New hopes and promises in the treatment of ovarian cancer focusing on targeted treatment-a narrative review.

Unfortunately, ovarian cancer is still diagnosed most often only in an advanced stage and is also the most lethal gynecological cancer. Another problem is the fact that treated patients have a high risk of disease recurrence. Moreover, ovarian cancer is very diverse in terms of molecular, histological features and mutations. Many patients may also develop platinum resistance, resulting in poor response to subsequent lines of treatment. To improve the prognosis of patients with ovarian cancer, it is expected to make better existing and implement new, promising treatment methods. Targeted therapies seem very promising. Currently, bevacizumab - a VEGF inhibitor and therapy with olaparib - a polyADP-ribose polymerase inhibitor are approved. Other methods worth considering in the future include: folate receptor α, immune checkpoints or other immunotherapy methods. To improve the treatment of ovarian cancer, it is also important to ameliorate the determination of molecular features to describe and understand which group of patients will benefit most from a given treatment method. This is important because a larger group of patients treated for ovarian cancer can have a greater chance of surviving longer without recurrence.

Phytotherapy of Vulvovaginal Candidiasis: A Narrative Review.

Vulvovaginal candidiasis (VVC) is a real gynecological problem among women of reproductive age from 15 to 49. A recent analysis showed that 75% of women will have an occurrence at least once per year, while 5% are observed to have recurrent vaginal mycosis-these patients may become unwell four or more times a year. This pathology is caused in 85-90% of cases by fungi of the Candida albicans species. It represents an intractable medical problem for female patients due to pain and pruritus. Due to the observation of an increasing number of strains resistant to standard preparations and an increase in the recurrence of this pathology when using local or oral preferential therapy, such as fluconazole, an analysis was launched to develop alternative methods of treating VVC using herbs such as dill, turmeric, and berberine. An in-depth analysis of databases that include scientific articles from recent years made it possible to draw satisfactory conclusions supporting the validity of herbal therapy for the pathology in question. Although phytotherapy has not yet been approved by the Food and Drug Administration, it appears to be a promising therapeutic solution for strains that are resistant to existing treatments. There is research currently undergoing aimed at comparing classical pharmacotherapy and herbal therapy in the treatment of vaginal candidiasis for the purpose of increasing medical competence and knowledge for the care of the health and long-term comfort of gynecological patients.

The impact of endometriosis on depressive and anxiety symptoms and quality of life: a systematic review.

Introduction: Endometriosis is a common gynecological disorder affecting approximately 10-15% of women of reproductive age. The main complaints of patients with endometriosis are pain and fertility problems. Symptoms of endometriosis can impact the psychological functioning of the patients and significantly compromise their mental health. Methods: The aim of this review was to assess the prevalence of depressive and anxiety symptoms and quality of life in endometriosis patients. For this systematic review, we searched the PubMed, MEDLINE, ProQuest, EMBASE, Cochrane, CINAHL, Google Scholar, Scopus, and ScienceDirect electronic databases up to March 2023 to identify potentially relevant studies. The systematic review in the present paper is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Results: Of four records identified, 18 were eligible to be reviewed on the association between endometriosis and symptoms of depression and anxiety. Of 8,901 records identified, 28 were reviewed on the association between endometriosis and quality of life. The reviewed articles showed a prevalence ranging from 9.8 to 98.5% for depressive symptoms and 11.5 to 87.5% for anxiety. The quality of life in patients with endometriosis was significantly impaired, regardless of the tool used for evaluation. Discussion: This systematic review shows that endometriosis is associated with depressive and anxiety symptoms and impaired HRQoL. Broad correlating factors modulate mental health outcomes, indicating the complex relationship between the disease and the psychological health of the patients.

Treatment of Vulvovaginal Candidiasis-An Overview of Guidelines and the Latest Treatment Methods.

Vulvovaginal candidiasis (VVC) is a common condition associated with discomfort in affected women. Due to the presence of different forms of the disease, diverse treatment regimens are developed; the newest ones include oteseconazole and ibrexafungerp. Here, we focus on the most up-to-date recommendations regarding VVC treatment, as well as novel treatment options. Topical and oral azoles are the drugs of choice in uncomplicated mycosis. The efficacy of probiotics and substances such as TOL-463 and chlorhexidine is indicated as satisfactory; however, there are no relevant guidelines. Although the majority of researchers agree that the treatment of non-albicans VVC should be long-lasting, the recommendations are inconsistent. Another clinical problem is the treatment of VVC with azole intolerance or resistance, for which literature proposes the use of several drugs including oteseconazole, ibrexafungerp, and voriconazole. The treatment schedules for recurrent VVC include mainly fluconazole; however, alternative options such as immunotherapeutic vaccine (NDV-3A) or designed antimicrobial peptides (dAMPs) were also described. We also focused on VVC affecting pregnant women, which is a substantial challenge in clinical practice, also due to the heterogeneous relevant guidelines. Thus far, few precise recommendations are available in the literature. Future studies should focus on atypical VVC forms to elucidate the inconsistent findings.

Possible Correlation between Urocortin 1 (Ucn1) and Immune Parameters in Patients with Endometriosis.

The etiology of endometriosis (EMS) has not been clearly elucidated yet, and that is probably the reason why its diagnostic process is frequently long-lasting and inefficient. Nowadays, the non-invasive diagnostic methods of EMS are still being sought. Our study aimed to assess the serum and peritoneal fluid levels of urocortin 1 (Ucn1) in patients with EMS and healthy women. Moreover, considering the immune background of the disease, the association between Ucn1 and several immune parameters was studied in both groups. We found that the serum Ucn1 level was significantly upregulated in women with EMS compared to healthy patients. Moreover, higher serum Ucn1 levels tended to correspond with more advanced stages of the disease (p = 0.031). Receiver operating characteristic (ROC) analysis revealed that based on serum Ucn1 levels, it is possible to distinguish deep infiltrating endometriosis (DIE) from among other EMS types. Together, these results indicate Ucn1 as a possible promising biomarker of EMS: however, not in isolation, but rather to enhance the effectiveness of other diagnostic methods.

Gonadotropin-Releasing Hormone Antagonists-A New Hope in Endometriosis Treatment?

Endometriosis is a chronic disease, in which endometrial-like tissue is found outside the uterine cavity. Lesions are typically located in the true pelvis but can be found, in addition to extragenital endometriosis, in the respiratory system, the diaphragm, the pleura or the pericardium. As the extrauterine endometrial lesions undergo the menstrual cycle, they cause many symptoms, including pain, and besides infertility, they all mostly affect the quality of the patient's life. Pharmacological management of endometriosis significantly increases in importance either as a first-line treatment or as a complementary therapy after surgery. Yet, current research on antagonists of the gonadotropin-releasing hormone (GnRH) has revealed their potential benefits in endometriosis treatment. Their mechanism of action is to down-regulate the hypothalamic-pituitary-gonadal axis and therefore induce a hypoestrogenic state. The resulting reduction of estrogen levels prevents disease progression and diminishes the recurrence rate after surgical removal of endometriosis. The present review summarizes recent reports of the role oral GnRH antagonists have as a significant treatment option for pain reduction in endometriosis patients.

Future Perspectives of Ectopic Pregnancy Treatment-Review of Possible Pharmacological Methods.

Ectopic pregnancy, that is, a blastocyst occurring outside the endometrial cavity of the uterus, affects nearly 2% of pregnancies. The treatment of ectopic pregnancy is surgical or pharmacological. Since surgical management is associated with numerous serious side effects, conservative treatment is sought. The treatment of choice in the majority of cases is based on pharmacotherapy with methotrexate (MTX) in a single- or multi-dose regimen. Although the efficacy of methotrexate reaches between 70 and 90%, its use requires specific conditions regarding both the general condition of the patient and the characteristic features of the ectopic pregnancy. Moreover, MTX can cause severe adverse effects, including stomatitis, hepatotoxicity and myelosuppression. Therefore, clinicians and researchers are still looking for a less toxic, more effective treatment, which could prevent surgeries as a second-choice treatment. Some studies indicate that other substances might constitute a good alternative to methotrexate in the management of ectopic pregnancies. These substances include aromatase inhibitors, especially letrozole. Another promising substance in EP treatment is gefitinib, an inhibitor of EGFR tyrosine domain which, combined with MTX, seems to constitute a more effective alternative in the management of tubal ectopic pregnancies. Other substances for local administration include KCl and absolute ethanol. KCl injections used in combination with MTX may be used when foetal heart function is detected in cervical ectopic pregnancies, as well as in heterotopic pregnancy treatment. Absolute ethanol injections proved successful and safe in caesarean scar pregnancies management. Thus far, little is known about the use of those substances in the treatment of ectopic pregnancies, but already conducted studies seem to be promising.

Gender Dysphoria Disrupting the Course of Treatment of a Recurrent Juvenile Granulosa Cell Tumor in an Adolescent Female: A Case Report.

We present the case of an adolescent female patient with gender dysphoria (GD) who was diagnosed with a recurrent ovarian neoplasm - juvenile granulosa cell tumor (JGCT). The 17-year-old female patient presented multiple endocrine pathologies and a recurrent JGCT. During the surgery qualification process, the patient admitted having identified herself as a male. The patient reported being uncomfortable with her body and with the expected roles of her assigned gender. Due to that, the patient requested a total hysterectomy with a bilateral salpingo-oophorectomy. As a minor, she required the permission of her parents, which was not granted. The patient underwent several specialist consultations, after which she agreed to the unilateral removal of tumor-changed pathologies and additional hormonal, psychological, and psychiatric diagnostics. To the best of our knowledge, this is the first detailed report of co-occurrence of GD spectrum disorders and JGCT in an adolescent female. This case contains many therapeutic and ethical problems regarding both physical and mental health. It should be noted that adolescents with GD spectrum rarely develop persistent transsexuality. Modulations from developmental psychology, psychotherapy, family dynamics, hormonal treatment, and the removal of JGCT in the presented case may have potential therapeutic implications for GD.

[Ovarian teratomas as the cause of diseases of the nervous, endocrine and haematology system].

Teratomas are the most common tumors of the ovary occurring in girls and young women. Derived from primordial germ cell and embryonic gonads have the ability to differentiate into the three germ layers. In about 95% of cases are benign, and their most common form is a dermoid cyst of the ovary. This paper aims to present the relationship described tumors of autoimmune hemolytic anemia, anti-NMDA-dependent autoimmune inflammation of the brain and thyroid disease. It reminds us that teratomas are not always insulated disease entities and may have a significant impact on the course of coexisting diseases and their treatment.

[Expression of caspase 9 and p53 in uterine leiomyosarcomas]. / Ocena ekspresji kaspazy 9 i bialka p53 w miesakach macicy.

UNLABELLED: Uterine sarcomas are heterogeneous malignancies, both clinically and histologically. The process of oncogenesis depends on gene mutations and uncontrolled mitotic cell division that is promoted by blocking pathways of apoptosis. Caspase 9 and p53 protein play an important role in the process of cell apoptosis. OBJECTIVES: The aim of the study was to assess the expression of selected apoptosis proteins (caspase 9 and p53) using immunohistochemistry. MATERIAL AND METHODS: A total of 28 tissue samples diagnosed in postoperative histopathological examination as leiomyosarcoma were tested. Twenty eight samples of leiomyomas were used as the control group. Colorful reactions with appropriate antibodies were performed to assess the expression of caspase 9 and p53. From every section 5 fields on view were chosen, in each one 100 cells were assessed using 400x magnification. T-Student parametric test and U Mann-Whitney test were used for statistical analysis. RESULTS: Expression of caspase 9 was significantly lower (p < 0.05) in leiomyosarcoma tissues (33.2%) as compared to leiomyomas (60.4%). Expression of p53 protein was significantly lower in leiomyosarcoma tissues than in leiomyomas (30.1% vs. 51.3%, p < 0.001). CONCLUSIONS: Significantly lower expression of caspase 9 and p53 in leiomyosarcoma tissue samples suggests that impaired deregulation of apoptosis mechanisms plays a role in the development of these tumors.

[Mesothelin in ovarian cancer]. / Mezotelina w raku jajnika.

Ovarian cancer is a neoplasm with high mortality rate. Its progression is mostly asymptomatic, which results in its first diagnosis in a late stage of the disease. Currently there are no reliable diagnostic methods for early detection of ovarian cancer. Molecular mechanisms leading to its development are not yet fully discovered. Recent studies show that mesothelin gene is up-regulated in patients with serous ovarian cancer. Mesothelin is a glycoprotein found in cell membranes of mesothelial cells lining the peritoneum, pericardium and pleura. Association of mesothelin in the development of ascites, intraperitoneal spread of the neoplasm, and its capability to modulate immune response have been show. It has been found that patients diagnosed with ovarian cancer have elevated serum mesothelin specific IgG levels. Mesothelin is also able to induce a cellular immune response, which is used in researches of ovarian cancer vaccines. High mesothelin expression in cancer tissues and its regular low expression in physiologic ones makes the glycoprotein a worthy candidate for the purpose of ovarian cancer treatment. Current studies assess the use of mesothelin as a target antigen as well as its immunogenicity. The methods of treatment include the use of recombined immunotoxin synthesized from the Pseudomonas exotoxin A (SSIP), MORAb-009 - chimeric monoclonal antibody, immunoconjugates (antibody - drug conjugates), cancer vaccines and gene therapy. The results of these studies are promising but further trials in larger population are required to confirm this.