Peripartum cardiomyopathy (PPCM) is a condition with an incompletely understood etiology, although many risk factors for this disorder have been mentioned. Preeclampsia (PE) is a rare but undoubtedly very important cause of PPCM. Early recognition and prompt treatment of preeclampsia and peripartum cardiomyopathy are essential to optimize pregnancy outcomes. An extensive manual search of major electronic databases was conducted in November 2021. The following literature review provides a comprehensive discussion of peripartum cardiomyopathy and preeclampsia and quantifies the prevalence of PE in women with PPCM. The authors highlighted aspects such as epidemiology, risk factors, cardiovascular changes, diagnosis and clinical presentation, and management and complications. Accumulating data indicate that both conditions have a similar pathogenesis characterized by vascular abnormalities. In both conditions we can observe an increase in interleukin-6 and gamma interferon, CCL2/MCP1, and decreased SOD activity. sFLT1 (a soluble form of fms-like tyrosine kinase 1), a substance with antiangiogenic and probably cardiotoxic effects, may be important. Preeclampsia and peripartum cardiomyopathy are characterized by recurrence rates that follow a similar pattern in subsequent pregnancies, and mortality remains a concern. Our analysis highlights the need to better understand the co-morbidity of PE and PPCM, and the need to qualify patients for the same clinical trials because of the common origin of these conditions.
A growing number of reports point to the possible role of environmental factors in determining the age of onset of menopause. Specific metals, such as mercury, cadmium, arsenic and lead can lead to fertility disorders, to endocrine dysregulation, and in addition, their high blood concentrations correlate with the onset of menopause. Changing concentrations of hormones in the blood during this period of a woman’s life can also have an impact on SARS-CoV-2 infection, and excessively high or low levels of metals may also be an important predictor for the course of COVID-19. Postmenopausal women are exposed to greater risk of serum biochemical changes, and with the possibility of nutritional disturbances, particularly involving trace minerals, the risk of age-related diseases is very high during this period. These adverse changes in serum trace minerals should be taken into consideration for the early diagnosis and prevention of menopause-related diseases. Dietary supplementation may be necessary, especially where levels are significantly reduced. We performed a manual search of scientific articles cited in major electronic databases (PubMed, EMBASE, Web of Science and Google Scholar) in November 2022 to identify studies relevant to the relationship between metals, COVID-19 and menopause. The effects of metals on the course of menopause is a broad topic and should certainly still be a subject of research, due to, among other things, continuing environmental pollution and the use of metals in many areas of life.
Cardiac tumors are a heterogeneous group of pathologic masses of the heart that contain primary tumors—benign or malignant, and secondary tumors. Metastases are significantly more frequent, mostly originating from lung, breast, gastrointestinal tract, or ovary carcinomas. Secondary cardiac tumors may be asymptomatic or may cause cardiovascular, systemic, or embolic symptoms. The study is a summary of the available knowledge on cancerous metastatic lesions of the heart. Pleural mesothelioma (48.4%), adenocarcinoma (19.5%), or squamous cell carcinoma (18.2%) of lung, breast carcinoma (15.5%), ovarian carcinoma (10.3%), and bronchoalveolar carcinomas (9.8%) are cited as the most common origin of secondary heart tumors. Masses can spread by direct tumor invasion, by lymphatic vessels, veins, or arteries. Patients with cancer and nonspecific cardiovascular symptoms should be particularly vigilant, and the possibility of metastasis in an unusual location such as the myocardium should be considered in the diagnosis. Diagnostic methods include echocardiography, cardiac magnetic resonance, computed tomography, positron emission tomography, and histologic evaluation. Treatment of choice is managing primary carcinoma, due to the poor outcomes of surgical methods.
ImportancePregnancy-associated melanomas (PAMs)—this is how melanomas identified during the childbearing years or up to 1 year after birth have been defined, accounting for one third of women in whom it is diagnosed. The exact epidemiology of melanoma is difficult to determine. However, its incidence is undoubtedly increasing, most likely related to the increasing age of mothers.ObjectiveThe purpose of this study was to review the prognosis, diagnosis, and treatment; the effect of melanoma on pregnancy; and the effect of pregnancy on melanoma and melanocytic lesions.Evidence AcquisitionAn extensive manual search of major electronic databases was conducted in January 2022. The following literature review provides comprehensive coverage of PAMs.ResultsAny new nevus detected during pregnancy and changes in the nevus regarding color, diameter, symmetry, or lesion border require medical evaluation. New therapies for malignant melanoma, such as immunotherapy and targeted therapy, have improved overall survival and progression-free survival, but their use is often contraindicated in pregnant patients. Melanoma is considered to be the neoplasm most commonly involving the fetus and placenta.ConclusionsThere are reports where immunotherapy and targeted therapy used in the patient were not associated with serious consequences for the fetus, being a therapeutic option for the patient. The described cases of pregnancy outcome during modern melanoma treatment are extremely important and may allow to shape the optimal therapeutic regimen in pregnant women with melanoma.RelevanceEducation of pregnant women in the context of observation of skin lesions as well as maintenance of oncological vigilance by physicians seem to be an important element in limiting difficult decisions related to therapy of more advanced disease. Further large-scale studies using modern treatment in pregnant women with melanoma are needed.Target AudienceObstetricians and gynecologists, family physicians.Learning ObjectivesAfter completing this activity, the learner should be better able to describe the importance of oncologic vigilance in the context of developing melanoma in a pregnant woman; discuss the need for further research on the use of immunotherapy and targeted therapy in pregnant women with melanoma; and explain the need for oncologic vigilance in the context of melanoma in children of mothers who developed melanoma during pregnancy.
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