The Need of Differential Diagnosis Between Vulvar Lichen Sclerosus and Autoimmune Dermatoses in Adolescent Girls.

INTRODUCTION: Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition affecting the anogenital region, which can manifest in prepubertal or adolescent patients. The prevailing theories point to autoimmune and genetic factors. The primary symptoms of VLS typically include vulvar itching, discomfort, dysuria, and constipation. Physical examination often reveals a characteristic figure 8 pattern, involving the labia minora, clitoral hood, and perianal region. However, these symptoms and the age of onset are nonspecific and require differentiation from autoimmune dermatoses such as bullous diseases, pemphigus diseases, epidermolysis bullosa acquisita, and dermatitis herpetiformis. We performed this study to distinguish VLS from autoimmune dermatoses, and in doing so, uncover the underlying causes of chronic vulvar changes. This knowledge will enable healthcare providers to offer appropriate medical care to affected patients. METHODS: The study was conducted between July 2020 and February 2021, with a sample of 55 girls aged 2-18 years who did not have any systemic diseases. The study group was composed of 20 girls previously diagnosed with vulvar lichen sclerosus, while the control group included 35 girls without VLS. Questionnaires regarding the medical history of the children were completed by their legal guardians. Blood samples were collected and analyzed biochemically to assess human immunoglobulin A (IgA), IgG, and IgM antibodies against various substrates, including the desmosome of stratum spinosum, basement membrane zone, desmoglein 1 (DSG1), desmoglein 3 (DSG3), BP180-NC16A-4X, BP230gC, pemphigoid antigen, collagen type VII NC1, transitional epithelium, gliadin (GAF-3X), endomysium (EMA), and cellular nucleus (ANA). RESULTS: The analysis of the study group revealed that the most commonly observed signs and symptoms included: itching, soreness, burning sensations, and excoriation, as well as erythema or/and pallor of the skin and perineal mucosa. Among the assessed antibodies, only anti-GAF3x antibodies and ANA antibodies were detected. However, the results did not reach statistical significance (p > 0.5).

The Potential Coexistence of Autoimmune Thyroid Diseases and Pediatric Vulvar Lichen sclerosus.

INTRODUCTION: Vulvar lichen sclerosus (VLS), a chronic inflammatory skin disorder, often coexists with autoimmune thyroid disease (AITD). VLS presents with subtle symptoms including vulvar itching and discomfort. Clinically, a "Figure 8" pattern involving the labia minora, clitoral hood, and perianal region is often observed. It is prevalent both in pre-pubertal girls and women aged 40-60, and the link between VLS and AITD remains unclear, with proposed causes including autoimmune, hormonal or genetic factors, and environmental triggers. This study addresses the lack of research on the association in children, aiming to investigate the largest group of underage girls to date. AIM: This study aimed to investigate the coexistence of thyroid autoimmune diseases in girls diagnosed with vulvar lichen sclerosus (VLS) and to assess the presence of antibodies for specific thyroid autoimmune diseases. MATERIALS AND METHODS: Our study was conducted from July 2020 to February 2021, involving a sample of 55 girls aged 2-18 years old, all free from systemic diseases. The study group comprised 20 girls previously diagnosed with vulvar lichen sclerosus (VLS), while the control group included 35 girls without VLS. Legal guardians completed questionnaires detailing the medical history of their children. Blood samples were collected from all participants and subjected to biochemical analysis. The presence of human IgG antibodies against thyroid peroxidase and IgG antibodies against thyroglobulin was assessed using the immunoenzymatic method with commercially available ELISA kits. RESULTS: In the study group, common symptoms included itching, soreness, burning sensation, excoriation, and erythema or pallor of the skin and perineal mucosa. An evaluation of anti-thyroglobulin and anti-thyroid peroxidase antibodies revealed no statistical significance between the study and control groups (anti-TG p = 0.379, anti-TPO p = 0.96). Family history of autoimmune diseases showed no significant correlation with anti-thyroid antibodies in girls. Although no significant relation between VLS occurrence and antibody levels was found, it emphasizes the need for multidisciplinary medical care. Further research with larger patient groups is necessary.

The Impact of COVID-19 Pandemic on Female Sexual Function.

Introduction: The outbreak of the COVID-19 pandemic affected many aspects of life involving sexual functioning. Methods: This prospective, noninterventional, observational research was performed from July 2020 to August 2020, involving a total of 644 patients. Female sexual function index (FSFI) scores of those women were compared in relation to results of our research from April 2020. Questionnaires were collected concerning socio-demographic characteristics of patients as well as the impact of the COVID-19 pandemic on their lives. Results: Every domain significantly decreased in the first month of the lockdown. Before the pandemic, the total FSFI was reported at 30.1 ± 4.4, while in the first month of the pandemic it was at 25.8 ± 9.7 (p < 0.001). The lowest FSFI score was reported by women who lived in average conditions. There was a statistically significant increase in the overall FSFI score in the fifth month of the pandemic (27.5 ± 6.8) when compared to the FSFI score in the first month of the pandemic (25.8 ± 9.7). The scores in arousal, lubrication, orgasm and pain were reported as higher (respectively p < 0.001, p < 0.001, p < 0.001, p < 0.05), while desire was reported lower (p < 0.001). The satisfaction score remained almost the same (p < 0.05). Conclusions: Our study indicates a significant decrease in FSFI scores across all domains. There are still many questions whether the statue from the vaccinated person or convalescents affects the sense of security and, thus, increases sexual satisfaction.

Female Sexual Function in Twin Pregnancy.

INTRODUCTION: The incidence of twin pregnancy is estimated at 1 per 80 single pregnancies. As the topic of sexual function among women with multiple pregnancy is insufficiently developed, we believe it is appropriate to raise this subject. METHODS: A prospective study was conducted on 100 women during subsequent trimesters of pregnancy. RESULTS: From a group of 100 women, 54 women were primiparous, while 46 women had a history of previous delivery. The mean overall FSFI (female sexual function index) was found to be 24.3 ± 6.1. Mean FSFI was the highest in the first trimester at 25.6. The result decreased successively to 24.8 ± 7 and 22.6 ± 8.4 in the second and third trimesters, respectively. The patient's place of residence had a crucial impact on their FSFI score. The results were considerably higher for residents of small and medium towns or cities-24.4 ± 3.8 and 25.9 ± 4.9, respectively-while for those living in rural areas, the FSFI reached only 21.7 ± 5.4. CONCLUSIONS: The present study shows that the FSFI decreased throughout twin pregnancy. The lowest observed FSFI occurred in the third trimester, while the highest FSFI occurred during the first trimester.

Pediatric Vulvar Lichen Sclerosus-A Review of the Literature.

Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition affecting the anogenital region, which may present in a prepubertal or adolescent patient. The most popular theories are its autoimmune and genetic conditioning, although theories concerning hormonal and infectious etiology have also been raised. The most common presenting symptoms of VLS is vulva pruritus, discomfort, dysuria and constipation. In physical examination, a classic "Figure 8" pattern is described, involving the labia minora, clitoral hood, and perianal region. The lesions initially are white, flat-topped papules, thin plaques, or commonly atrophic patches. Purpura is a hallmark feature of VLS. The treatment includes topical anti-inflammatory agents and long-term follow-up, as there is a high risk of recurrence and an increased risk of vulvar cancer in adult women with a history of lichen sclerosus. This article reviews vulvar lichen sclerosus in children and provides evidence-based medicine principles for treatment in the pediatric population. A systematic search of the literature shows recurrence of VLS in children. Maintenance regimens deserve further consideration.

Ileal transposition helps to regulate plasma hepatokine levels in obese Zucker (Crl:ZUC(ORL)-Leprfa) rats.

We studied the long-term effect of ileal transposition (IT) metabolic surgery on the hepatokines: retinol-binding protein-4 (RBP4), α-2-HS-glycoprotein (aHSG/fetuin-A), and fibroblast growth factor 21 (FGF21), C-reactive protein (CRP) plasma levels, glucose metabolism, body weight, liver histology, as well as total lipids concentration in muscle, liver, and fat tissue of obese Zucker (Crl:ZUC(ORL)-Leprfa) rats. 14 adult males were randomly submitted either to IT or SHAM (control) surgery. Pre-operative hepatokines plasma levels were not significantly different in rats submitted to IT or SHAM protocol. Three months after the procedures the plasma levels of RBP4, aHSG, FGF21, and CRP were significantly lower in IT-operated animals when compared to SHAM-operated group. Three and 12 weeks after the IT and SHAM surgery, the AUCOGTT were significantly lower than AUCOGTT before the surgery. HOMA-IR was lower in rats after IT surgery in comparison to the SHAM-operated rats. Muscle and liver total lipids concentration was reduced after the IT procedure when compared to pre-IT conditions. IT had a significant reductive impact on the body weight in comparison to SHAM surgery in the 4th, 6th, 8th, and 10th week after the surgery. We conclude that IT reduces hepatokines' plasma concentrations, muscle and liver total lipids concentration but not the inflammatory processes in the liver of Zucker (Crl:ZUC(ORL)-Leprfa) rats.

The impact of motherhood on sexuality.

OBJECTIVES: Motherhood is a beautiful, extremely satisfying time ina woman's life, but also very challenging at the same time. Forty weeks of pregnancy, delivery, postpartum and breastfeeding periods affect physiological and mental functions that may unfortunately hinder women sexuality. MATERIAL AND METHODS: A longitudinal study was carried out. The questionnaire was developed to include a validated tool as wells as socio-demographic and medical data. The completely self-administered questionnaire was provided to patients twice - before pregnancy and postpartum. Finally, 398 women were included in the study and filled out the survey. RESULTS: Pregnancy and childbirth significantly (p < 0.001) reduce female sexual activity by lowering FSFI score. A similar relationship occurs in the six domains included in the FSFI scale.The number of women who received ≤ 26 points (which may indicate sexual dysfunctions) before pregnancy is 34 (8.54%) and after giving birth it is 167 (41.96%) CONCLUSIONS: Pregnancy and childbirth significantly reduce female sexual activity by lowering FSFI score. The number of women who with sexual dysfunctions increases fivefold after giving birth, and may even reach the value of 40% of young mothers. The role of the medical personnel in maintain women's sexual health is extremely important.

Is weight just a number? Relationship between overweight, obesity and domains of sexual functioning among young women.

OBJECTIVES: Being overweight and obesity, one of the biggest health problems in developing countries, is known to affect reproductive health problems. More and more Polish women are struggling with infertility and sexual dysfunctions. Such complications are often diagnosed to be linked directly with patients' excess weight. The main objectives of the study were to assess the influence of increased BMI (≥ 25.0) on sexual activity and the prevalence of sexual dysfunctions in overweight and obese women in Upper Silesia. Additionally, the occurrence of health problems existing along with obesity was analyzed. MATERIAL AND METHODS: The study was carried out at the Department of Pregnancy Pathology, Department of Woman's Health, School of Health Sciences in Katowice of Medical University of Silesia in Poland. From 526 examined patients, 38% had normal BMI (18.5-24.9), 27% were overweight (BMI 25-29.9) and 35% were obese (BMI score ≥ 30). The patients answered a completely self-administered questionnaire, which was divided into two parts. The first part consisted of general questions about the patient and her past medical history. The second part was the Polish version FSFI questionnaire. The results obtained from FSFI were analyzed using the STATISTICA program. RESULTS: Statistically significant (p < 0.001) reduction in the level of satisfaction was found in the group of obese women when compared to patients with BMI < 30. Also among obese patients the occurrence of sexual dysfunction (FSFI ≤ 26) was significantly increased (p < 0.05). A significantly higher number of patients from an average socio-economic situation suffered from sexual dysfunctions, when compared with patients from good a socio-economic group. CONCLUSIONS: Obesity and being overweight lead to more frequent sexual dysfunctions, especially through prevalence of decreased level of sexual satisfaction. Sexual activity problems may be exacerbated by increased body weight in combination with its comorbidities such as insulin resistance, PCOS, obstetric difficulties and irregular menstruation. What is more, a worse socio-economic situation of women predisposes them to the occurrence of sexual dysfunctions.

General, 21-Day Postoperative Rehabilitation Program Has Beneficial Effect on Oxidative Stress Markers in Patients after Total Hip or Knee Replacement.

Imbalance in prooxidant-antioxidant equilibrium plays an important role in the progression of osteoarthritis (OA). Postoperative rehabilitation significantly improves the functional activity of patients with OA. We aimed to assess the effect of the general 21-day postoperative rehabilitation on the oxidative stress markers in patients after total hip arthroplasty or knee replacement. Patients (n =41) started individually designed postoperative rehabilitation ca. 90 days after endoprosthesis implantation. We used the six-minute walk test (6MWT) to quantify the changes in their exercise capacity. We analyzed the oxidative stress markers: total antioxidant capacity (TAC), total superoxide dismutase (SOD), Cu-Zn-superoxide dismutase (CuZnSOD) and ceruloplasmin (Cp) activity, malondialdehyde (MDA) and lipofuscin (LPS) concentration in patients serum to asses changes in the oxidative stress intensity. We found that after 21-days postoperative rehabilitation program: the average distance walked by patients increased by 69 m; TAC increased by 0.20 ± 0.14 mmol/l; both SOD isoforms activities increased by 1.6 (±1.7) and 1.72 (±1.5) NU/ml, respectively; but Cp activity decreased by 1.8 (0.7-3.7) mg/dl. Also, we observed lower concentrations of lipid peroxidation markers: by 19.6 ± 24.4 µmol/l for MDA and by 0.4 ± 0.5 RF for LPS. A 21-day postoperative rehabilitation program effectively reduces oxidative processes, which helps the patients after total hip or knee replacement in a successful recovery.

Recommendations of the Group of Experts of the Polish Society of Gynecologists and Obstetricians in the field of gynecological and obstetric care of young women with physical and intellectual disabilities.

The recommendations present the current knowledge and procedures, which can be modified and changed in some cases, after careful analysis of a given clinical situation, which in the future may become the basis for their modification and updating.

The Oxidative Stress Markers in the Erythrocytes and Heart Muscle of Obese Rats: Relate to a High-Fat Diet but Not to DJOS Bariatric Surgery.

Obesity and high-fat diet (HF) are prevalent causes of oxidative stress (OS). Duodenal-jejunal omega switch (DJOS) is a bariatric procedure used for body mass reduction, extensively tested in animal models. We studied the long-term impact of bariatric surgery and an HF diet on the oxidative stress markers in erythrocytes and heart muscles of rats. We analyzed superoxide dismutase (SOD), catalase (CAT), glutathione transferase (GST), glutathione reductase (GR), glutathione peroxidase (GPx) activity and malondialdehyde (MDA) concentration in DJOS or SHAM (control) operated rats fed with different dietary protocols (control diet (CD) and high-fat diet (HF)), before and after the surgery (CD/CD, HF/HF, CD/HF, and HF/CD). We observed higher erythrocytes CAT, GST and GPx activity in DJOS-operated (vs. SHAM) rats fed with an HF/HF diet. For DJOS-operated rats, erythrocytes CAT and GPx activity and MDA concentration were significantly lower in CD/CD group. We observed increased heart muscle GR activity in SHAM-operated rats (vs. DJOS bariatric surgery) fed with an HF/HF diet. Change from HF to CD diet increased heart muscle GPx activity after DJOS bariatric surgery. Heart muscle SOD activity was lower in HF/HF and CD/CD groups after DJOS bariatric surgery (vs. SHAM). DJOS surgery significantly reduced heart muscle MDA concentration in HF/HF and HF/CD groups (vs. SHAM). We conclude that the selected dietary patterns had a stronger impact on oxidative stress markers in erythrocytes and heart muscle than DJOS bariatric surgery.

Symptomatic uterine fibroids in pregnancy - wait or operate? Own experience.

OBJECTIVES: Uterine fibroids are one of the most common benign tumors of the female genital tract. The major complication of myomas in pregnancy is a recurrent pain, however the misscariage is the main threat. The negative impact of myomas on the course of pregnancy may also result in i.e. uterine bleeding, higher incidence of a maternal-fetal incommunicability, an incorrect position of the fetus and its deformities. MATERIAL AND METHODS: The patient aged 31 was admitted to Mother and Child Health Center in Zabrze due to the threatened miscarriage. The primigravid at 19 weeks' gestation was previously diagnosed with myoma. On admission the ultrasonography revealed one alive fetus in the uterus and a nodular change on the right side of the uterine fundus, 13 x 11 cm in size and non-homogenous echo. RESULTS: The patient was qualified to the conservative myomectomy. 11 days after the enucleation of 25 cm in diameter myoma, patient in good condition, with the maintained, alive foetus was discharged from the hospital. Patient at 34 weeks' gestation was re-admitted due to the beginning of uterine contraction. After one week of observation within the ward, with tocolytic drugs and steroids administered, at 35th week of pregnancy the patient gave birth to a live daughter via the Ceasarian section. CONCLUSIONS: Prenatal myomectomy can be safely performed in the first and second trimester of pregnancy, however it is recommended to deliver the baby via Caesarean section, due to fear of intrauterine rupture of the uterus.

The influence of high fat diet on plasma incretins and insulin concentrations in Sprague-Dawley rats with diet-induced obesity and glucose intolerance undergoing ileal transposition.

BACKGROUND: The benefits of IT surgery are based on incretin effects. In this study we show the influence of high fat diet (HFD) used both before and after surgery, on ileal transposition (IT) effects. METHODS: Forty-eight male rats were assigned to two groups: HFD and control diet (CD) fed rats. After eight weeks, HFD and CD fed rats were randomly assigned to two types of surgery: IT and SHAM, then for 50% of animals of each group the diet was changed, whereas the other 50% received the same type of diet. Eight weeks after surgery the incretin level, glucose tolerance as well as body mass and insulin level were assessed. RESULTS: GLP-1 plasma concentration was significantly higher in the IT operated CD/CD group compared to fasting state and did not differ significantly from the SHAM operated CD/CD animals. IT influenced the glucose stimulated PYY plasma level when compared with SHAM operated animals in the CD/HFD group, where the PYY plasma level was higher than in the SHAM operated animals. The effect of IT as well as of pre and postoperative diet on GIP plasma levels were insignificant. The IT group members maintained on the CD were characterised by a lower fasting glucose level, both pre and postoperatively, compared with the SHAM operated animals. The effect of IT on the fasting glucose level in groups preoperatively maintained on an HFD was insignificant. CONCLUSIONS: IT surgery itself seems to have rather limited incretin effects in rats, whose obesity is the result of HFD.

Impact of Ileal Transposition Surgical Intervention on Antioxidant Status Measured in Liver Tissue of Obese Zucker Rats (Crl:ZUC-Leprfa).

BACKGROUND: The main factor characteristic for low-grade systemic inflammation typical for obesity is oxidative stress (OS). Reactive oxygen species (ROS) production is higher and more increased in time in the obese patients than in lean subjects. AIMS: To assess the effect of ileal transposition (IT) and sham types of bariatric procedures on the antioxidative systems in the liver tissue of Zucker rats (Crl:ZUC Leprfa). METHOD: 21 animals were divided into the experimental groups: control group (n = 7), sham group (n = 7), and IT group (n = 7). Sham and IT animals underwent selected surgery. The concentration of total antioxidant capacity (TAC), total antioxidant status (TOS), and activity of glutathione reductase (glutathione-disulfide reductase, GR, GSR), catalase (CAT), glutathione peroxidase (GPx), glutathione S-transferase (GST), and total superoxide dismutase activity (SOD) were assessed in liver tissue 3 months after surgery. RESULTS: IT procedure significantly increased TAC when compared to sham and the control group. Animals after IT showed higher levels of TOS when compared to sham procedure. The total amount of TOS was similar in IT and control groups. GPx activity was increased in the groups submitted to the sham and IT surgery in relation to control. GR and CAT activities were significantly higher after IT in comparison to control and sham procedures. Total SOD and MnSOD were significantly higher in sham-operated animals in comparison to IT intervention and control groups. CONCLUSIONS: IT procedure had a positive impact on the diminishing of oxidative stress measured by TAC and TOS markers. The dynamic, adaptive, and protective mechanisms of enzymatic antioxidant systems were observed after the IT but not sham procedure. Nevertheless, 3 months after surgery, the midterm effect of bariatric surgery was observed, which might not fully balance the antioxidative response.