The efficacy of topical imiquimod in high-grade cervical intraepithelial neoplasia: A systematic review and meta-analysis

OBJECTIVE

A major side effect of cervical excision for high-grade cervical intraepithelial neoplasia (CIN) is premature birth. A non-invasive treatment for reproductive age women is warranted. The aim of the present study was to determine the efficacy of topical imiquimod in the treatment of high-grade CIN, defined as a regression to ≤CIN 1, and to determine the clearance rate of high-risk human papillomavirus (hr-HPV), compared with surgical treatment and placebo.

METHODS

Databases were searched for articles from their inception to February 2023.The study protocol number was INPLASY2022110046. Original studies reporting the efficacy of topical imiquimod in CIN 2, CIN 3 or persistent hr-HPV infections were included. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist.

RESULTS

Five studies were included (n = 463). Histological regression to ≤CIN 1 was 55% in imiquimod versus 29% in placebo, and 93% in surgical treatment. Imiquimod-treated women had a greater odds of histological regression to ≤CIN 1 than placebo (odds ratio [OR] 4.17, 95% confidence interval [CI] 2.03-8.54). In comparison to imiquimod, surgical treatment had an OR of 14.81(95% CI 6.59-33.27) for histological regression to ≤CIN 1. The hr-HPV clearance rate was 53.4% after imiquimod and 66% after surgical treatment (95% CI 0.62-23.77).

CONCLUSIONS

The histological regression rate is highest for surgical treatment followed by imiquimod treatment and placebo.

Prevalence of mild cognitive impairment in surgical menopause: subtypes and associated factors

OBJECTIVE

The aim of this study was to determine the prevalence and associated factors of mild cognitive impairment (MCI) and subtypes, amnestic MCI (aMCI) and non-amnestic MCI (naMCI), in women with surgical menopause.

METHODS

We obtained the database containing information for 200 women with surgical menopause from our previous study. The Montreal Cognitive Assessment - total score, the Montreal Cognitive Assessment - memory index score (MoCA-MIS) and their age, years since menopause, education, medical and surgical history, hormone therapy use, exercise, sleep duration, alcohol use, smoking and family history of dementia were obtained. All participants without the MoCA-MIS were excluded.

RESULT

The average age of the 164 participants was 56.3 ± 6.9 years. The prevalence of MCI, aMCI and naMCI was 43.3%, 9.8% and 33.5%, respectively. The duration of education reduced MCI for 93% (95% confidence interval 0.03-0.20) of the women. In late postmenopause, hormone therapy >10 years showed 47% lower prevalence of MCI (age-adjusted odds ratio = 0.53, 95% confidence interval 0.22-1.28). Finally, length of education was the only independent factor associated with MCI and its subtypes.

CONCLUSION

We found a high prevalence of MCI and the non-amnestic subtype in women with surgical menopause. Further study is needed to clarify the long-term effects of surgical menopause on cognitive function.

Effect of surgical menopause and frontal lobe cognitive function

OBJECTIVE

This study aims to explore the prevalence of decreased frontal lobe function and its associated factors in women with surgical menopause.

METHODS

This study is a retrospective analysis of a cross-sectional study conducted between October 2013 and July 2014. Data from 164 women with surgical menopause were analyzed. The Montreal Cognitive Assessment Thai version (MoCA-T) test was administered by a psychologist. The MoCA frontal lobe function score was derived from visuospatial/executive, abstraction, attention, and verbal fluency tests. Multivariable logistic regression was used to assess data associated with decreased frontal lobe function.

RESULTS

The mean age of participants was 56.3 ± 6.9 years, and the mean time since menopause was 11.3 ± 7.4 years. The prevalence of decreased frontal lobe function score was 73.8%, with an average score of 6.21 ± 1.84. The independent factor associated with a lower MoCA frontal lobe function score was duration of education greater than 6 years.

CONCLUSION

Our study adds information about decreased frontal lobe function in almost three-quarters of women with surgical menopause. Duration of education greater than 6 years was a protective factor. Menopause hormone therapy usage did not seem to increase the detrimental effect on frontal lobe function when initiated in young women with surgical menopause.