Mental illness and sleep disorders among women with gynecological problems.

This retrospective cohort study identifies differences between rates of selected mental illnesses and sleep disorders according to eight gynecological problems. Analyses utilize medical claims data for adult employees of a large corporation during 2017-2021. Women with a gynecological problem (most notably pain, endometriosis, pelvic inflammation and bleeding) are significantly more likely to experience mental illness. Several gynecological problems are also significantly associated with sleep disorders. Women with a gynecological problem (vs. none) are 50% more likely to have a mental health problem and 44% more likely to have a sleep disorder after adjusting for age, marital status, dependent children and year. The largest differences between higher (%) mental illness and sleep disorders appear for hyperplasia (6% vs. 45%), cancer (11% vs. 68%), pelvic inflammation (46% vs. 79%) and pain (79% vs. 43%), respectively. On the other hand, the rate of having one or more gynecological problems ranges from 7.1% for women with no mental illness or sleep disorder to 20.6% for women with schizophrenia. Understanding the association between gynecological problems, mental illness and sleep disorders can help clinicians more effectively identify and treat patients.

Effectiveness and safety of SR-ENS-600endoscopic surgical system in benign and malignant gynecological diseases: a prospective, multicenter, clinical trial with 63 cases.

Single-port laparoscopy has gained more attention, but inherent technical challenges hinder its wider use. To overcome the disadvantage of traditional single-port surgery, robotic laparoendoscopic single-site surgery system was designed and clinically utilized. This multi-center single-arm trial was aimed to present the clinical outcomes of the SHURUI robotic endoscopic single-site surgery system. 63 women with ovary cysts, myoma, cervical epithelial neoplasm, or endometrial carcinoma were recruited at 6 academic medical centers in different districts of China. The trial was registered on September 5, 2023, with the register number: ChiCTR2300075431, retrospectively registered. Patients underwent robotic LESS surgery with the SHURUI endoscopic surgical system from January 17 to May 26, 2023. Demographic information, perioperative parameters, complications, scar healing, and operator satisfaction scores were recorded. Patients were followed up for 30 ± 4 days. Average operative time and estimated blood loss were 157.03 ± 75.24 min and 63.86 ± 98.33 ml, respectively, for all surgeries. Average anal exhaust time and hospitalization stay were 30.99 ± 14.25 h and 3.63 ± 1.59 days, respectively. Patients' postoperative rehabilitation assessment showed satisfactory results on the day of discharge and 30 ± 4 days after surgery. The surgery achieved good cosmetic benefits and was surgeon friendly. There were no conversions to alternative surgical modalities, complications, or readmissions. The SHURUI endoscopic surgical system showed both the technical feasibility and safety of this surgical modality for gynecologic patients. Further randomized studies comparing this modality with traditional LESS surgery are suggested.

Genital route in experimental infection, a promising approach to study genital leptospirosis in ruminants.

Infection by Leptospira sp., mainly strains from the Sejroe serogroup, impairs the reproductive efficiency of ruminants leading to economic losses. Although the majority of experimental studies use the intraperitoneal route of leptospiral infection, it has been suggested that natural infection occurs frequently by sexual transmission. Thus, we assessed the genital route of infection to study genital leptospirosis in the sheep model. A strain of L. borgpetersenii serogroup Sejroe, serovar Hardjobovis was inoculated in 18 ewes, divided into three groups for inoculation: intraperitoneal (n=6; Gip), cervical superficial (genital) (n=6; Ggen) and conjunctival (n=6; Gconj). Monthly, for 90 days, blood samples were collected for serology (MAT) and PCR was performed on urine, cervical-vaginal mucus, and uterine fragments. All ewes were successfully infected, independently of the infection route. Gip and Ggen did not differ throughout the experiment, either on seroconversion or on PCR positivity on urine or genital samples. In contrast, Gconj presented fewer seroreactive animals (P<0.05) and fewer PCR-pos on genital samples than the other groups. The results obtained demonstrated that, although all groups presented both urinary and genital infections, the genital route was more efficient and did not differ from the traditional intraperitoneal. It indicates that genital via, besides being a naturally occurring transmission via, represents a promising and interesting route regarding future studies related to genital leptospirosis in ruminants, and its use should be encouraged.

Knowledge of female genital schistosomiasis and urinary schistosomiasis among final-year midwifery students in the Volta Region of Ghana.

BACKGROUND: Female genital schistosomiasis (FGS) is a gynaecological complication of urinary schistosomiasis (US) with an estimated burden of 20-120 million cases in endemic areas. A neglected sexual and reproductive health disease in sub-Saharan Africa, FGS increases susceptibility to sexually transmitted infections including cervical cancer and infertility among other morbidities. However, there appears to be limited FGS knowledge among practicing and pre-service health providers with implications for control. We assessed FGS awareness among final-year midwifery students who would soon be delivering primary maternal and reproductive health care. METHODS: A cross-sectional study was conducted among 193 randomly selected final-year students from all three midwifery training institutions in the Volta region of Ghana in August/September, 2022. Data on participants' demographics and knowledge of the transmission, signs and symptoms, complications, treatment and prevention of both FGS and US were collected using structured questionnaires. Summary statistics were presented as frequencies, proportions and percentages. RESULTS: Only 23.3% (44/189) of participants had heard about FGS compared to 64% (123/192) for US. Of the former, 42 (95%), 40 (91%) and 36 (81.8%) respectively identified genital itching/burning sensation, bloody vaginal discharge and pelvic pain/pain during intercourse as part of the symptoms of FGS. Less than a third (13/44) and about half (25/44) of those who indicated hearing about FGS knew it can be a risk for ectopic pregnancies and infertility respectively. Majority of these participants, 40 (91%), wrongly selected antibiotics as treatment for FGS while 9 indicated it is prevented by sleeping in insecticide-treated nets. CONCLUSION: Awareness of FGS was limited among the study participants. The high prevalence of knowledge of some FGS symptoms related to the genitalia needs cautious interpretation. Health care training institutions must make deliberate efforts to highlight FGS in the training of midwives as the condition has diagnostic and management implications for some sexual and reproductive health conditions.

Aetiology of vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa: A systematic review and meta-regression.

BACKGROUND: Syndromic management is widely used to treat symptomatic sexually transmitted infections in settings without aetiologic diagnostics. However, underlying aetiologies and consequent treatment suitability are uncertain without regular assessment. This systematic review estimated the distribution, trends, and determinants of aetiologies for vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa (SSA). METHODS AND FINDINGS: We searched Embase, MEDLINE, Global Health, Web of Science, and grey literature from inception until December 20, 2023, for observational studies reporting aetiologic diagnoses among symptomatic populations in SSA. We adjusted observations for diagnostic test performance, used generalised linear mixed-effects meta-regressions to generate estimates, and critically appraised studies using an adapted Joanna Briggs Institute checklist. Of 4,418 identified records, 206 reports were included from 190 studies in 32 countries conducted between 1969 and 2022. In 2015, estimated primary aetiologies for vaginal discharge were candidiasis (69.4% [95% confidence interval (CI): 44.3% to 86.6%], n = 50), bacterial vaginosis (50.0% [95% CI: 32.3% to 67.8%], n = 39), chlamydia (16.2% [95% CI: 8.6% to 28.5%], n = 50), and trichomoniasis (12.9% [95% CI: 7.7% to 20.7%], n = 80); for urethral discharge were gonorrhoea (77.1% [95% CI: 68.1% to 84.1%], n = 68) and chlamydia (21.9% [95% CI: 15.4% to 30.3%], n = 48); and for genital ulcer were herpes simplex virus type 2 (HSV-2) (48.3% [95% CI: 32.9% to 64.1%], n = 47) and syphilis (9.3% [95% CI: 6.4% to 13.4%], n = 117). Temporal variation was substantial, particularly for genital ulcer where HSV-2 replaced chancroid as the primary cause. Aetiologic distributions for each symptom were largely the same across regions and population strata, despite HIV status and age being significantly associated with several infection diagnoses. Limitations of the review include the absence of studies in 16 of 48 SSA countries, substantial heterogeneity in study observations, and impeded assessment of this variability due to incomplete or inconsistent reporting across studies. CONCLUSIONS: In our study, syndrome aetiologies in SSA aligned with World Health Organization guidelines without strong evidence of geographic or demographic variation, supporting broad guideline applicability. Temporal changes underscore the importance of regular aetiologic re-assessment for effective syndromic management. PROSPERO NUMBER: CRD42022348045.

The Role of Nanomedicine in Benign Gynecologic Disorders.

Nanomedicine has revolutionized drug delivery in the last two decades. Nanoparticles appear to be a promising drug delivery platform in the treatment of various gynecological disorders including uterine leiomyoma, endometriosis, polycystic ovarian syndrome (PCOS), and menopause. Nanoparticles are tiny (mean size < 1000 nm), biodegradable, biocompatible, non-toxic, safe, and relatively inexpensive materials commonly used in imaging and the drug delivery of various therapeutics, such as chemotherapeutics, small molecule inhibitors, immune mediators, protein peptides and non-coding RNA. We performed a literature review of published studies to examine the role of nanoparticles in treating uterine leiomyoma, endometriosis, PCOS, and menopause. In uterine leiomyoma, nanoparticles containing 2-methoxyestradiole and simvastatin, promising uterine fibroid treatments, have been effective in significantly inhibiting tumor growth compared to controls in in vivo mouse models with patient-derived leiomyoma xenografts. Nanoparticles have also shown efficacy in delivering magnetic hyperthermia to ablate endometriotic tissue. Moreover, nanoparticles can be used to deliver hormones and have shown efficacy as a mechanism for transdermal hormone replacement therapy in individuals with menopause. In this review, we aim to summarize research findings and report the efficacy of nanoparticles and nanotherapeutics in the treatment of various benign gynecologic conditions.

Successful use of tralokinumab for the treatment of atopic dermatitis on the genitals.

BACKGROUND: Genital involvement in atopic dermatitis(AD) can have a significant impact on the patient's quality of life. However, inspection of genital areas is not usually conducted during routine examination and patients may be reluctant to inform the clinician or show this area. OBJECTIVE: to evaluate the efficacy of tralokinumab in AD patients with genital involvement. METHODS: Adult patients with moderate/severe AD and genital involvement receiving tralokinumab have been analyzed. Primary endpoints were EASI, DLQI, PP-NRS, genital-IGA (g-IGA) and genital itching (GI) at week 16. RESULTS: out of 48 patients with moderate/severe AD under treatment with tralokinumab, 12 patients (25%) showed a genital involvement. Seven patients reported itching in the genital area (58%), while none reported a positive history of genital infections. Median scores at T0 were EASI 17.5, PP-NRS 8 and DLQI 14. After 16 weeks of treatment, we observed a median EASI of 3, a median PP-NRS of 1 and a median DLQI of 1. Finally, concerning the genital response, after 16 weeks of treatment, we observed a statistically significant decrease in mean GI and g-IGA scores. CONCLUSION: despite the small size of our sample, tralokinumab can be considered as a valid treatment option for AD with genital involvement.

Beyond the reproductive tract: gut microbiome and its influence on gynecological health.

PURPOSE OF REVIEW: The analysis of microbiome in association with female health is today a "hot topic" with the main focus on microbes in the female reproductive tract. Nevertheless, recent studies are providing novel information of the possible influence of the gut microbiome on gynecological health outcomes, especially as we start to understand that the gut microbiome is an extended endocrine organ influencing female hormonal levels. This review summarizes the current knowledge of the gut microbes in association with gynecological health. RECENT FINDINGS: The gut microbiome has been associated with endometriosis, polycystic ovary syndrome, gynecological cancers, and infertility, although there is a lack of consistency and consensus among studies due to different study designs and protocols used, and the studies in general are underpowered. SUMMARY: The interconnection between the gut microbiome and reproductive health is complex and further research is warranted. The current knowledge in the field emphasizes the link between the microbiome and gynecological health outcomes, with high potential for novel diagnostic and treatment tools via modulation of the microenvironment.

Fusobacterium nucleatum: An Overview of Evidence, Demi-Decadal Trends, and Its Role in Adverse Pregnancy Outcomes and Various Gynecological Diseases, including Cancers.

Gynecological and obstetric infectious diseases are crucial to women's health. There is growing evidence that links the presence of Fusobacterium nucleatum (F. nucleatum), an anaerobic oral commensal and potential periodontal pathogen, to the development and progression of various human diseases, including cancers. While the role of this opportunistic oral pathogen has been extensively studied in colorectal cancer in recent years, research on its epidemiological evidence and mechanistic link to gynecological diseases (GDs) is still ongoing. Thus, the present review, which is the first of its kind, aims to undertake a comprehensive and critical reappraisal of F. nucleatum, including the genetics and mechanistic role in promoting adverse pregnancy outcomes (APOs) and various GDs, including cancers. Additionally, this review discusses new conceptual advances that link the immunomodulatory role of F. nucleatum to the development and progression of breast, ovarian, endometrial, and cervical carcinomas through the activation of various direct and indirect signaling pathways. However, further studies are needed to explore and elucidate the highly dynamic process of host-F. nucleatum interactions and discover new pathways, which will pave the way for the development of better preventive and therapeutic strategies against this pathobiont.

Quality of life in long-term cervical cancer survivors compared with healthy women and women with benign gynecological disorders.

OBJECTIVE: The impact of cervical cancer treatment on the quality of life of long-term survivors compared with the general female population is controversial, and no studies have been conducted comparing patients with benign gynecological diseases. The aim of this study was to compare the quality of life of cervical cancer survivors with that of healthy controls. STUDY DESIGN: A case-control study was conducted to compare the quality of life of 106 cervical cancer survivors from a tertiary hospital and 185 women admitted to a gynecological outpatient clinic from the same health area for a healthy woman check-up (n 46) or for a benign gynecological disorder (symptomatic, n 113; asymptomatic, n 26). To measure quality of life, self-administered questionnaires, such as the Functional Assessment Cancer Therapy-cervix and World Health Organization quality of life-brief version, were employed. Baseline scores were collected when patients first reported, and further evaluations were completed at 0-6, 7-12, 13-24, 25-60, and more than 60 months. For the contrastive analysis hypothesis, we employed R statistical software. RESULTS: Except for the environment domain at 0-6, 7-12, and 13-24 months (51.52 vs. 60.73, p < 0.0001; 52 vs. 60.73, p < 0.0001; 49.81 vs. 60.73, p < 0.0001, respectively), we found no statistically significant differences in the quality of life between cervical cancer survivors and controls. We did find differences in the physical health domain scores at 0-6 months (60.22 vs. 72.42, p = 0.039) and the social relationships domain scores at 13-24 months (54 vs. 71.42, p = 0.017) between cases and asymptomatic controls. CONCLUSION: Except for physical well-being, environment and social relationships, which were substantially better for controls, especially in the asymptomatic, long-term cervical cancer survivorsquality of life did not vary from that of controls.

Exploring the therapeutic potential of tonic Chinese herbal medicine for gynecological disorders: An updated review.

ETHNOPHARMACOLOGICAL RELEVANCE: Gynecological disorders have the characteristics of high incidence and recurrence rate, which sorely affects female's health. Since ancient times, traditional Chinese medicine (TCM), especially tonic medicine (TM), has been used to deal with gynecological disorders and has unique advantages in effectiveness and safety. AIM OF THE REVIEW: In this article, we aim to summarize the research progress of TMs in-vivo and in-vitro, including their formulas, single herbs, and compounds, for gynecological disorders treatment in recent years, and to offer a reference for further research on the treatment of gynecological disorders and their clinical application in the treatment of TMs. MATERIALS AND METHODS: Relevant information on the therapeutic potential of TMs against gynecological disorders was collected from several scientific databases including Web of Science, PubMed, CNKI, Google Scholar and other literature sources. RESULTS: So far, there are 46 different formulas, 3 single herbs, and 24 compounds used in the treatment of various gynecological disorders such as premature ovarian failure, endometriosis breast cancer, and so on. Many experimental results have shown that TMs can regulate apoptosis, invasion, migration, oxidative stress, and the immune system. In addition, the effect of TMs in gynecological disorders treatment may be due to the regulation of VEGF, PI3K-AKT, MAPK, NF-κB, and other signaling pathways. Apparently, TMs play an active role in the treatment of gynecological disorders by regulating these signaling pathways. CONCLUSION: TMs have a curative effect on the prevention and treatment of gynecological disorders. It could relieve and treat gynecological disorders through a variety of pathways. Therefore, the appropriate TM treatment program makes it more possible to treat gynecological disorders.

Predicting nutrition and environmental factors associated with female reproductive disorders using a knowledge graph and random forests.

OBJECTIVE: Female reproductive disorders (FRDs) are common health conditions that may present with significant symptoms. Diet and environment are potential areas for FRD interventions. We utilized a knowledge graph (KG) method to predict factors associated with common FRDs (for example, endometriosis, ovarian cyst, and uterine fibroids). MATERIALS AND METHODS: We harmonized survey data from the Personalized Environment and Genes Study (PEGS) on internal and external environmental exposures and health conditions with biomedical ontology content. We merged the harmonized data and ontologies with supplemental nutrient and agricultural chemical data to create a KG. We analyzed the KG by embedding edges and applying a random forest for edge prediction to identify variables potentially associated with FRDs. We also conducted logistic regression analysis for comparison. RESULTS: Across 9765 PEGS respondents, the KG analysis resulted in 8535 significant or suggestive predicted links between FRDs and chemicals, phenotypes, and diseases. Amongst these links, 32 were exact matches when compared with the logistic regression results, including comorbidities, medications, foods, and occupational exposures. DISCUSSION: Mechanistic underpinnings of predicted links documented in the literature may support some of our findings. Our KG methods are useful for predicting possible associations in large, survey-based datasets with added information on directionality and magnitude of effect from logistic regression. These results should not be construed as causal but can support hypothesis generation. CONCLUSION: This investigation enabled the generation of hypotheses on a variety of potential links between FRDs and exposures. Future investigations should prospectively evaluate the variables hypothesized to impact FRDs.

Therapeutic roles of platelet-rich plasma to restore female reproductive and endocrine dysfunction.

Millions of women worldwide are infertile due to gynecological disorders, including premature ovarian insufficiency, polycystic ovary syndrome, Asherman syndrome, endometrial atrophy, and fallopian tube obstruction. These conditions frequently lead to infertility and have a substantial impact on the quality of life of the affected couples, primarily because of their psychological implications and high financial costs. Recently, using platelets to stimulate cell proliferation and tissue differentiation has emerged as a promising approach in regenerative medicine. Platelet-rich plasma (PRP) shows considerable potential for promoting endometrial hypertrophy and follicle development, making it a promising therapeutic option for tissue repair or replacement. This review provides an overview of the recent advancements and underlying mechanisms of PRP therapy for various female reproductive diseases and presents new therapeutic options for addressing female infertility.

Robotic-assisted hysterectomy for benign gynecologic disease in the United States: in-hospital use of opioid and non-opioid analgesics.

To compare the in-hospital opioid and non-opioid analgesic use among women who underwent robotic-assisted hysterectomy (RH) vs. open (OH), vaginal (VH), or laparoscopic hysterectomy (LH). Records of women in the United States who underwent hysterectomy for benign gynecologic disease were extracted from the Premier Healthcare Database (2013-2019). Propensity score methods were used to create three 1:1 matched cohorts stratified in inpatients [RH vs. OH (N = 16,821 pairs), RH vs. VH (N = 6149), RH vs. LH (N = 11,250)] and outpatients [RH vs. OH (N = 3139), RH vs. VH (N = 29,954), RH vs. LH (N = 85,040)]. Opioid doses were converted to morphine milligram equivalents (MME). Within matched cohorts, opioid and non-opioid analgesic use was compared. On the day of surgery, the percentage of patients who received opioids differed only for outpatients who underwent RH vs. LH or VH (maximum difference = 1%; p < 0.001). RH was associated with lower total doses of opioids in all matched cohorts (each p < 0.001), with the largest difference observed between RH and OH: median (IQR) of 47.5 (25.0-90.0) vs. 82.5 (36.0-137.0) MME among inpatients and 39.3 (19.5-66.0) vs. 60.0 (35.0-113.3) among outpatients. After the day of surgery, fewer inpatients who underwent RH received opioids vs. OH (78.7 vs. 87.5%; p < 0.001) or LH (78.6 vs. 80.6%; p < 0.001). The median MME was lower for RH (15.0; 7.5-33.5) versus OH (22.5; 15.0-55.0; p < 0.001). Minor differences were observed for non-opioid analgesics. RH was associated with lower in-hospital opioid use than OH, whereas the same magnitude of difference was not observed for RH vs. LH or VH.

Rapid screening of infertility-associated gynecological conditions via ambient glow discharge mass spectrometry utilizing urine metabolic fingerprints.

Infertility presents a widespread challenge for many families worldwide, often arising from various gynecological diseases (GDs) that hinder successful pregnancies. Current diagnostic methods for GDs have disadvantages such as low efficiency, high cost, misdiagnose, invasive injury and etc. This paper introduces a rapid, non-invasive, efficient, and straightforward analytical method that utilizes desorption, separation, and ionization mass spectrometry (DSI-MS) platform in conjunction with machine learning (ML) to detect urine metabolite fingerprints in patients with different GDs. We analyzed 257 samples from patients diagnosed with polycystic ovary syndrome (PCOS), premature ovarian insufficiency (POI), diminished ovarian reserve (DOR), endometriosis (EMS), recurrent pregnancy loss (RPL), recurrent implantation failure (RIF), and 87 samples from healthy control (HC) individuals. We identified metabolite differences and dysregulated pathways through dimensionality reduction methods, with the result of the discovery of 7 potential biomarkers for GDs diagnosis. The ML method effectively distinguished subtle differences in urine metabolite fingerprints. We anticipate that this innovative approach will offer a patient-friendly, rapid screening, and differentiation method for infertility-related GDs patients.

Patient navigation in women's health care for maternal health and noncancerous gynecologic conditions: a scoping review.

PURPOSE: This study investigated the scope of patient navigation studies on women's health care for maternal health and noncancerous gynecologic conditions and aimed to report the characteristics of the identified patient navigation programs. METHODS: A scoping review was conducted following Arksey and O'Malley's framework. Five electronic databases were searched for relevant studies published in English: PubMed, Embase, Cochrane Library, CINAHL, and PsycInfo. There were no restrictions on the publication date and the search was completed in July 2023. RESULTS: This scoping review included 14 studies, which collectively examined seven patient navigation programs. All selected studies were related to maternal health issues (e.g., perinatal health problems and contraception for birth spacing). Close to two-thirds of the patient navigation services were provided by women (n=9, 64.3%) and half by lay navigators (n=7, 50.0%). The majority incorporated the use of mobile health technologies (n=11, 78.6%). All of the patient navigation programs included in the review coordinated the necessary clinical and social support services to improve women's access to care. CONCLUSION: Patient navigation appears to be in its nascent phase in the field of maternal health. The results of this study suggest that the implementation of patient navigation services could potentially improve access to care for socially disadvantaged women and families. Furthermore, providing patient navigation services that are specifically tailored to meet women's needs could improve the quality of maternity care.

Evaluation of hopelessness in patients with endometriosis / Evaluación de desesperanza en pacientes con endometriosis

Purpose: To explore the prevalence of hopelessness in patients diagnosed with endometriosis and how it may influence their relationships. Material and methods: Prospective–descriptive study among patients with a clinical and/or anatomopathological diagnosis of endometriosis. Demographic data (age, religion, educational level, marital status, occupation, etc.) and pain data have been processed. Pain associated with endometriosis has been evaluated with an analogue scale of pain. The Beck Hopelessness Scale (BHS) was used to determine the level of hopelessness. The results have been classified into 0–3 normal; 4–8 mild; 9–14 moderate and 15–20 severe. SPSS Statistics 26 has been used and the statistical significance has been stipulated at p<0.05. Results: One hundred and ten patients have been recruited with an average age of 39.8±7.09 years. The average on the Beck Hopelessness Scale is 5.08 with a SD 3.14. In our sample, we obtained that 38.2% of women experienced some level of hopelessness at the time the questionnaire was completed (mild=28.2%, moderate=9.1%, severe=0.9%). We found a significant relation between hopelessness and low income but not with regard to education, employment status or marital status. Regarding the pain experienced and its relation with hopelessness, we found that it was significantly connected to pain during urination and dyspareunia and not to chronic pelvic pain dysmenorrhea and dyschezia. Conclusion: Four out of ten patients with endometriosis experience hopelessness, mostly mildly. This hopelessness is influenced by demographic factors such as income level and also pain, specifically pain during intercourse and during urination.(AU)

Antecedentes: El objetivo es analizar la prevalencia de desesperanza en pacientes con endometriosis y cuáles pueden ser los factores relacionados con la misma. Material y método: Se ha desarrollado un estudio prospectivo descriptivo entre mujeres con diagnóstico clínico y/o anatomopatológico de endometriosis. Se recogieron datos demográficos junto al grado de dolor evaluado por la escala visual analógica. Para el estudio de la desesperanza se ha empleado la Escala de Desesperanza de Beck (BHS). Los resultados fueron clasificados en 0-3 normal; 4-8 leve; 9-14 moderado y de 15-20 como severa. El programa estadístico empleado fue Statistical Package for the Social Sciences (SPSS) 26 (IBM Corp, Armonk, NY, USA) y se estipuló la significancia estadística en p<0,05. Resultados: Un total de 110 pacientes fueron encuestadas con una edad media 39,8±7,09 años. La media obtenida en la escala es de 5,08 con una desviación estándar (DE) de 3,14. En nuestro estudio 38,2% de las participantes experimentaban desesperanza en algún grado (leve=28,2%, moderado=9,1%, severa=0,9%). Se ha encontrado una relación significativa entre la experimentación de desesperanza con usuarias con recursos económicos más bajos, pero no con la educación, situación laboral o estado civil. Con respecto al malestar experimentado, hemos observado una asociación con el provocado durante la micción o las relaciones sexuales, pero no con la disquecia, dismenorrea o el dolor pélvico crónico. Conclusión: Cuatro de cada 10 pacientes con endometriosis experimentan un grado de desesperanza, principalmente leve. Se relaciona con dispareunia y dolor en la micción, así como en mujeres con bajos recursos económicos.(AU)

¿Cuál es el manejo óptimo de la leiomiomatosis peritoneal diseminada? Un caso clínico con 15 años de seguimiento sin malignización / What is the optimal management of disseminated peritoneal leiomyomatosis? A case report with 15 years of follow-up without malignancy

Introducción: La leiomiomatosis peritoneal diseminada (LPD), se trata de una enfermedad benigna, que se define por la presencia de múltiples nódulos diseminados en el peritoneo de diferentes tamaños compuestos por haces de células de músculo liso. Se postulan varias teorías sobre su origen relacionadas con el estímulo hormonal, la susceptibilidad genética y la iatrogenia tras cirugías como las miomectomías por vía laparoscópica. Hallazgos clínicos: Las pacientes suelen presentar molestias abdominales de diversa índole, incluso puede cursar de forma asintomática siendo un hallazgo casual en pruebas de imagen. Diagnósticos principales: En el diagnóstico diferencial se suelen incluir la carcinomatosis, la endometriosis, la endosalpingiosis, los tumores del tracto gastrointestinal o el leiomiosarcoma. Intervenciones terapéuticas: No hay suficiente evidencia acerca de cuál es el mejor abordaje, algunos optan por manejo expectante o tratamientos médicos y otros abogan por un manejo quirúrgico más radical. Dentro de los tratamientos médicos, uno de los más usados son los agonistas de la GnRH, también se han utilizado con buenos resultados inhibidores de la aromatasa y los moduladores selectivos de los receptores de progesterona como el acetato de ulipristal. Resultados: En este caso presentamos una paciente con LPD con 15 años de seguimiento en nuestro hospital, sin evidencia de malignización. Conclusión: Conociendo la naturaleza generalmente benigna de esta enfermedad, es necesario optar por el abordaje menos invasivo posible. Se desconoce la evolución a largo plazo de esta enfermedad, pues la mayoría de casos publicados no tienen suficiente tiempo de seguimiento.

Introduction: Disseminated peritoneal leiomyomatosis (DPL) is a benign pathology, defined by the presence of multiple disseminated nodules in the peritoneum of different sizes composed of bundles of smooth muscle cells. Several theories are postulated about its origin related to hormonal stimulus, genetic susceptibility and iatrogenesis after surgeries such as laparocopic myomectomies. Clinical findings: Patients usually present with abdominal discomfort of various kinds, and it may even be asymptomatic, being an incidental finding on imaging tests. Main diagnoses: The differential diagnosis usually includes carcinomatosis, endometriosis, endosalpingiosis, tumours of the gastrointestinal tract or leiomyosarcoma. Therapeutic interventions: There is insufficient evidence about the best approach, with some advocating expectant management or medical treatment and others advocating more radical surgical management. Among medical treatments, one of the most widely used are GnRH agonists, aromatase inhibitors and selective progesterone receptor modulators such as ulipristal acetate have also been used with good results. Results: In this case we present a patient with LPD with 15 years of follow-up in our hospital, with no evidence of malignancy. Conclusion: Knowing the generally benign nature of this disease, it is necessary to opt for the least invasive approach possible. The long-term evolution of this disease is unknown, as most published cases do not have sufficient follow-up time.(AU)

Impacto de la fragmentación del ADN espermático y la tecnología de microfluidos en los resultados de fecundación in vitro / Impact of sperm DNA fragmentation and microfluidic technology on IVF outcomes

Un diagnóstico acertado en los pacientes infértiles es clave para determinar el tratamiento de elección en un programa de reproducción asistida. En el caso del varón, el diagnóstico inicial se basa en el resultado del seminograma, el cual permite hallar problemas relacionados con la esterilidad de la pareja, pero es insuficiente para la correcta detección de la infertilidad masculina, puesto que no predice la capacidad funcional de los espermatozoides. En los últimos años, han aparecido múltiples estudios que relacionan la integridad del ADN espermático con la fertilidad. Al mismo tiempo, los laboratorios de fecundación in vitro (FIV) tienen a su alcance nuevos métodos de selección del esperma, como los microfluidos, que ayudarían a disminuir el grado de fragmentación del ADN espermático (SDF) en la muestra. En este trabajo revisamos el impacto que tienen la SDF y el uso de los dispositivos de microfluidos en los resultados de FIV con base en una selección de estudios relevantes publicados hasta febrero de 2023.(AU)

An accurate diagnosis in infertile patients is key to determine the treatment of choice in an assisted reproduction program. In the case of the male, the initial diagnosis is based on the result of the semen analysis. The semen analysis can detect problems related to the couple's infertility, but it is insufficient for the correct diagnosis of male infertility, since it does not predict the functional capacity of the spermatozoa. In recent years, multiple studies have appeared that relate sperm ADN integrity to fertility. At the same time, IVF laboratories have within their reach new methods of sperm selection, such as microfluidics, which would make it possible to reduce the degree of ADN fragmentation in the sample. In this paper we review the impact of sperm ADN fragmentation and the use of microfluidic devices on IVF outcomes based on a selection of relevant studies published up to February 2023.(AU)

Preservación de la fertilidad en el tumor ovárico borderline / Fertility preservation in borderline ovarian tumors

Los tumores ováricos borderline (TOBL) son definidos como «tumores de bajo potencial maligno». Se trata de neoplasias epiteliales que debutan principalmente en mujeres jóvenes, siendo habitualmente diagnosticados en estadios iniciales de la enfermedad. La clave principal de su tratamiento es la cirugía, viéndose así comprometida la fertilidad de la paciente que no ha cumplido su deseo genésico. En general, la elección de la cirugía para los TOBL debe considerar las características del tumor, los deseos de fertilidad de la paciente y la extensión de la enfermedad. Las decisiones tomadas al respecto deben ser individualizadas y asesoradas por un equipo multidisciplinar. La preservación de la fertilidad (PF) juega un papel importante en el manejo de estas pacientes, existiendo distintas estrategias para mejorar y mantener su calidad de vida. El asesoramiento reproductivo debería ser una parte integral del manejo clínico, debiendo considerarse cuidadosamente los riesgos y beneficios. Dada su baja incidencia existe poca literatura al respecto, necesitándose estudios prospectivos bien diseñados para abordar los problemas específicos de fertilidad tanto en el diagnóstico inicial como en las recurrencias de los pacientes con TOBL.(AU)

Borderline ovarian tumors (BOTs) are defined as “tumors of low malignant potential”. These are epithelial neoplasms that debut mainly in young women, and are usually diagnosed in the initial stages of the disease. The main key to its treatment is surgery, thus compromising the fertility of the patient who has not fulfilled her reproductive desire. In general, the choice of surgery for BOTs should consider the characteristics of the tumor, the patient's fertility desires, and the extent of the disease. The decisions made in this regard must be individualized and advised by a multidisciplinary team. Fertility preservation (FP) plays an important role in the management of these patients, and there are different strategies to improve and maintain their quality of life. Reproductive counseling should be an integral part of clinical management, with risks and benefits carefully considered. Given its low incidence, there is little literature on the matter, requiring well-designed prospective studies to address specific fertility problems both in the initial diagnosis and in recurrences of patients with BOTs.(AU)