Adequate Counseling Research Articles

PMON238 Bone mineral density in middle-aged women with reproductive disorders

Abstract Objective Reproductive disorders, such as premature ovarian insufficiency (POI) and polycystic ovary syndrome (PCOS), are associated with hormonal and metabolic changes, which might lead to changes in bone mineral density (BMD). On the one hand women with POI enter menopause too early and have less estrogen exposure rendering them more prone to develop low BMD. On the other hand women with PCOS, who often have a delayed menopause and therefore experience longer estrogen exposure, may have an increased BMD. A third reproductive disorder, preeclampsia (PE) does not seem to affect BMD or menopausal age. The effect of these reproductive disorders, with different menopausal ages, on BMD could be most evident in middle-aged women. We hypothesized that the duration of estrogen exposure is a key factor in BMD. Materials and methods In this cross-sectional study we compared the BMD of 258 women with a history of PE as a reference group (age 46.0; 40% postmenopausal) to 90 women with POI (age 48.1; 100% postmenopausal) and 84 women with PCOS (age 48.3; 26% postmenopausal). BMD was measured using non-contrast coronary CT scans in three consecutive thoracic vertebrae (in the T7-T10 range). Secondary outcomes included T-scores, prevalence of osteoporosis and osteopenia and the comparison of measured BMD to predicted BMD, calculated by a formula based on age. We performed linear regression analysis to assess differences in BMD between groups, adjusted for age and BMI. Results Compared to women with a history of PE, women with POI had lower BMD (p<0.001) and women with PCOS had higher BMD (p=0.003). Prevalence of osteoporosis was higher in women with POI (12.2%) compared to PE (0.8%; P=0.002) and none of the women with PCOS fulfilled the criteria for osteoporosis. Prevalence of osteopenia was significantly higher in the POI group and lower in the PCOS group compared to the PE group (57.8%, 17.9% and 26.4% respectively; p<0.01). As expected, measured BMD of women with POI was significantly lower than the predicted BMD. On the contrary, the measured BMD of women with PCOS was significantly higher than the predicted BMD. Interestingly, the measured BMD of women with a history of PE was also higher than the predicted BMD. Conclusion Our results imply that prolonged estrogen exposure as in PCOS is associated with a higher BMD. A lower estrogen exposure associated with an early menopause in POI is associated with a lower BMD and osteoporosis. Patients with a history of PE could be seen as an intermediate group in terms of BMD and estrogen exposure, however, the measured BMD of women with a history of PE was higher than the predicted BMD. This study emphasizes the importance of adequate counseling on long term health issues when diagnosing a reproductive disorder. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

7426 Hysteroscopic Resection of an Endocervical Cesarean Scar Fibroid

<h3>Study Objective</h3> To present a case of a hysteroscopic resection of an endocervical fibroid from within a Cesarean scar defect (CSD), also known as an isthmocele. <h3>Design</h3> Video case presentation. <h3>Setting</h3> Operative hysteroscopic procedure performed at an urban, academic surgical center. <h3>Patients or Participants</h3> 37-year-old G4P3013 with a history of 3 prior Cesareans, a hysteroscopic and abdominal myomectomy. For 3 months following a spontaneous abortion, she experienced abnormal uterine bleeding. Saline infusion sonogram and MRI revealed a 2.9 cm anterior endocervical fibroid. Options for management were reviewed. Following a short course of progestins that resulted in persistent intermenstrual spotting, and considering desire for future pregnancy, hysteroscopic resection was subsequently decided. <h3>Interventions</h3> Hysteroscopic myomectomy of CSD myoma. <h3>Measurements and Main Results</h3> Successful hysteroscopic resection and techniques to limit intraoperative and postoperative bleeding are described. Postoperatively, the patient had heavy bleeding in PACU with a quantitative blood loss of 700 mL. <h3>Conclusion</h3> Preoperative, intraoperative, and postoperative considerations for this case are reviewed. Preoperative considerations include adequate counseling, imaging such as MRI, thorough discussion of the risks and understanding of the patient's desires in the event of possible hysterectomy. Intraoperatively, primary prevention of bleeding can be attempted with the use of vasoconstrictive agents for both parametrial and intra-myoma instillation to reduce blood flow to the uterus and fibroid. Minimizing the use of electrosurgery may be preferable given the high risk of perforation. Postoperatively, uterotonics are often ineffective at controlling CSD bleeding given the minimal residual myometrium, but antifibrinolytics such as tranexamic acid may be more helpful. If not placed in the operating room under hysteroscopic or ultrasound guidance, an intrauterine balloon can also be inserted postoperatively for tamponade.

Single Institute Experience – Linear Accelerator Based Total Body Irradiation Using Volumetric Modulated Arc Therapy Planning in Standard Size Linear Accelerator Room

<h3>Purpose/Objective(s)</h3> To share experience of linear accelerator based total body irradiation (TBI) with volumetric modulated arc therapy (VMAT) in a standard size linear accelerator room <h3>Materials/Methods</h3> 30 patients aged 2-18 years (between 2018-2021) were treated with TBI as conditioning for bone marrow transplant (BMT)using VMAT based plan on our linear accelerator in a standard sized linear accelerator room. Indication of BMT was – acute lymphoblastic leukemia, acute myelogenous leukemia, chronic myeloid leukemia, myelodysplasia, aplastic anemia etc. Patient selection involved assessment regarding need of anesthesia, details of previous radiation, details of conditioning regimen for scheduling, organs dysfunction, adequate counselling and written consent from parents. With or without anesthesia, patients were immobilized using full body vacloc, head rest, brain orfit cast and knee rest. Position was supine, hands by side. Both head first (HF) and feet first (FF) scans were acquired if body length was more than 120 cm (for 120 cm, HF scan alone was acquired). A wire was placed on thigh to aid fusion of HF and FF scans for plan evaluation. Fiducials at three levels and optically stimulated luminescent dosimeter for dose monitoring were placed. Dose was 2-4 Gy single fraction and 12-13.2Gy/6 fractions (twice daily over 3 days, with 6 hours gap) based on chemotherapy conditioning regimen- delivered to 14 and 16 patients respectively. The planning objective was 90-100% coverage and dose max less than 120%. For multifraction plans, target was mean dose to lungs and kidney less than 10 Gy and 8Gy respectively. VMAT plans were generated with 3-5 iso-centers with fixed couch vertical and lateral values and changing longitudinal value, ensuring only longitudinal couch movement. Plan was made using 6MV energy and 5-9 arcs and 3 cm overlap between fields (avoid over joints to prevent effusion and over lungs to reduce lung dose) <h3>Results</h3> Mean PTV V95 – 93% (92-96%), Dmax – 115% mean (109%-120%). Mean lung dose (for 12-13.2Gy plans) was 9.4Gy/ (9-10 Gy), kidney mean dose was 7.8Gy (7.5-8 Gy). Mean monitor units in the plans were 1120 for complete arc and 690 for partial arcs. Treatment was delivered in strict aseptic precautions, under cover of steroids and antiemetics - in presence of radiation oncologist and physicist. Cone beam CT scan was used for position verification before and after treatment. The mean duration of treatment was 75 mins (range 60-90 minutes). 18 patients had grade 2 nausea and vomiting, one had knee joint effusion. No other side effects were reported. All transplants were successful except one reported graft versus host disease. <h3>Conclusion</h3> The procedure needs careful planning and delivery. It is feasible and possible to deliver TBI using VMAT in a standard sized linear accelerator room and should be offered to patients requiring the same.

If We Treat Them, They May Live: A Single Center’s Experience with Treating Neonates Born at 22 Weeks of Gestation

Objective To describe a single center’s experience with the management of neonates born at 22 weeks of gestation. Study Design Retrospective review of 18 neonates born alive at 22 weeks GA to 16 mothers (cohort included 2 sets of twins) from January 2017 to December 2020, and admitted to a level IV Neonatal Intensive Care Unit. Data on antenatal management was collected from maternal charts. Results Nine mothers delivered due to preterm labor, 5 due to preterm pre-labor rupture of membranes with intra-amniotic infection, and 2 after antepartum hemorrhage. Fourteen mothers received antenatal counseling, 75% received antenatal steroids (25% received a full course), and 31% delivered via caesarean section in honor of parental wishes. All the neonates were actively resuscitated, with 5 surviving to discharge (28%). All survivors had at least 1 morbidity at discharge. None of the infants who underwent extensive resuscitation including chest compressions, epinephrine administration, or volume expansion survived to discharge. Conclusions Adequate antenatal counseling with personalized decision-making consistent with parental desires is the preferred approach at the limits of viability. Although not evident in this study, antenatal interventions such as corticosteroids may improve outcomes and should be considered for families who desire neonatal resuscitation at 22 weeks.

Genetic variants in Colombian patients with inherited cardiac conditions.

Clinical and molecular diagnosis of inherited cardiac conditions is key to find at-risk subjects and avoid preventable deaths. This study aimed to identify genetic variants in a sample of Colombian patients diagnosed with inherited cardiac conditions. Next-generation sequencing (Illumina platform) using a 231 gene panel was performed in blood samples of 25 unrelated patients with age disease onset between 9 and 55 years. Genetic testing yield was 52%. Two novel likely pathogenic/ pathogenic variants were found: a DSP nonsense variant in a patient with arrhythmogenic cardiomyopathy and a KCNE1 frameshift variant in two patients with long QT syndrome. Younger individuals (<18 years) had the highest genetic testing yield (66.6%) compared to 50% and 20% in young adults and patients over 40 years, respectively. All subjects affected with long QT syndrome with a severe event while exercising had a positive genetic test. They also had four times more loss of consciousness events and, resuscitated sudden cardiac arrest was more representative. This study is the first one undertaken in Colombia to evaluate inherited cardiac conditions. It highlights the need to perform mutational analysis to provide adequate genetic counseling and to be able to identify patients at risk of severe events.

Status of female sexual dysfunction among postmenopausal women in Bangladesh

BackgroundWomen's sexual health and physical desire for sex are most important for their emotional and physical well-being. This study aimed to examine the status of sexual dysfunction among postmenopausal women in Bangladesh and assess the significant risk factors behind this.MethodsA cross-sectional study was conducted among 45–55 years in four public and private hospitals in Bangladesh from April 2021 to June 2021 using a multi-stage sampling technique to enroll the study participants. The female sexual function index (FSFI) scale measured the prevalence of FSD, and the relationship of independent risk factors were assessed using a multivariate logistic regression model.ResultsThe total score of FSFI among postmenopausal Bangladeshi women was 18.07 ± 8.51. Among 260 participants, the prevalence of FSD was 56.9%. Out of all the significant risk factors, increasing age, urban population group, multiparous, homemakers, duration of menopause, and postmenopausal women with no hormone therapy were significantly associated with FSD. In contrast, those with regular physical activity were protective of FSD.ConclusionIn conclusion, a significant proportion of postmenopausal Bangladeshi women are enduring sexual dysfunction. Proper hormonal therapy and non-hormonal therapies such as physical activity and pelvic floor muscle (Kegel) exercise with adequate counseling are helpful to cope in this distressing situation.

Assessing the digenic model in rare disorders using population sequencing data

An important fraction of patients with rare disorders remains with no clear genetic diagnostic, even after whole-exome or whole-genome sequencing, posing a difficulty in giving adequate treatment and genetic counseling. The analysis of genomic data in rare disorders mostly considers the presence of single gene variants in coding regions that follow a concrete monogenic mode of inheritance. A digenic inheritance, with variants in two functionally-related genes in the same individual, is a plausible alternative that might explain the genetic basis of the disease in some cases. In this case, digenic disease combinations should be absent or underrepresented in healthy individuals. We develop a framework to evaluate the significance of digenic combinations and test its statistical power in different scenarios. We suggest that this approach will be relevant with the advent of new sequencing efforts including hundreds of thousands of samples.

A Hitchhiker's Guide to Worldwide COVID-19 Vaccinations: A Detailed Review of Monovalent and Bivalent Vaccine Schedules, COVID-19 Vaccine Side Effects, and Effectiveness Against Omicron and Delta Variants.

For the primary prevention of coronavirus disease 2019 (COVID-19), there are currently four different vaccines available in the USA. These are Pfizer (messenger RNA [mRNA]), Moderna (mRNA), Novavax (recombinant protein), and Jansen/Johnson & Johnson (adenoviral vector). All individuals should get vaccinated, and the Centers for Disease Control and Prevention (CDC) has provided comprehensive guidelines on recommended doses, their frequency by age group, and vaccine types, all discussed in detail in this article. Vaccines are a critical and cost-effective tool for preventing the disease. Prior to receiving a vaccine, patients should get adequate counseling regarding any potential adverse effects post vaccination. Appropriate safety precautions must be taken for those more likely to experience adverse consequences. Healthcare professionals should be aware of the symptoms, indicators, and treatment of any adverse event post-vaccination. We have provided a comprehensive review of the different characteristics of COVID-19 vaccines available in the United States, including their effectiveness against various variants, adverse effects, and precautions necessary for healthcare professionals and the general population. This article also briefly covers COVID-19 vaccines available worldwide, specifically their mode of action and effectiveness.

Metabolic syndrome and dyslipidemia in xanthelasma palpebrarum and associated risk-2 factors-A case-control study.

Xanthelasma palpebrarum (XP) primarily causes cosmetic disfigurement. However, systemic associations like metabolic syndrome (MetS) and dyslipidemia need consideration. Determining the prevalence of MetS and dyslipidemia in XP patients and explore risk factors. Our case-control study included 106 XP patients(cases) and 106 age-and-sex matched healthy controls. All subjects underwent detailed history taking, physical examination, and biochemical investigations. MetS and obesity were diagnosed by NCEP-ATP III criteria and modified BMI classification for Asian-Indians, respectively. The odds ratio (OR) and 95% CI for XP patients vs. non-XP controls were 1.6 (95% CI 0.8-3.2, p= 0.1) for MetS, 1.4 (95% CI 0.6-3.1, p= 0.4) for dyslipidemia and 0.2 (95% CI 0.07-0.4, p< 0.0001) for overweight/obesity. Extensive disease, DM, and low serum HDL-C were significantly associated with MetS in XP patients (vs. controls). Normal waist circumference (AOR 21.3, 95% CI 3.5-127.6, p= 0.0008), normal blood glucose (AOR 21.4, 95% CI 3.1-145.1, p= 0.002), and normal blood pressure (AOR 22.3, 95% CI 3.9-124.9, p= 0.0004) significantly reduced the risk of MetS, while bilateral ocular involvement (AOR 4.3, 95% CI 1.1-18.7, p= 0.04) significantly increased the risk of dyslipidemia in XP patients. Xanthelasma palpebrarum patients are more prone to develop MetS and dyslipidemia and need evaluation, despite being a primarily cosmetic concern. Extensive disease and bilateral ocular involvement are significant risk factors. Adequate counseling and healthy life-style measures are crucial to minimize systemic complications.

Predicting IVF outcome in poor ovarian responders

BackgroundPoor responders to ovarian stimulation are one of the most challenging populations to treat. As a failed cycle can cause a considerable emotional and economical loss, adequate fertility counseling addressing patients’ expectations are highly important when facing patients with poor ovarian response. The study aimed to evaluate reproductive outcomes and to identify factors associated with live birth (LB) after fresh autologous IVF/intracytoplasmic sperm injection (ICSI) cycles of patients fulfilling the Bologna criteria for poor ovarian response (POR).MethodsA retrospective study included 751 IVF/ICSI treatment cycles which yielded up to three retrieved oocytes, at a tertiary referral hospital between January 2016 and February 2020. A logistic regression analysis was used to adjust for confounders.ResultsClinical pregnancy and LB rate per cycle were significantly higher among women younger versus older than 40 years (9.8% and 6.8% vs 4.5% and 2.1%, p < 0.01, respectively). Patients who achieved LB were significantly younger, had higher number of oocytes retrieved, fertilization rate and top-quality embryos (p < 0.05). Multivariable regression analysis identified patient’s age (OR 0.90; 95% CI 0.845–0.97; p = 0.005) and mean number retrieved oocytes (OR 1.95; 95% CI 1.20–3.16; p = 0.007) as factors significantly associated with the probability of a LB.ConclusionsThe woman’s age and the number of retrieved oocytes are both independent predicting factors of live birth in poor ovarian responders. Considering the risks, the high financial investment and poor reproductive outcomes involved in IVF treatments, raises questions regarding the adequacy of providing treatments in these patients' population. POR younger than 40 years may represent a possible exception due to acceptable probability for a LB.

Incidental urinary tract injury and the formation of vesicovaginal fistula at the time of hysterectomy for benign indications.

The association between hysterectomy type, laparoscopy use and vesicovaginal fistula (VVF) is currently unclear and would be useful to determine route of surgery and provide adequate patient counseling. The objective of this study was to evaluate the magnitude of association between the use of laparoscopic assistance, recognized intraoperative urinary tract injury and subsequent VVF repair and to quantify any differences in fistula repair and injury detection by hysterectomy type. Lastly, we sought to determine whether the type of hysterectomy is a risk factor for VVF repair independent of injury identification. We performed a retrospective cohort study utilizing the Healthcare Cost and Utilization Project database examining benign hysterectomies performed in California, New York and Florida from 2005-2011. Multivariable logistic regression models were used to evaluate associations among hysterectomy type, reported injury and VVF. Of 581,395 eligible hysterectomies, urinary tract injuries occurred in 6702 patients (1.15%) and 640 patients developed VVF (0.11%). Patients with reported injury were 20-fold more likely to develop VVF than those without (OR = 20.6; 1.96% vs. 0.089% respectively). The association between reported injury and VVF development was stronger if laparoscopy was involved (OR = 30) than if it was not (OR = 17). Patients undergoing laparoscopic procedures were less likely to have injury reported (OR = 0.6) but more likely to undergo VVF repair (OR = 1.5). This association with VVF repair was independent of injury identification. Patients developing VVF were more likely to have undergone total abdominal hysterectomy compared to other hysterectomy types. Laparoscopy is an independent risk factor for the need for subsequent VVF repair, independent of hysterectomy type and presence of intraoperatively recognized urinary tract injury.

Contraceptive Use in Premenopausal Women With Early Breast Cancer

As life span has increased among patients with cancer, survivorship has become an important component of breast cancer care. Among survivorship concerns, adequate contraceptive counseling is needed for premenopausal patients who are not seeking to become pregnant. To examine contraceptive use and chosen methods and to assess factors associated with contraceptive use over time in patients with early breast cancer. The Cancer Toxicity (CANTO) study was a multicenter nationwide prospective cohort study that enrolled women diagnosed with stage I to stage III breast cancer in France between March 2012 and December 2017. This analysis included 2900 premenopausal women who were 50 years of age or younger at diagnosis. Data were analyzed from July 2020 to July 2022. Contraceptive use and method at diagnosis, shortly after the end of primary treatment (year 1), and during follow-up (year 2). Contraceptive use and methods were longitudinally evaluated at diagnosis, year 1, and year 2 after breast cancer diagnosis. Multivariable logistic regression models were used to assess the associations of clinical, socioeconomic, treatment, adverse effect, and patient-reported outcome variables with contraceptive use after diagnosis. A total of 2900 patients (mean [SD] age, 43.1 [5.6] years) were included in the analysis; 2050 of 2894 women (70.8%) received chemotherapy, and 2305 of 2880 women (80.0%) received endocrine therapy. After diagnosis, 1182 of 2625 patients (45.0%) at year 1 and 1553 of 2363 patients (65.7%) at year 2 reported consulting with a gynecologist in the previous year. At diagnosis, 1487 of 2744 patients (54.2%) reported contraceptive use, with most patients (921 of 1470 women [62.7%]) using hormonal methods. The use of contraception significantly decreased after diagnosis (911 of 2342 patients [38.9%] at year 1 and 808 of 1961 patients [41.2%] at year 2; P < .001 for trend), when most patients (848 of 900 women [94.2%] at year 1 and 767 of 805 women [95.3%] at year 2) reported use of nonhormonal methods; these methods were primarily reversible mechanical approaches (copper intrauterine devices: 656 of 848 patients [77.4%] at year 1 and 577 of 767 patients [75.2%] at year 2; male condoms: 115 of 848 patients [13.6%] at year 1 and 110 of 767 patients [14.3%] at year 2). In the multivariable model, factors significantly associated with contraceptive use at year 1 included using contraception at diagnosis (adjusted odds ratio [aOR], 4.02; 95% CI, 3.15-5.14), being younger (aOR, 1.09; 95% CI, 1.07-1.13 per decreasing year), having better sexual function (aOR, 1.13; 95% CI, 1.07-1.19 per 10-point increment), having children (aOR, 4.21; 95% CI, 1.80-9.86), reporting the presence of leukorrhea (aOR, 1.32; 95% CI, 1.03-1.70), receiving tamoxifen treatment alone (aOR, 1.39; 95% CI, 1.01-1.92), and consulting with a gynecologist in the previous year (aOR, 1.29; 95% CI, 1.02-1.63). Similar factors were associated with contraceptive use at year 2, with the addition of partnered status (aOR, 1.61; 95% CI, 1.07-2.44). Findings from this study support the importance of raising awareness and improving targeted contraceptive counseling for premenopausal women with early breast cancer.

Arterial tortuosity syndrome (variants in SLC2A10 gene) in two pediatric patients in the same city of Spain: a case report

BackgroundArterial tortuosity syndrome (ATS) (OMIM #208050) is a very rare autosomal recessive connective tissue disease characterized by elongation, tortuosity, and predisposition of aneurysms formation in medium and large-caliber arteries, vascular dissection, and ischemic events. To date, approximately 100 patients have been reported carrying some of the fewer than 35 causal mutations in the SLC2A10 gene.Case presentationHere we present the clinical and molecular characterization of two new Spanish pediatric ATS patients from two unrelated families in the same city in a short period of time. Due to the knowledge of the pathology through the first case this pathology was suspected from birth in the second case, requesting the directed genetic study.ConclusionIn addition to arterial tortuosity and connective tissue features, sequencing analysis revealed the homozygous and heterozygous Frameshift Deletion. Confirm diagnosis in the first few years of life is the most critical for possible life-threatening events and to offer adequate genetic counseling.

Fertility Preservation in Girls and Women: State of Art and Future Possibilities

Objective: Many women worldwide are diagnosed with cancer in prepubertal, postpubertal and childbearing age. Oncological treatments can compromise future fertility through different mechanisms mainly depending on the type of treatment and the age of the patient. International societies recommend that cancer patients should receive information regarding the effects of oncological treatments on their reproductive health and cancer survivors should not be discouraged from becoming pregnant. About a quarter of these patients still do not receive an adequate counselling and young cancer survivors may face several barriers to conceiving a pregnancy due to the concerns from gynaecologists and oncologists. This review aims to investigate the infertility risk for female cancer patients who undergo oncological treatments and to provide an overview of actual and future fertility preservation possibilities for female cancer patients. Mechanism: We examined the current and future possibilities of preserving fertility for women with cancer in the available literature. Findings in brief: Different fertility preservation techniques have been developed in order to ensure the possibility for cancer survivors to complete their family planning after cancer. Oocyte/embryo freezing and ovarian tissue cryopreservation are the established choices, but the research is still going on to increase the success rate of these techniques and to develop other techniques to overcome actual limitations. Patients with a systemic oncological disease such as leukaemia could particularly benefit from the new experimental techniques which involve the creation of an artificial ovary or the in vitro growth of follicles or even the obtaining of mature oocytes from stem cells. All these techniques would allow the achievement of pregnancy without the risk of reintroducing malignant cells within autologous cryopreserved ovarian tissue transplantation. Regarding the concerns over pregnancy in cancer survivors, research is rapidly advancing and reassuring data are increasing. Conclusions: The rate of utilisation of gametes, embryos or ovarian tissue previously stored for fertility preservation is still low and the motivations can be various. Further data are needed in order to reassure both women and oncologists about the safety of pregnancy in cancer survivors and in order to increase the rate of women experiencing pregnancy after cancer.

Prescribing Narcotics for Pain: Reconsider the Fifth Vital Sign.

Prescribing Narcotics for Pain: Reconsider the Fifth Vital Sign.

Management and Outcomes of Primary Aldosteronism in Pregnancy: A Systematic Review.

Primary aldosteronism (PA) in pregnancy (PAP) can be a serious condition and is challenging to diagnose. This study was conceived to help in the diagnosis of PAP and provide suggestions on management of PAP based on evidence retrieved using a Population, Intervention, Comparison, and Outcome search strategy. Based on the changes of aldosterone and renin occurring in normal pregnancies, we developed a nomogram that will allow to identify PAP cases. Moreover, we found that published PAP cases fell into 4 main groups differing for management and outcomes: (1) unilateral medically treated, (2) unilateral surgically treated, (3) bilateral medically treated and (4) familial forms. Results showed that complications involved 62.2% of pregnant women with nonfamilial PA and 18.5% of those with familial hyperaldosteronism type I. Adrenalectomy during pregnancy in women with PAP did not improve maternal and fetal outcomes, over medical treatment alone. Moreover, cure of maternal hypertension and mother and baby outcome were better when unilateral PA was discovered and surgically treated before or after pregnancy. Therefore, fertile women with arterial hypertension should be screened for PA before pregnancy and, if necessary, subtyped to identify unilateral forms of PA. This will allow to furnish adequate counseling, a chance for surgical cure and, therefore, for a pregnancy not complicated by aldosterone excess.

Endometrial Cancer Incidence in Patients With Atypical Endometrial Hyperplasia According to Mode of Management.

It is well established that around one-third of patients with atypical endometrial hyperplasia (AEH) go on to develop endometrial cancer (EC). This retrospective cohort study included 119 patients recruited from the University Hospitals of Leicester from 01/01/2015 to 01/01/2020 with a diagnosis of AEH by endometrial biopsy. Patients were divided into two groups according to the management modality: Primary surgery (n=99), and conservative treatment (n=20). The aim of this study was to determine the incidence of EC in patients with AEH in University Hospitals of Leicester, UK, and to explore the reasons why patients with AEH opted for conservative management. EC was diagnosed in 34.4% of patients with AEH managed by primary surgery. Moreover, the incidence of EC in patients with AEH managed conservatively was 25%. The main reason for opting for conservative management was that patients were unfit for surgery when assessed in the high-risk Anaesthetic Clinic (35%). AEH is a pre-malignant lesion that has high risk of EC regardless of the mode of management. Total hysterectomy is the safest first line of treatment in AEH due to the high risk of concurrent EC and progression to EC. Currently, there is no reliable follow-up intervention to distinguish between concurrent EC and progression of AEH. Adequate discussion and counselling are essential when discussing conservative management for women with complex AEH. Patients should be counselled regarding the high risk of developing concurrent EC and risk of progression to EC.

Síndrome Crouzon em um paciente de Angola: caso clínico

Introduction: Crouzon syndrome is an autosomal dominant disease characterized by craniosynostosis causing secondary alterations of the facial bones and other facial structures. This article aims to report a case of Crouzon syndrome seen at the Benguela General Hospital. Case: The patient was a female infant, one month and 14 days old, of Angolan nationality, from Benguela province, Kalomanga commune, born from a eutocic delivery at 9 months of gestational age. At the physical and dysmorphological exam, bulging of the frontal region, macrocranium, palpable coronal suture, craniosynostosis, exophthalmos, proptosis, divergent strabismus, hypertelorism, parrot nose, carpal mouth, macroglossia, ogival and cleft palate in the posterior region, short neck, excavated chest, and globous abdomen, among other manifestations, were observed. Conclusion: Early diagnosis of Crouzon syndrome allows for adequate genetic counselling and individual and family clinical follow-up. This case of a rare genetic disease shows that in Angola, in addition to the epidemiological pattern characteristic of infectious diseases, diseases of genetic nature are also represented.

Assessment of Self-care practices, Treatment satisfaction and Quality of Life among Diabetes Type2 Patients in Pokhara, Nepal

INTRODUCTION: Treatment satisfaction and health-related quality of life are related and important for successful treatment of diabetes patients. The main objective of this research is to assess the self-care practices, treatment satisfaction and quality of life among diabetes type2 patient in Pokhara. MATERIALS AND METHODS: A cross-sectional study was conducted among the diabetes type2 patients from June 2019 to December 2019 in Pokhara Metropolitan. The sample size for this study was 248. Consecutive sampling technique was used for the selection of participants. Interview schedule was used for doing face to face interview. A collection of questions adapted from Diabetes-39 and it was used as a tool for assessing the quality of life of the participants. The Nepali version of the D-39 instrument was pre-tested among 10% (25) of total sample in Metrocity hospital to check its simplicity before data collection. Likert scale of 5 points was used to assess treatment satisfaction. Chi-square test was obtained to find out the association between dependent and independent variables and crude odd ratio was calculated to measure the strength of association. RESULTS: Two-fourth (41.9%) of the participants were engaged in physical activity. Two-fifth (39.9%) of the participants test blood sugar monthly. About four-sixth (68.5%) of the participants had good quality of life and rest had poor quality of life. Almost all 98.0% were satisfied with the treatment. Factors such as age, sex, marital status, physical activity and duration of diabetes mellitus were associated with quality of life. CONCLUSIONS: The study showed that physical activities should be focused to promote healthier life. One should focus on promoting a self-care practices in order to prevent the complication of disease. Quality of life can be achieved through adequate self-care practice, proper treatment and counselling.

Demography and COVID-19 Symptoms of South African Oral Health Workers in an Academic Hospital

Oral health care workers constitute a high-risk profession to contract COVID-19. The aim of this study was to determine the prevalence and clinical experience of COVID-19 infected oral health workers at an academic hospital in Gauteng, South Africa. A cross-sectional, questionnaire-based study was conducted among staff who contracted COVID-19 betweenMay and December 2020. Data was captured in Excel and analyzed with Stata (StataCorp, USA). COVID-19 prevalence among 219 members of staff was 22.4%, and 46 participated. The majority ranged in age between 31- 40 years (n=18, 39%, 95% CI 25.78-54.32) and 41 – 50 years (n=19, 41%, 95% CI 7.88-56.4). Clinicians and dental assistants constituted 48%, while 76% perceived to be infected at work, with 72.7% sharing an office with ≥ 3 persons. Twenty-four staff members received post-test counselling, of whom 21.7% were counselled at work. Sixteen participants remained asymptomatic while most prevalent self-reported COVID-19 symptoms included cough (47.7%), sore throat (27.3%) and shortness of breath (20.5%). Significantly more females (55%) reported no COVID-19 symptoms than males (Chi2test, p = 0.01). The COVID-19 prevalence in this study was much higher than previously reported for oral health workers in an academic setting. The high percentage of staff who remained asymptomatic raises the possibility of more staff being infected without being tested. Infection prevention and awareness training of all staff should be routinely provided and mitigating measures instituted to reduce office occupancy, including adequate post-test counselling