4 articles
Surgical menopause triggers an abrupt and early decline in ovarian hormones, contributing to the development of climacteric symptoms, including vasomotor and psycho-emotional manifestations. This hormonal deficiency is associated with reduced activity of antioxidant enzymes and elevated oxidative stress markers, mechanisms that may exacerbate symptom severity and increase the risk of metabolic and cardiovascular complications. The present study aimed to evaluate the impact of hysterectomy with or without oophorectomy on the severity of climacteric syndrome and oxidative stress markers, with the objective of identifying distinct pathophysiological patterns.
An analytical observational cohort study was conducted involving 100 women who underwent hysterectomy, including 50 women with bilateral oophorectomy (G1A) and 50 women with ovarian preservation (G1B). To establish reference baseline values, a control group (G0) consisting of 50 healthy women was assessed through a single evaluation. The surgical cohorts were followed longitudinally, with clinical and biochemical assessments performed preoperatively and at 10–12 days, 6 months, and 12 months postoperatively. Symptom severity was assessed using the Greene Climacteric Scale, whereas oxidative stress status was evaluated through seven biomarkers: MDA, PPOA, NO₂⁻, NO₃⁻, SOD, CAT, and AAT. Statistical analyses included one-way analysis of variance (ANOVA) with Tukey’s post hoc test for comparisons at individual time points and repeated-measures analysis of covariance (RM-ANCOVA) for longitudinal assessments.
In the preoperative period, total Greene Climacteric scores were higher in G1B (13.34 ± 6.09) than in G1A (9.06 ± 6.26) and G0 (3.38 ± 2.98; p < 0.001). Postoperatively, scores increased in both surgical groups, reaching peak values at 6 months (G1A: 14.46 ± 5.72; G1B: 16.46 ± 7.71) and stabilizing at 12 months. Vasomotor symptoms were more pronounced in G1A (2.88 ± 1.17 at 6 months; p < 0.05). Oxidative stress markers (MDA, PPOA, NO₂⁻, NO₃⁻) indicated a persistent redox imbalance, more marked in G1A, whereas antioxidant markers (SOD, CAT, AAT) were higher in G1B. Correlations between oxidative stress markers and total Greene scores were generally not significant.
Ovarian preservation attenuated the decline in antioxidant markers despite a greater psychosomatic symptom burden, whereas bilateral oophorectomy was associated with acute vasomotor symptoms and reduced antioxidant capacity. These distinct clinical and biochemical profiles highlight the need for individualized perioperative management, including psychological, hormonal, and antioxidant interventions, to optimize quality of life following surgical menopause.
icronutrient deficiencies during pregnancy remain a major global public health concern, with implications for maternal health, fetal development, and long-term child outcomes. International organizations such as the WHO and FIGO have issued evidence-based guidelines on micronutrient supplementation, which are increasingly being adapted into national protocols.
This narrative review was based on literature searches in PubMed, Scopus, Web of Science, and Google Scholar, covering January 2000 to May 2025. Peer-reviewed studies, systematic reviews, and clinical guidelines from WHO, FIGO, and the Moldovan Ministry of Health were included. The review focused on iron, folic acid, iodine, calcium, vitamin D, and selected trace elements.
Iron and folic acid emerged as the most consistently recommended supplements across guidelines, with proven efficacy in reducing maternal anemia and neural tube defects. Iodine and calcium are also emphasized, particularly in regions with documented dietary insufficiency. Moldova’s antenatal care protocol largely aligns with WHO and FIGO recommendations, prioritizing targeted over universal supplementation for nutrients beyond iron and folate. Evidence on routine supplementation with multivitamin complexes remains inconclusive.
Evidence-based micronutrient supplementation is essential to optimizing pregnancy outcomes. Universal iron and folic acid supplementation remain the cornerstone of antenatal nutrition strategies. Context-specific approaches, as exemplified by the Moldovan model, can enhance implementation in resource-limited settings.
Pediatric ovarian tumors represent a rare but clinically important category of gynecologic conditions, comprising approximately 1-2% of all childhood malignancies and about 5% of pediatric abdominal masses. While most are benign, a meaningful percentage can be hormonally active, raising diagnostic and therapeutic challenges. Due to nonspecific symptoms such as abdominal pain or distension, early diagnosis is often delayed, potentially compromising fertility preservation and long-term outcomes. A multidisciplinary, age-specific approach is essential to optimize management.
This study is a narrative literature review based on an extensive search across PubMed, ScienceDirect, SpringerLink, and Google Scholar. The search covered the period from 2008 to 2025 and included terms such as "pediatric ovarian tumors", "germ cell tumors", "sex cord-stromal tumors", "diagnostic imaging", and "fertility preservation". Inclusion criteria encompassed peer-reviewed, full-text articles in English focusing on patients aged 0-19 years. A total of 20 sources, including clinical guidelines and articles, were selected for their thematic relevance and quality of evidence.
Pediatric ovarian tumors show wide clinical and histological variability, with germ cell tumors being the most prevalent malignant subtype. Transabdominal ultrasound is the first-line imaging tool, while Magnetic Resonance Imaging is reserved for complex or inconclusive cases. Tumor markers, such as alpha-fetoprotein, beta-human chorionic gonadotropin, lactate dehydrogenase, and Inhibin B, are essential in differentiating tumor types and guiding management. Surgical decisions prioritize minimally invasive, fertility-sparing approaches when malignancy is unlikely. Long-term follow-up includes hormonal, reproductive, and psychosocial monitoring. Psychological support is particularly important for adolescents. Despite advancements, diagnostic delays, lack of pediatric-specific guidelines, and disparities in care, especially in low-resource settings, remain critical challenges.
Pediatric ovarian tumors require an individualized, multidisciplinary management strategy that integrates early detection, age-appropriate surgical care, fertility preservation, and long-term endocrine and psychological support. This review highlights the need for pediatric-specific protocols and improved access to diagnostics to enhance outcomes and preserve the future reproductive potential of affected children and adolescents.
Hematological inflammatory markers may be promising diagnostic markers for assessing the severity of intrahepatic cholestasis of pregnancy. The aim of the study was to evaluate and compare the levels of hematological inflammatory markers in intrahepatic cholestasis of pregnancy.
A prospective cohort study of 142 clinical cases, divided into two groups depending on the presence of cholestasis gravidarum, was carried out. The research was conducted by assessing the level of bile acids and hematological inflammatory markers in the mother's blood, as well as by studying medical records. The IBM Statistics SPSS 21 program was used to process the statistical data. To compare categorical variables, the χ² without the Yates' continuity correction test was applied.
There was an increase in platelet-to-lymphocyte ratio in pregnant women with intrahepatic cholestasis of pregnancy compared to the control group (146.0±6.8 versus 135.2±7.3, respectively). The values of neutrophil-to-lymphocyte ratio and the average volume of platelets were similar in both groups. At the same time, the study found a decrease in the values of erythrocyte distribution among women whose pregnancy was complicated by cholestasis gravidarum.
The study showed a significant increase in platelet-to-lymphocyte ratio in women whose pregnancy was complicated by cholestasis gravidarum, as well as an increase in this indicator with increasing levels of bile acids. Thus, this ratio may be a promising diagnostic marker in assessing the severity of intrahepatic cholestasis of pregnancy.