnóstico definitivo de cáncer de mama se realizó mediante biopsia, en un tiempo promedio de 3.8 meses; en el 37% de los casos se realizó examen transoperatorio, el tipo histológico más frecuente fue el ductal infiltrante en 67.4%; se realizó el diagnóstico en estadio II en 46.3%. Al comparar la estadificación clínica con la patológica, el tamaño tumoral y ganglionar coincidieron en 64.7 y 59.5%, respectivamente. Conclusiones: El cáncer de mama constituye hoy una gran amenaza, y es uno de los desafíos más importantes para los profesionales de la salud de la mujer. Por lo tanto, el ginecoobstetra tiene un papel fundamental en la atención, diagnóstico y tratamiento de las enfermedades de la mama en la mujer.

The breast cancer is the first cause of death among cancers in Mexico, since 2006. Late diagnosis means that treatment is more expensive, painful, and has less chance of cure. Objective: Analyze the diagnostic approach done by the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes. Material and methods: A retrolective, observational, descriptive, cross sectional study was done, from January 2004 to December 2010. 54 patients, between 29 to 85 years of age were studied. The most important symptom to request consultation was tumor of the mammary gland, with an evolution of 8.4 months. 84% of the cases had a palpable lesion. Mastography was done in 82.4% of the cases and ultrasound in 80.4%. The final diagnosis of breast cancer, was done through biopsy in an average of 3.8 months, and in 37% of the cases an intraoperatory study was done. The histological type most seen was the ductal infiltrative, in 67.4% of the cases. The stage at the time of diagnosis was II, in 46.3% of the cases. Comparing clinical staging with pathological tumor size and nodal agreed 64.7 and 59.5% respectively. Conclusions: Therefore the OB-GYN has a key role in addressing the diagnosis and treatment of breast diseases in women.