OBJECTIVES The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically updated evidence on the management of uterine fibroids, specifically incidence and prevalence of fibroids, treatment outcomes, comparisons of treatment, modifiers of outcomes, and costs. DATA SOURCES We searched MEDLINE(R), Cochrane Collaboration resources, and Embase. REVIEW METHODS We included studies published in English from February 2000 through August 2006. We excluded studies with low sample size (based on study design, cases series < 100 and cohorts < 40) or lack of relevance to uterine fibroids. Of 107 included studies, 3 were good quality, 56 fair, and 48 poor. RESULTS The cumulative incidence by age 50 is 70 percent to 80 percent; black women are more likely to get fibroids at younger ages. Appearance of new fibroids and growth of existing fibroids after treatment are poorly studied. Trials of preoperative medical management indicate that treatment reduces fibroid volume but do not provide sufficient evidence of improvement in important operative outcomes. When women are treated for reasons other than symptom relief, such as when pregnancy is desired, weak evidence supports treating submucous fibroids via hysteroscopy. No well-conducted trials in U.S. populations directly compared treatment options, including the option of expectant management, or followed women to determine whether the intervention met their treatment objectives. Common procedures such as hysterectomy and myomectomy, including choice among types of myomectomy, still cannot be meaningfully compared. Studies comparing uterine artery embolization (UAE) with other procedures reported procedure time and length of stay favoring UAE, but inconsistency of the direction of effect for complications and absence of key information on longer-term outcomes suggest that this evidence base is inadequate to comment on the relative risks and benefits of UAE versus hysterectomy or myomectomy. Costs of fibroid treatment, despite shorter average lengths of stay, are rising. CONCLUSIONS The dearth of high-quality evidence supporting the effectiveness of most interventions for uterine fibroids is remarkable, given how common this problem is. The current state of the literature does not permit definitive conclusions about benefit, harm, or relative costs to help guide women's choices. Significant research gaps include well-conducted trials in U.S. populations that directly compare interventions on short- and, especially, long-term outcomes, studies on therapeutics for medical management, and information on treatment decisions for women who desire a pregnancy.

Management of uterine fibroids: an update of the evidence.

The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents ...

https://journals.sagepub.com/doi/pdf/10.1177/2050312118807624

The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities:

SARS CoV-2 is a novel coronavirus which has caused many deaths in the recent pandemic. This study aimed to determine zinc, copper and magnesium status on pregnant women with COVID-19. 100 healthy (33/32/35) and 100 SARS-CoV-2 positive (34/33/33) pregnant women were included in the study according to their trimesters. Blood samples were obtained from the patients along with the initial laboratory tests for clinical outcomes upon their first admission to hospital. In the first and third trimesters serum zinc level was lower (p:0,004 and p:0,02), serum copper level was higher (p:0,006 and p:0,008), the Zn / Cu ratio decreased(p < 0.0001 and p < 0.0001) and the serum magnesium level was higher(p < 0.0001 and p < 0.0001) in the COVID-19 group.In the second trimester COVID-19 patients had lower serum zinc (p:0,05) and copper levels (p:0,0003) compared to controls. Disease severity correlated with zinc/copper ratio in COVID19 patients (p:0.018, r:-0.243). Serum zinc and Zn/Cu ratio levels had a negative relationship with acute phase markers such as IL-6, Erythrocyte Sedimentation Rate, procalcitonin and C-reactive Protein. Also, increased serum magnesium level may play a role in decreased white blood cell, neutrophil, lymphocyte cell count and increased CRP levels in the third trimester. This study indicated that trace element status changed in pregnant women with COVID-19. The effect of trace elements on pregnant women diagnosed with COVID-19 infection was investigated in comparison with healthy pregnant women for the first time. This effect will be revealed better in more comprehensive studies to be planned in the future.

/pdf/the-relation-between-trace-element-status-zinc-copper-19l9pdi37c.pdf

The Relation Between Trace Element Status (Zinc, Copper, Magnesium) and Clinical Outcomes in COVID-19 Infection During Pregnancy.

Iron (Fe), copper (Cu), and zinc (Zn) are microelements essential for the proper functioning of living organisms. These elements participatein many processes, including cellular metabolism and antioxidant and anti-inflammatory defenses, and also influence enzyme activity, regulate gene expression, and take part in protein synthesis. Fe, Cu, and Zn have a significant impact on the health of pregnant women and in the development of the fetus, as well as on the health of the newborn. A proper concentration of these elements in the body of women during pregnancy reduces the risk of complications such as anemia, induced hypertension, low birth weight, preeclampsia, and postnatal complications. The interactions between Fe, Cu, and Zn influence their availability due to their similar physicochemical properties. This most often occurs during intestinal absorption, where metal ions compete for binding sites with transport compounds. Additionally, the relationships between these ions have a great influence on the course of reactions in the tissues, as well as on their excretion, which can be stimulated or delayed. This review aims to summarize reports on the influence of Fe, Cu, and Zn on the course of single and multiple pregnancies, and to discuss the interdependencies and mechanisms occurring between Fe, Cu, and Zn.

The Role of Fe, Zn, and Cu in Pregnancy.

Increasing numbers of individuals may be exposed to nanomaterials during pregnancy. The overarching goal of this investigation was to determine if prenatal inhalation exposure to copper nanoparticles (Cu NPs) has an effect on dams and offspring, including an analysis of inflammatory markers (Th1/Th2 cytokine profiles). Physicochemical characterization of Cu NPs was performed. Pregnant and non-pregnant mice (C57Bl/6 J) were exposed to Cu NPs or laboratory air in the whole-body chamber for 4 hrs/day on gestation days (GD) 3–19 (3.5 mg/m3). Animals were euthanized on GD 19 (0 week) or 7 weeks later. Bronchoalveolar lavage (BAL) fluid was analyzed for total and differential cells. Cytokine/chemokine concentrations were determined in the BAL fluid and the plasma of dams/non-pregnant mice and pups. Cu content was determined in the lungs and the blood of dams/non-pregnant mice and pups, in the placentas as well as in the whole bodies of pups immediately after delivery. Lungs and placentas were evaluated for histopathological changes. Gene expression of the Th1/Th2 profiles were analyzed in spleens of pups. The survival rate of 7 week old pups exposed to Cu NPs was significantly lower than control pups (73 vs. 97 %). The average litter size, male/female ratio, body weight and lenght at birth were not different between Cu NP-exposed and control mice. Both pregnant and non-pregnant mice exposed to Cu NPs had significant pulmonary inflammation with increased number of neutrophils in the BAL fluid compared to controls. Perivascular lymphoplasmacytic cuffing was found in the lungs of exposed mice and was more pronounced in the non-pregnant group. Similarly, levels of inflammatory cytokines/chemokines IL-12(p40), G-CSF, GM-CSF, KC, MCP-1, MIP-1α, MIP-1β, RANTES and TNF-α in BAL fluid were significantly higher in non-pregnant than pregnant exposed mice. Histopathology evaluation of placentas did not identify any pathological changes. No translocation of Cu into the placenta or the fetus was found by inductively coupled plasma-mass spectroscopy. Expression of several Th1/Th2 or other immune response genes in pups’ spleens were found to be significantly up- or down-regulated. Prenatal exposure to Cu NPs caused a profound pulmonary inflammation in dams and strong immunomodulatory effects in offspring. There was no clear polarization of genes expressed in pups’ spleens towards Th1 or Th2 type of response.

/pdf/effects-of-prenatal-inhalation-exposure-to-copper-3veejo230k.pdf

Effects of prenatal inhalation exposure to copper nanoparticles on murine dams and offspring

Introduction. Copper is essential micronutrient and has an important role in
 the human body. The serum copper increases during pregnancy and is doubled at
 full term. Lower levels of serum copper in pregnancy are connected with some
 pathological conditions. Objective. The aim of this study was to estimate the
 levels of serum copper in normal and pathological pregnancies, comparing them
 with values of serum copper in non-pregnant women, to determine if serum
 copper is lower in some pathological pregnancies and if this is of some
 importance. Methods. A total of 2170 plasma samples for copper analyses were
 made in the following groups: healthy non-pregnant women; healthy pregnant
 women from the 5th-40th gestational week, during the first delivery stage and
 during the first three postpartum weeks, in pregnant women with habitual
 abortion, imminent abortion, abortion in progress, missed abortion (9th-24th
 weeks), missed labour and premature rupture of membranes (29th-40th weeks).
 Levels of serum copper were determined by colorimetric technique of
 bathocuproin with disulphate as a chromogen. Results. Serum copper values in
 non-pregnant women range from 11.6-25.8 μmol/L. In healthy pregnant women,
 there is a constant trend of the increase of serum copper. The mean serum
 copper values revealed three significant peaks at the 22nd, 27th and 35th
 gestational week. Serum copper values in the patients with some pathological
 pregnancies in relation to the serum copper values of the healthy pregnant
 women were significantly lower. Conclusion. Serum copper values can be used
 as an indicator of some pathological pregnancies.

/pdf/variations-of-serum-copper-values-in-pregnancy-1jegg2du5o.pdf

Variations of serum copper values in pregnancy.

Introduction In contrast to animal species in which linear relationships exist between hormonal status and sexual behaviour sexuality in human population is not determined so simply by the level of sexual steroids. The article analyses female sexuality in the light of hormonal status. Administration of sexual steroids during pregnancy and sexual differentiation High doses of gestagens, especially those with high androgen activity, widely used against miscarriages may lead to tomboys, but without differences in sexual orientation. However, it has been observed that the frequency of bisexual and lesbian women is higher in women with congenital adrenogenital syndrome. HORMONES SEXUAL DESIRE AND SEXUALITY DURING MENSTRUAL CYCLE: It has been established that sexual desire, autoeroticism and sexual fantasies in women depend on androgen levels. There are a lot of reports claiming that sexual desire varies during the menstrual cycle. Hormonal contraception and sexuality Most patients using birth control pills present with decreased libido. But, there are reports that progestagens with antiandrogenic effect in contraceptive pills do not affect sexual desire. HORMONAL CHANGES IN PERI- AND POSTMENOPAUSAL PERIOD AND SEXUALITY: Decreased levels of estrogen and testosterone in older women are associated with decreased libido, sensitivity and erotic stimuli. Sexuality and hormone replacement therapy Hormonal therapy with estrogen is efficient in reference to genital atrophy, but not to sexual desire. Really increased libido is achieved using androgens. Also, therapy with dehydroepiandrosterone (DHEA) and tibolone have positive effects on female libido. Conclusion Effect of sexual steroids on sexual sphere of women is very complex. The association between hormones and sexuality is multidimensional, as several hormones are important in regulation of sexual behaviour. Still, it should be pointed out that sexuality is in the domain of hormonal, emotional-motivational and social factors.

/pdf/sex-hormones-and-female-sexuality-bltbp8ngyx.pdf

Sex hormones and female sexuality

Introduction. Termination of pregnancy - induced abortion is inevitable in family planning as the final solution in resolving unwanted pregnancies. It can be the cause of major physical and phychological concequences on women's health. Diverse opinions on psychological consequences of induced abortion can be found in literature. Material and methods. A prospective study was performed in order to predict acute stress disorder (ASD) after the induced abortion and the possibility of post-traumatic stress disorder (PTSD). Seven days after the induced abortion, 40 women had to fill in: 1. a special questionnaire made for this investigation, with questions linked to some risk factors inducing stress, 2. Likert's emotional scale and 3. Bryant's acute stress reaction scale. Results. After an induced abortion 52.5% women had ASD and 32.5% women had PTSD. Women with ASD after the abortion developed more sense of guilt, irritability, shame, self-judgement, fear from God and self-hatred. They were less educated, had lower income, they were more religious, did not approve of abortion and had worse relationship with their partners after the abortion in comparison to women without ASD. Age, number of previous abortions and decision to abort did not differ between the two groups. Discussion and conclusion. Induced abortion represents a predisposing factor for ASD and PTSD in women. Some psychosocial factors contribute to the development of stress after abortion. Serbia has a task to reduce the number of abortions which is very high, in order, to preserve reproductive and phychological health of women.

/pdf/investigation-of-risk-factors-for-acute-stress-reaction-1ho4g5snc1.pdf

Investigation of risk factors for acute stress reaction following induced abortion

SUMMARy Introduction Hysteroscopy is one of the oldest endoscopic procedures which uses the cervix for introducing a telescope to place a camera into the uterine cavity. Objective The aim of the study was to present our experiences with this procedure during the long- term work starting from the time when hysteroscopic method of treatment was first introduced at this Clinic until today. Methods This prospective study involved 2000 female patients referred to the Clinic for Gynecology and Obstetrics in Novi Sad from January 2005 till January 2011 for diagnostic and operative hysteroscopy. The following parameters were analyzed: the presence of minor and major pathology of the endometrium, type of anesthesia, technique of operative work, instruments and energy used during hysteroscopy and complications. Results Seventy-eight percent of all procedures were done under intravenous anesthesia. The most common operative procedure was polypectomy and the most complicated one was myomectomy. By histopathological examination of hysteroscopic biopsy specimens four endometrial carcinomas were revealed. The combination of mechanical instrument and bipolar energy were used in most of the cases, while the percentage of complications was extremely low. Conclusion Hysteroscopy is a safe, highly sensitive, precise diagnostic and operative endoscopic procedure. Our experiences and dilemmas open a field for discussion and offer salutations to everyday problems. The introduction of this procedure into out-patients conditions has contributed to the efficiency of the treatment of vaginal pathological processes, thus enabling that the method has become available to all gynecologists. This fact requires further study and new results.

http://www.doiserbia.nb.rs/img/doi/0370-8179/2012/0370-81791212728K.pdf

Results and Experiences After 2000 Performed Hysteroscopies

This study investigated the efficacy of Zoladex depot 3.6 mg (goserelin acetate) during a 4-month treatment of infertile patients with uterine myomas of different size and location. The investigation comprised 30 patients aged 22-42 years, distributed into 2 groups regarding uterine and myoma volume. The first group included patients with uterine myomas less than 70 ml and uterus less than 300 ml. The second group included patients in whom these volumes exceeded the above mentioned values. Zoladex depot was administered every 28 days for 4 months with ultrasonographic follow-up of volume decrease, whereas patients with submucous myomas underwent control hysteroscopy. The obtained results point to efficacy of Zoladex in decreasing the volumes of both myomas and uterus by more than 50%, which correlates with literature data. Of particular interest is complete disappearance of myomas in about 60% of patients of the first group. Serum concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) were followed-up prior to and during Zoladex therapy where multivariate variance analysis showed statistically significant differences. The side effects were recorded and are similar to those of other GnRH analogues.

/pdf/clinical-efficacy-of-goserelin-zoladex-in-the-treatment-of-1e6lpvqarv.pdf

Aleksandra Kapamadzija

Papers

Variations of serum copper values in pregnancy.

Sex hormones and female sexuality

Investigation of risk factors for acute stress reaction following induced abortion

Results and Experiences After 2000 Performed Hysteroscopies

Clinical efficacy of goserelin (Zoladex) in the treatment of uterine myomas in infertile patients.