Level of satisfaction in patients giving birth in Poland/Rzeszów and in the Federal Republic of Germany/Gross-Gerau

Aim of the study: The main purpose of the study was to examine opinions on perinatal care expressed by women hospitalized after childbirth in Poland and Germany. Different socio-demographic variables were also analyzed in order to evaluate the quality of perinatal care in two different countries. Materials and methods: The study group comprised of postpartum patients from two facilities: the Clinical Ward of Gynecology and Obstetrics of Frideric Chopin Province Specialist Hospital in Rzeszów, Poland, and the Obstetrics-Gynecology Hospital in Gross-Gerau, Germany. The group of randomly selected women, who were initially invited to participate in the study, included 259 Polish and 230 German females. In order to measure the level of satisfaction with perinatal care, the authors used “The Newcastle Satisfaction with Nursing Scale” (originally constructed at the Center for Health Services Research, University of Newcastle upon Tyne, UK, and adopted in Poland by Poznań University of Medical Sciences) and their own questionnaire. Finally, 200 patients, one hundred from Poland and one hundred from Germany, were enclosed. Statistical analysis was performed using the Statistics 8.0 software and a p valued below 0.05 was regarded significant. Results: Generally, perinatal care was assessed as being satisfactory by both Polish (91%) and German (97%) respondents. The study population varied in terms of age, education, place of residence or marital status. Only one socio-demographic variable (education) had a significant impact on the perception of the obtained perinatal care. However, a limited number of patients (25% in Poland and 47% in Germany) participated in the prental and parenting classes. Conclusions: 1. Perinatal care was positively assessed by Polish and German patients of both hospitals. 2. The greatest importance in selecting the location for childbirth was attributed by both Polish and German subjects to such factors as: opinion of their friends, highly qualified personnel, modern medical equipment and instruments on premises. Additionally, Polish respondents found it important that the doctor who had provided care for a given woman during pregnancy was employed at that particular hospital. In turn, German respondents also paid particular attention to the distance between their place of residence and hospital. 3. All study participants, regardless of their nationality, admitted that the hospitals offered to their close relatives the possibility to visit and accompany the patients during childbirth

Clinicoprognostical features of endometrial cancer patients with somatic mtDNA mutations

Somatic mitochondrial DNA (mtDNA) mutations have been found in a subset of endometrial cancers (EC) from different populations. We have investigated the relationship between mtDNA changes and clinical and pathological variables of women affected by EC. mtDNA mutations were detected both in early (3/32; 9%) and in advanced (1/8; 12%) stages of uterine tumors. However, patients carrying the mtDNA mutations or the normal mtDNA sequence had indistinguishable clinicopathological data, including age, clinical stage, histological grade and type or depth of myometrial invasion. It is noteworthy that mtDNA mutations were not detected in hyperplastic endometrial tissues or in ECs coexisting with hyperplasia, nor in a single case of endometrial stromal sarcoma. LOH at the tumor suppressor genes RB1 and TP53 as well as p16INK4A alterations (LOH, gene deletion) were found in tumors carrying mtDNA mutations. These results suggest that somatic mtDNA mutations are detected in a subset of ECs, although they are unrelated to clinicopathological variables of cancer

Pregnant woman infected with SARS-COV-2 – diagnosis and treatment

Introduction: COVID-19 is an infection caused by the new SARS-CoV-2 virus. In pregnant women with COVID-19, compared to non-pregnant women, there is an increased risk of a severe course of the infection. Pregnant women are more often hospitalized in the Intensive Care Unit and require mechanical ventilation. In the course of COVID-19 infection, pregnant women have a greater risk of miscarriage, premature birth or having a baby with low birth weight, compared to their healthy pregnancy peers. The aim of the study: To present, based on the available literature, the principles of management of a pregnant woman infected with SARS-CoV-2 virus. State of knowledge: The evidence of infection is the detection of the virus in the clinical specimen confirmed by PCR. Chest computer tomography can be useful in diagnosis, especially when the PCR test result is negative. Particular attention should be paid to pharmacological treatment, which should be both effective and safe for the fetus. Certain antiviral and anti-inflammatory drugs as well as anticoagulants drugs are used in COVID-19 therapy. Oxygen and fluid therapy is also important. The condition of the fetus should be monitored regularly. It is recommended to measure the fetal heart rate, perform cardiotocography, pregnancy ultrasound and assess the volume of amniotic fluid. The decision about the time and method of delivery should be made individually on the basis of obstetric indications and the maternal-fetal condition. Summary: The therapy of a pregnant patient infected with SARS-CoV-2 should be adjusted individually depending on the woman's health condition. In therapeutic interventions, the welfare of both the mother and the fetus should be taken into account

The role of obstetricians and neonatologists in childcare in the time of the COVID-19 pandemic

Introduction: The COVID-19 pandemic has caused numerous changes to the healthcare system, including care for the newborns. Aim of the study: The aim of the study was to create a clear set of recommendations used in the care of a newborn during the SARS-CoV-2 pandemic. State of knowledge: Despite the low risk of infection of the newborn in utero or during vaginal delivery, in rare cases there is a possibility of vertical transmission of the SARS-CoV-2 virus. Every newborn baby whose mother has been diagnosed with COVID-19 disease should be screened for infection. Suspected neonates should be isolated from healthy children and kept in quarantine until the test result is obtained. It is essential to constantly monitor your baby's health and be alert to any possible signs of infection. Medical personnel should ensure adequate protection when handling an infected newborn. A healthy infant whose mother is SARS-Cov-2 positive may be discharged home provided it is looked after by a healthy caregiver. Summary: New patterns of management in maternity and neonatal departments are associated with changes that may have a significant impact on the mother-child relationship. When making decisions aimed at reducing the spread of SARS-CoV-2 infection, it is necessary to seek solutions taking into account the needs of this particular group of patients

COVID-19 vaccination in pregnant and lactating women

Introduction: The COVID-19 pandemic significantly changed the lifestyle of pregnant women. Pregnant women with COVID-19 are more likely to suffer from severe disease, as well as unfavorable pregnancy and childbirth. Currently, there is no causal treatment for this disease available, so attention should be paid to preventing infection with vaccines. Aim of the study: A review of the literature on the influence of COVID-19 vaccines on the course of pregnancy and summary of recommendations regarding the use of COVID-19 vaccines during pregnancy and breastfeeding.  State of knwoledge: Three types of COVID-19 vaccines are most commonly used: mRNA vaccines, vector vaccines as well as subunit vaccines. In preclinical developmental and reproductive toxicity studies in animal models, there were no alarming safety signals, and observations of vaccinated pregnant women did not reveal any complications with respect to the course of pregnancy and development of the fetus. No cases of neonatal death have been reported in the first 28 days after birth. Most of the side effects following vaccination, such as injection site pain or tenderness, fatigue, fever or muscle pain, were moderate and resolved within 24 hours. The current research results confirm a positive immune response in pregnant women. Moreover, it is important that the presence of antibodies in the umbilical cord blood makes it possible to protect and reduce the risk of SARS-CoV-2 infection of the newborn. Summary: All pregnant women, irrespective of trimester, and breastfeeding mothers are advised to administer a booster dose of the COVID-19 vaccine within an appropriate period of time after the primary vaccination schedule

Common mitochondrial polymorphisms as risk factor for endometrial cancer

Endometrial carcinoma is the most commonly diagnosed gynaecological cancer in developed countries. Although the molecular genetics of this disease has been in the focus of many research laboratories for the last 20 years, relevant prognostic and diagnostic markers are still missing. At the same time mitochondrial DNA mutations have been reported in many types of cancer during the last two decades. It is therefore very likely that the mitochondrial genotype is one of the cancer susceptibility factors. To investigate the presence of mtDNA somatic mutations and distribution of inherited polymorphisms in endometrial adenocarcinoma patients we analyzed the D-loop sequence of cancer samples and their corresponding normal tissues and moreover performed mitochondrial haplogroup analysis. We detected 2 somatic mutation and increased incidence of mtDNA polymorphisms, in particular 16223C (80% patients, p = 0.005), 16126C (23%, p = 0.025) and 207A (19%, p = 0.027). Subsequent statistical analysis revealed that endometrial carcinoma population haplogroup distribution differs from the Polish population and that haplogroup H (with its defining polymorphism - C7028T) is strongly underrepresented (p = 0.003), therefore might be a cancer-protective factor. Our report supports the notion that mtDNA polymorphisms establish a specific genetic background for endometrial adenocarcinoma development and that mtDNA analysis may result in the development of new molecular tool for cancer detection

Znaczenie polimorfizmu CYP1A1 i regulacji jego transkrypcji w podatności na raka jajnika i endometrium

Abstract Human cytochrome P450 1A1 is one of the most important enzymes participating in human carcinogenesis because it metabolites several procarcinogens to active carcinogenic metabolites. Additionally, enzymes of CYP450 family play an important role in estrogenes catabolization (17-β-estradiol and estron) to intermediate products (2-, 4-hydroxyestradiol and 2-, 4-hydroxyestrone) including CYP1A1 that catalyses hydroxylation to 2-hydroxyestrogens in the endometrium. Derivates of these compounds (4-hydroxyestrogens) are carcinogenic and could induce DNA damage leading to tumour transformation. The presence of CYP1A1 enzyme in genital tract tissues could induce chemical carcinogenesis initiating cancer development. Recent studies also confirmed the role of CYP1A1 in the development of ovarian and endometrial cancer in humans. The presence of mutated CYP1A1 polymorphic variants influencing the CYP1A1 activity could be responsible for different interindividual susceptibility to genital cancers in women.Streszczenie Ludzki cytochrom CYP4501A1 jest jednym z najważniejszych enzymów uczestniczących w procesie kancerogenezy, ponieważ metabolizuje wiele pro-kancerogenów do ich aktywnych kancerogennych metabolitów. Dodatkowo, enzymy z rodziny CYP450 odgrywają ważną rolę w katabolizmie estrogenów (17-β-estradiol i estron) do produktów pośrednich (2-, 4-hydroksyestradiol oraz 2-, 4-hydroksyestron) uwzględniając CYP1A1, który katalizuje hydroksylację do 2-hydroksyestrogenu w endometrium. Pochodne tych związków (4-hydroksyestrogeny) są kancerogenne i mogą indukować uszkodzenia DNA prowadząc do transformacji nowotworowej komórki. Obecność enzymu CYP1A1 w tkankach narządów płciowych może indukować chemiczną kancerogenezę inicjując rozwój nowotworu. Najnowsze badania potwierdziły rolę CYP1A1 w rozwoju raka jajnika i endometrium. Obecność zmutowanych wariantów polimorficznych genu CYP1A1 wpływających na aktywność CYP1A1 może być związana ze zróżnicowaniem osobniczym w podatności na nowotwory narządów płciowych u kobiet

Atypical Endometrial Hyperplasia Arising in a Cesarean Section Scar: A Mechanism of Malignant Transformation

The incidence of scar endometriosis in Cesarean sections varies between 0.03 and 0.4%. However, the recently increased rate of Cesarean sections worldwide may be causing an increase in occurrence of scar endometriosis. This report presents anatomopathological evidence of an early-stage malignant transformation in endometriotic tissue from a post-Cesarean scar and briefly reviews possible underlying mechanisms. A 40-year-old woman with a body mass index of 42.7 was referred to the gynecological department with recurrent pain and presence of a palpable mass in her Cesarean section scar. She had undergone this procedure 7 years earlier and began experiencing discomfort and pain at the incision site 6 months postoperatively. Surgical treatment was instituted with complete removal of the lesion. Anatomopathological examination revealed endometriotic tissue intertwined with atypical endometrial hyperplasia and fibrosis. At 2 years’ follow-up, she was asymptomatic, both clinically and based on ultrasound examination. Endometriotic foci inoculated within an abdominal scar may undergo malignant transformation. Long-lasting abdominal scar endometriosis, in morbidly obese women, requires special attention from the physician

Endometrial cancer diagnostic and prognostic algorithms based on proteomics, metabolomics, and clinical data: a systematic review

Endometrial cancer is the most common gynaecological malignancy in developed countries. Over 382,000 new cases were diagnosed worldwide in 2018, and its incidence and mortality are constantly rising due to longer life expectancy and life style factors including obesity. Two major improvements are needed in the management of patients with endometrial cancer, i.e., the development of non/minimally invasive tools for diagnostics and prognostics, which are currently missing. Diagnostic tools are needed to manage the increasing number of women at risk of developing the disease. Prognostic tools are necessary to stratify patients according to their risk of recurrence pre-preoperatively, to advise and plan the most appropriate treatment and avoid over/under-treatment. Biomarkers derived from proteomics and metabolomics, especially when derived from non/minimally-invasively collected body fluids, can serve to develop such prognostic and diagnostic tools, and the purpose of the present review is to explore the current research in this topic. We first provide a brief description of the technologies, the computational pipelines for data analyses and then we provide a systematic review of all published studies using proteomics and/or metabolomics for diagnostic and prognostic biomarker discovery in endometrial cancer. Finally, conclusions and recommendations for future studies are also given