Jelena Dotlic

Evaluation of the risk malignancy index diagnostic value in patients with adnexal masses.

BACKGROUND/AIM Ovarian cancer is the leading cause of death from gynecologic malignancies. Risk of malignancy index (RMI) is recommended in assessment of patients with adnexal masses. The aim of this study was to verify the effectiveness of the RMI in the discrimination between benign lesions and malignant adnexal masses in clinical practice. METHODS Ultrasounds were performed for all the patients and menopausal status, CA125 level and calculated RMI were defined. All the patients were divided into 3 groups depending on RMI (< 25, 25-200, > 200). After operations all adnexal masses were analyzed histopathologically (HP) and then sensitivity, specificity and predictive value of RMI were calculated. RESULTS Out of a total of 81 patients involved benign tumor had 51 (62.96%) and malignant 30 (37.04%) of the patients. The average value of CA125 in the group of patients with benign adnexal masses was 68.3 U/mL and in the group of patients with malignant adnexal masses it was 581.95 U/mL. In the group of patients with benign adnexal masses the average RMI was 284.9 and in the group of patients with malignant adnexal masses RMI was 469.2. All the results showed a positive correlation between both HP categories and RMI categories. The more malignant HP result produced higher RMI and the cut off value was RMI = 200. Sensitivity of RMI w as 83.33%, specificity was 94.12%, positive predictive value was 89.29% and negative predictive value was 90.57%. CONCLUSION Our study showed that RMI is very reliable in differentiation benign from malignant adnexal masses.

Influence of red clover-derived isoflavones on serum lipid profile in postmenopausal women

Aim:  Menopause is associated with adverse metabolic changes, especially in plasma lipoprotein and cholesterol levels. Estrogens have beneficial effects on lipid metabolism. Phytoestrogens are plant substances that are structurally and functionally similar to 17β‐estradiol and are capable of producing estrogenic effects. The goal of the present study was to estimate the effects of red clover‐derived isoflavones on serum lipid levels in postmenopausal women.

EVALUATION OF ADNEXAL MASSES: CORRELATION BETWEEN CLINICAL, ULTRASOUND AND HISTOPATHOLOGICAL FINDINGS

BACKGROUND/AIM Concerning the growth of ovarian carcinoma incidence and bad prognosis for malignant forms, early and precise diagnostics is gaining in importance as a condition for precise and appropriate therapy for ovarian tumor masses. The aim of this study was to analyze pre- and postoperative findings of patients with adnexal masses in order to identify factors which could predict the nature and stage of the tumor prior to surgery. METHODS All patients with adnexal masses who were treated in a 6-month period in the Institute of Obstetrics and Gynecology, Clinical Center of Serbia, (IOG, CCS), Belgrade, had their epidemiologic and gynecologic anamnesis and standard laboratory analyses taken prior to surgery. Also, clinical and ultrasonographic check up of pelvic organs was performed, as well as calculation of body mass index (BMI) and risk of malignancy index (RMI). After surgery we analyzed histopathological (HP) findings of tumors as a mean of final diagnosis and staging. For statistical analysis, we used SPSS 15 program. RESULTS Throughout a 6-month period, we examined 81 patients with adnexal masses treated in the IOG CCS. HP findings showed that there were significantly more benign (n = 51) than malignant (n = 30) tumors in all the patients (Chi2 = 5.512). The patients with malignant HP findings were significantly older than those with benign adnexal masses (t = 3.362; p = 0.001). Significantly more patients with malignant HP findings were in menopause (p = 0.034). BMI values were highly significantly higher in the patients with malignant adnexal tumors (t = 3.421; p = 0.001). There was a statistically significant positive correlation between HP categories (benign, malignant) and RMI categories (low, intermediate and high risk) of all the patients (high risk, more malignant HP) (Ro(xy) = 0.428; df = 78; p = 0.000). CONCLUSION . Patients in menopause, especially older ones, with high BMI and RMI should immediately be referred to a tertiary level institution, where appropriate surgery could be performed.

Risk of malignancy index validity assessment in premenopausal and postmenopausal women with adnexal tumors

OBJECTIVE The aim of this study was to investigate the validity of the risk of malignancy index (RMI) in premenopausal and postmenopausal patients with adnexal masses. MATERIALS AND METHODS The study involved all women treated for adnexal tumors throughout an 18-month period in the Clinic for Gynecology and Obstetrics, Clinical Center of Serbia (Belgrade, Serbia). On admission, detailed anamnestic and laboratory data were obtained and an expert ultrasound scan was performed. The RMI was calculated for all patients and the obtained data were related to histopathological findings of the tumors. For statistical analysis, we used descriptive and analytical statistics methods and an SPSS computer program. RESULTS From a total number of 540 women, 85 women had malignant tumors; 20 women, borderline tumors; and 435 women, benign adnexal tumors. The RMI was reliable in 84.6% of all patients; in 77% of premenopausal patients, and in 81.1% of postmenopausal patients. The sensitivity of the RMI in the overall population was 83.81%; the specificity was 77.24%; the positive predictive value (PPV) was 47.06%, and the negative predictive value (NPV) was 95.18%. In premenopausal women, the RMI sensitivity was 83.87%; specificity, 80.31%; PPV, 28.89%; and NPV, 98.12%. In postmenopausal women the RMI sensitivity was 83.78%; specificity, 68.18%; PPV, 63.92%; and NPV, 74.71%. CONCLUSION The RMI was a reliable factor for differentiating benign from malignant adnexal masses in premenopausal and postmenopausal patients.

Translation and validation of the Utian Quality of Life Scale in Serbian peri- and postmenopausal women.

Objective:This study aimed to translate the Utian Quality of Life Scale (UQOL) into the Serbian and to assess its validity and psychometric properties in Serbian peri- and postmenopausal women. Methods:This survey included 200 perimenopausal and postmenopausal women. Women were approached after their regular gynecological checkup in two community health centers (city center and outskirts) in the capital city Belgrade. The following instruments were used: general questionnaire (sociodemographics, habits, and medical history), UQOL, Short Form-36, and Beck Depression Inventory. The UQOL was translated according to the recommended methodology for translating questionnaires, and its psychometric properties (internal consistency, factor analysis, discriminant validity, construct validity, and criterion validity) were tested. Results:The mean (SD) UQOL total score was 80.5 (13.5). The Cronbachs &agr; coefficient for the entire scale was 0.83 (Occupational, &agr; = 0.76; Health-Related, &agr; = 0.72; Emotional, &agr; = 0.36; Sexual, &agr; = 0.66). All corrected item–total correlation coefficients were greater than 0.40, confirming that all items were appropriate parts of the UQOL. On exploratory factor analysis, we obtained six factors (five items formed two new clusters: Physical Fitness and Professional Recognition) that explained 85.7% of the total variance. The UQOL total score was significantly negatively correlated with Beck Depression Inventory score (P = 0.001) and significantly positively correlated with all Short Form-36 domains (P = 0.001). In addition, significant intercorrelations of UQOL domains also indicated good criterion validity. Conclusions:The Serbian version of the UQOL demonstrates satisfactory reliability and validity in the assessment of quality of life among peri- and postmenopausal women. The Serbian version of the UQOL is an adequate quality-of-life instrument in the Serbian language that can be applied in the everyday clinical setting.

Current diagnostic approach to patients with adnexal masses: which tools are relevant in routine praxis?

OBJECTIVE The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant specialist. METHODS Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index (PDI), risk of malignancy index (RMI) and body mass index (BMI) were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. RESULTS The study included 689 women (112 malignant, 544 benignant, and 33 borderline tumors). Malignant and borderline tumors were more frequent in postmenopausal women (P=0.000). Women who had benignant tumors had the lowest BMI (P=0.000). There were significant (P<0.05) differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen (CEA) levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors (P=0.000). Women with malignant tumors had highest values of RMI and PDI (P=0.000). CONCLUSIONS Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.

Serbian version of the Women’s Health Questionnaire: psychometric properties

Abstract Objective The aim of this study was to translate the Women’s Health Questionnaire (WHQ) into the Serbian language and assess its validity and reliability in a population of Serbian menopausal women. Methods The study included peri- and postmenopausal women from two Community Health Centers in Belgrade. Women filled out the WHQ, the Short Form-36 questionnaire (SF-36) and Becks Depression Inventory (BDI). The WHQ was translated according to recommended methodology for cultural adaptation of questionnaires and its psychometric characteristics (internal consistency, inter-rater reliability, factor analysis, sensitivity, discriminant, construct and criterion validity) were tested. Results In the Serbian population, the mean values of the WHQ domains were mostly comparable with reference Mediterranean countries. Whole-scale Cronbach’s α was 0.838. Moreover, five WHQ domains had a value of Cronbach’s α above the acceptable limit. There were no significant differences in WHQ scores between our two investigators. On exploratory factor analysis, we obtained ten factors (two items formed a new factor – ‘Menstrual pathology’). Almost all SF-36 domains were significantly associated with WHQ domains, while the BDI was associated with domains: depressive mood, anxiety and sleep problems. Based on ROC analysis, WHQ is slightly more reliable for perimenopausal than postmenopausal Serbian women. Conclusion The Serbian version of the WHQ showed very good reliability and validity in assessment of quality of life among menopausal women. The WHQ is applicable for both peri- and postmenopausal women.

Diagnostic value of serum tumor markers for adnexal masses

ObjectiveThe study aim was to investigate the diagnostic value of measuring preoperative serum tumor markers in patients with adnexal masses.MethodsThe study included all (358) consecutive patients treated for adnexal tumors at the Clinic of Obstetrics and Gynecology, Clinical Center of Serbia during 12 months. Tumor-marker levels (Ca 125, CEA, HE 4, Ca 19.9 and Ca 15.3) obtained from all women on admission were compared with histopathological findings in cases in which tumors were removed.ResultsWomen with malignant tumors had the highest levels of Ca 125, CEA and HE 4 (p<0.01). Mucinous adenocarcinoma produced the highest amounts of Ca 19.9 and CEA. Ca 15.3 was the highest in women with endometrioid carcinoma. There were no significant differences in the levels of all serum tumor markers between women with benign and borderline tumors (p>0.05). Malignant forms of tumors were well indicated by Ca 125, HE 4 and Ca 15.3 levels. The combination of Ca 125 and HE 4 resulted in the highest sensitivity, specificity, and positive or negative predictive value (91.04%, 87.6%, 67.9%, 77.2%, respectively).ConclusionsBlood levels of tumor markers can be effective? predictors of the nature of adnexal masses. For the most precise evaluation, a combination of serum tumor markers should be used.

Health-Related Quality of Life in Patients with Chronic Rhinosinusitis

INTRODUCTION The need for assessing the quality of life in chronic rhinosinusitis is emphasised by the medical, social and economic importance of this pathological condition. Questionnaires have been employed in majority of studies while there are no available data that Q method has been used for quality of life research in chronic rhinosinusitis up to the present. OBJECTIVE The aim of this study was to identify, group and analyse subjective perception of the impact of the disease on health-related quality of life in patients with chronic rhinosinusitis. METHODS The study involved 36 consecutive patients of both sexes, older than 10 years of age, diagnosed with chronic rhinosinusitis in the tertiary health clinic in three successive weeks. They were selected for medicamentous treatment. Health-related quality of life was assessed by Q method. Through 34 representative statements, which were sorted by the examinees related to subjective priorities, 10 key quality of life domains were examined. The data were processed by factor analysis employing specialised software package PQMethod. RESULTS Analysing individual opinions of the examinees, five different opinion-types (factors) on the impact of chronic rhinosinusitis on quality of life were demonstrated. They were marked numerically and descriptively according to dominant characteristics of the group: Factor 1--stable group (47.2% of individuals), Factor 2--symptomatic group (11.1% of individuals), Factor 3--mental group (5.6% of individuals), Factor 4--physical group (11.1% of individuals) and Factor 5--optimistic group (25.0% of individuals). Each group was systematically analysed. CONCLUSION Majority of patients with chronic rhinosinusits (72.2%) were found to be satisfied with the quality of life, while just a small number (5.6%) heavily bore the illness which especially jeopardised their mental health. This study demonstrates the strength of Q method in analysing and categorizing subjectivity and offers quality practical information which enables a more comprehensive approach and more adequate intervention in patients with chronic rhinosinusitis.

Factors associated with general and health-related quality of life in menopausal transition among women from Serbia

ABSTRACT This study assessed factors associated with quality of life (QOL) among Serbian peri- and postmenopausal women using two menopause-specific scales. This cross-sectional study included 500 women aged 40–65 years who had a gynecologic check-up in one of two Community Health Centers in Belgrade during February 2014 to January 2015. Women completed: a questionnaire about socio-demographics, habits, and health status; a menopause-specific questionnaire, Utian’s Quality of Life Scale (UQOL); and a Women’s Health Questionnaire (WHQ) and Beck’s Depression Inventory (BDI). Higher education was associated with better occupational UQOL and memory/concentration, but with lower emotional UQOL and more anxiety/fears. City center residency was associated with better occupational and sexual UQOL. Being employed was associated with better occupational UQOL and lower anxiety/fears. Higher income was associated with better emotional UQOL. Not having uterine prolapse, insomnia, or tachycardia was associated with better occupational UQOL and fewer sleep problems. Higher parity was associated with better sexual UQOL. Having regular recreation was associated with better health and sexual UQOL but with more frequent vasomotor symptoms. Leaner women felt more attractive. QOL during the menopausal transition does not entail only somatic symptoms and therefore requires a more comprehensive approach that includes psychosocial underpinnings.