Disease In Young Women Research Articles

Systematic review with meta‐analysis: clinical manifestations and management of autoimmune hepatitis in the elderly

Autoimmune hepatitis is an uncommon chronic progressive inflammatory disease of the liver, characterised by hypergammaglobulianemia, circulating autoantibodies, and interface hepatitis histologically. It is traditionally thought to be a disease of young women. However, recent epidemiological and retrospective studies suggest that it might be a disease predominantly of older women. Studies of AIH in elderly patients have been fairly limited. To investigate the differences in the clinical presentations and the management of AIH in the elderly and the younger patients. We conducted a search on MEDLINE (from 1946), PubMed (1946) and EMBASE (1949) through to November 2013 using the terms 'autoimmune hepatitis in the elderly', and the combinations of 'Autoimmune hepatitis' AND the following terms: 'elderly', 'aging', 'older patients', and 'older'. The reference lists of relevant articles were also searched for appropriate studies. A total of 1063 patients were identified with AIH in 10 retrospective studies. The definition of 'elderly' ranged from 60 to 65 years; 264 elderly and 592 younger patients were included for analysis. Elderly, 24.8%, were more likely to present asymptomatically, cirrhotic at presentation and HLA-DR4-positive. They are less likely to be HLA-DR3-positive and to relapse after treatment withdrawal after complete remission. AIH is an important differential in elderly patients with cirrhosis or abnormal LFTs. Elderly are more likely to be cirrhotic and asymptomatic at presentation. Glucocorticoids use should be readily considered in the elderly patients as the current evidence suggests that they respond well to the therapy, with less relapse after treatment withdrawal.

Are There Sex Differences in Acute Coronary Syndrome Presentation?

Are There Sex Differences in Acute Coronary Syndrome Presentation?

Crohn’s disease in women

This article provides an overview of the obstetric and gynecological manifestations of Crohn’s disease (CD). High incidence of the new onset of the disease in young women in their reproductive years demands special concern from physicians involved in their treatment. Pregnant women with CD are considered high-risk patients, regardless of disease activity index, due to associated complications. Predominately described complications are premature birth, low birth weight, and congenital anomalies. To minimize the risk for adverse pregnancy/birth outcomes, it is recommended that remission be achieved before conception. Treatment of CD in pregnant women is similar to that among the nonpregnant population, and there is no valid reason to terminate it, since most of the drugs are proven to be safe. Women with CD who wish to conceive or are already pregnant need to be properly advised according to the newest guidelines on the subject, given by the European Crohn’s and Colitis Organization. Gynecological manifestations are another special feature of CD. They are important in that they may facilitate early recognition of the underlying disease, which usually stays unrecognized for years before intestinal manifestation; in this way, the underlying manifestations are often mistreated.

Vegetable protein and vegetable fat intakes in pre-adolescent and adolescent girls, and risk for benign breast disease in young women

Previous investigations, of adolescent diet recalled in adulthood, found lower risk for benign breast disease (BBD) with higher intakes of vegetable fat and nuts during high school. We investigate whether vegetable protein and fat, derived from diets reported during pre-adolescence and adolescence, are associated with subsequent risk for BBD in young women. The Growing Up Today Study includes 9,039 females, 9-15 years in 1996, who completed questionnaires annually through 2001, and then in 2003, 2005, 2007, and 2010. Food frequency questionnaires (1996-2001) obtained intake data on a variety of foods. Beginning in 2005, women (18-30 years) reported whether they had ever been diagnosed with BBD that was confirmed by breast biopsy (n = 112 cases). Logistic regression estimated associations between intakes of vegetable protein and fat and biopsy-confirmed BBD. Those individual foods that were the largest contributors of protein and fat in this cohort were also investigated. In analyses of intakes from 1996 through 1998, when our cohort was youngest, vegetable fat (OR = 0.72/(10 gm/day), 95 % CI 0.53-0.98; p = 0.04) was inversely associated with BBD risk. The greatest sources of vegetable fat and protein in these girls were peanut butter, peanuts, nuts, beans (beans, lentils, and soybeans), and corn. A daily serving of any one of these was associated with lower risk (OR = 0.32/(serv/day), 95 % CI 0.13-0.79; p = 0.01). Peanut butter (and nuts) at age 11 years was inversely associated with risk (p = 0.01). In analyses of intakes at age 14 years, vegetable protein was associated with lower BBD risk (OR = 0.64/(10 gm/day), 95 % CI 0.43-0.95; p = 0.03). A daily serving at 14 years of any one of the foods was associated with lower risk (OR = 0.34, 95 % CI 0.16-0.75; p = 0.01), as was peanut butter (and nuts) (p = 0.02). Girls with a family history of breast cancer had significantly lower risk if they consumed these foods or vegetable fat. In conclusion, consumption of vegetable protein, fat, peanut butter, or nuts by older girls may help reduce their risk of BBD as young women.

Is Cardiovascular Disease in Young Women Overlooked?

Is Cardiovascular Disease in Young Women Overlooked?

Prevalence of high-risk HPV types and associated genital diseases in women born in 1988/89 or 1983/84 – results of WOLVES, a population-based epidemiological study in Wolfsburg, Germany

BackgroundHigh-risk human papilloma virus (HR-HPV) infection is associated with the development of cervical cancer. HPV vaccination reduces the risk of developing malignant lesions and is expected to change the dynamics of HPV transmission. Data from non-vaccinated women may provide an important benchmark to allow the impact of HPV vaccination programs to be assessed.This study was designed to prospectively determine the changing dynamics of HR-HPV infection and associated genital diseases in young women, most of whom were non-vaccinated.MethodsData from a population-based cohort study, comprising women of two predefined birth cohorts (women born in 1983/84 or 1988/89), were analyzed between 19 October 2009 and 31 December 2010 to determine risk factors for high-risk HPV infection and the association between specific HR-HPV types and atypical Pap smear test results. HPV status was determined by Hybrid Capture 2 (HC2) assay and genotyping.ResultsThe prevalence of HR-HPV was 22.8% in the 1983/84 cohort (150/659) and 23.7% in the 1988/99 cohort (142/599). Only the number of sexual partners was a significant risk factor for HPV infection (odds ratios 22.687 and 6.124 for more than five versus one partner 84 cohort,/84 and 1988/89 cohorts, respectively) in multivariate analysis. HPV16 positive-women were significantly more likely to have abnormal Pap smears of any degree than HPV16-negative women (22.0% versus 3.61%, p < 0.0001 for the 1983/84 cohort and 9.09% versus 2.52%, p = 0.0482 for the 1988/89 cohort). CIN3 was diagnosed in six women 84 cohort,/84 cohort and two in the 1988/89 cohort. All women with CIN3 tested positive for HC2-HR and all six CIN3 cases 84 cohort,/84 cohort tested positive for HPV16. In the 1988/89 cohort, the rate of HPV16 infection was significantly lower in vaccinated than non-vaccinated women (1.59% versus 8.88%; p = 0.003).ConclusionsHR-HPV infection was highly prevalent in both cohorts and associated with an increased risk of abnormal Pap smears and biopsy proven CIN2+. HPV16 infection was associated with a high risk of clinically relevant lesions. HPV vaccination significantly decreased the risk of HPV16 infection.

Desmoplastic small round cell tumor of the ovary: A rare but devastating disease in young women

•Desmoplastic small round cell tumor of the ovary is a rare clinical entity with poor prognosis.•Accurate diagnosis utilizes a combination of histological, immunohistological, and cytogenetic findings.•This disease should be kept on the differential diagnosis in young women with widespread disease on presentation.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Lower Anogenital Tract Squamous Terminology

Lower Anogenital Tract Squamous Terminology

C0027 Mondor\\'s disease in young woman due to hereditary thrombophilia

Mondor\'s disease is a rare entity characterized by thrombophlebitis of the subcutaneous veins of the anterolateral thoraco-abdominal wall, the etiology of which remains obscure. Trauma and surgical biopsies head the top of the list of known cases, it may also be associated with breast cancer, bandaging, tight clothes, infections and inravenous drug abuse. Fewer than 400 cases of this disease have been reported in the world literature and only in one case thrombophilia was found to be associated with this condition.

Rapidly progressive pulmonary venoocclusive disease in young women taking oral contraceptives

Pulmonary venoocclusive disease (PVOD) is a rare cause of pulmonary hypertension characterized by a progressive clinical course and poor outcomes if not treated by early lung transplantation. The pathogenesis of PVOD remains poorly understood. We report PVOD that developed in 2 young women soon after the initiation of oral contraceptives (OCs). The first patient is a 14-year-old girl, with no medical history, who started taking an OC 3 weeks before the onset of symptoms. The second patient is an 18-year-old girl, diagnosed 2 years previously with systemic lupus erythematosus and lupus anticoagulant, who started taking an OC 4 months before the onset of symptoms. Both patients required lung transplantation. Radiographic and histopathologic findings in both patients showed features of PVOD. Only 1 prior patient with PVOD and a handful of unclassified patients with pulmonary hypertension in association with OCs have been documented. The importance of PVOD as the basis of pulmonary hypertension in patients with connective tissue disease has been recently proposed, as well as the role of thrombogenesis, in the development of PVOD. The temporal sequence in these 2 patients suggests the thrombogenic action of OCs may contribute to the development of PVOD, with or without underlying connective tissue disease.

PP101. Preeclampsia and pregnancy induced hypertension and carotid artery atherosclerosis

Recent studies indicated preeclampsia (PE) and pregnancy-induced hypertension (PIH) as risk factors for cardiovascular diseases in young women. Women with a history of preeclampsia face double the risk of a heart disease during the 5-15years after pregnancy. We assessed the impact of these factors on endothelial function, atherosclerotic changes and lipid metabolism in young women with a history of preeclampsia and pregnancy-induced hypertension. The aim of this study was to examine whether women with a history of preeclampsia more often show signs of atherosclerosis compared with control group We analyzed serum levels of total cholesterol (TC), HDL-C, LDL-C and triglycerides (TG). Endothelium-dependent vasodilation and carotid artery intima-media thickness (CA-IMT) were evaluated in 18 patients with a history of PE, 16 with a history of PIH and 17 healthy controls (CN). Inter-group differences were calculated using Student's t-test. We found a worse lipid profile among women with PE and PIH. LDL-C was increased significantly in PE and PIH (PE: 3.17mmol/l [SD 0.50] and PIH: 3.37mmol/l [SD 0.48] vs CN: 2.83mmol/l [SD 0.35], p<0.05); TC and TG were higher in the PE and PIH groups, but not significantly (p>0.05). Compared to controls, endothelium-dependent vasodilation was significantly reduced in PE and PIH patients (10.5% [SD 4.3] and 8.8% [SD 3.1] vs 14.5% [SD 3.6], p<0.05). The mean combined CA-IMT was significantly higher in PE and PIH patients (0.66mm [SD 0.08] and 0.63mm [SD 0.09], respectively vs 0.52mm [SD 0.04]). We conclude that impaired endothelial vasoreactivity and increased CA-IMT are prevalent in women with a history of PE and PIH and are associated with traditional risk factors that strongly suggest that PE and PIH could be non-traditional cardiovascular risk factors.

Abstract 2070: Obesity, p53 and increased oxidative stress: The role of TXNIP

Abstract Background: Although epidemiological studies show a strong association between increased BMI and heightened risk of postmenopausal breast cancer, the underlying mechanisms by which obesity influences breast cancer susceptibility are multivariate and poorly characterized. One potential mechanism by which obesity contributes to breast cancer initiation is through induction of oxidative stress. Oxidative burden is strongly implicated in tumor initiating events through induction of chromosome instability, dysregulation of proapoptotic signaling, and redox modulation of the tumor suppressor gene, TP53. Obesity and p53 mutations are both associated with development of aggressive, ER-negative disease in younger women. Therefore, the goal of this study was to identify genes that link obesity to p53 and oxidative stress. Results: We isolated mRNA from the mammary fat pads of obese p53 +/+ and obese +/− mice. Using a qPCR array, we measured the expression of 85 genes related to oxidative stress and screened for transcripts that were altered by at least 2 fold. Expression of the gene thioredoxin-interacting protein (TXNIP) was increased by almost 30 fold in MFP of sedentary, obese p53 +/− mice compared to sedentary, obese p53 +/+ mice (n=3). We validated this finding using 6 mice from each group and found that Txnip mRNA was significantly increased by almost 3 fold in the MFP of obese p53 +/− mice compared to obese p53 +/+ mice (p&amp;lt;0.001). Interestingly, TXNIP expression is increased in response to high glucose flux, can mediate apoptosis through modulation of ROS, and is lost in many cancers, including breast. To further elucidate the function of TXNIP in breast cancer cells, MCF-7 cells were stably transfected with shRNA targeting TXNIP, p53, or both. Cells were incubated overnight in either serum-free media (SFM), 2% FBS, 2% serum from obese mice, or 2% serum from control mice. Cells were then assayed for ROS production, DNA damage, and apoptosis. Cells transfected with control shRNA exhibited a 7-fold increase in ROS when incubated in obese serum compared to cells incubated in SFM, 2%FBS, or 2% control serum. Increased production of ROS was abrogated by knockdown of TXNIP or p53. However, knockdown of both TXNIP and p53 resulted in a 35-fold increase in ROS levels. The significant increase in ROS production was associated with intense nuclear H2AX immunufluorescent staining. Despite high levels of oxidative stress and DNA damage, there was a 25% reduction in apoptosis. Conclusion: TXNIP expression is increased by obesity and p53-deficiency in the mouse mammary fat pad. In human breast cancer cells, TXNIP regulates ROS levels and reduces chronic oxidative stress associated with obesity by mediating an apoptotic response to excessive DNA damage. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2070. doi:1538-7445.AM2012-2070

Prevalence of cervical Chlamydia trachomatis infection in sexually active adolescents from Salvador, Brazil

The incidence of sexually transmitted diseases among adolescents is increasing worldwide. Genital Chlamydia trachomatis infection is one of the most prevalent sexually transmitted diseases in young women, and undetected disease is highly associated with long-term complications in women. Our goal was to determine the prevalence of cervical Chlamydia trachomatis infection in a sexually active population of female adolescents from Salvador, Brazil, and to describe their socio-demographic, behavioral, and clinical characteristics. 100 sexually active adolescents (10-19 years) were included in this study, between 2008 and 2010. Endocervical samples were obtained during gynecological examination. Inhouse polymerase chain reaction of cervical specimens was used for Chlamydia trachomatis detection. The overall prevalence of cervical Chlamydia trachomatis infection was 31% (95% CI 22-40). There were no statistically significant differences in the age at first sexual intercourse, number of sexual partners, and frequency of condom use between Chlamydia infected and uninfected adolescents. The prevalence of cervical Chlamydia trachomatis infection among adolescents from Salvador was the highest in Brazil up to the present date. These results demonstrate an urgent need for continued and comprehensive prevention strategies along with proper screening for Chlamydia in high-risk populations in order to decrease the rates of infection.

Abstract MP025: Physical Activity and Risk of Coronary Heart Disease in Young Women

Background: The majority of studies on the association between physical activity and coronary heart disease (CHD) risk have been conducted in middle-aged and older populations. Although physical activity has been shown to lower risk of CHD in women by approximately 30%, evidence for the benefits of exercise for CHD in young women is very limited. Methods and Results: We conducted a prospective cohort study among 114 054 women, 25–42 years of age at baseline, enrolled in the Nurses’ Health Study II and followed from 1989 to 2009. Leisure-time physical activity was assessed at baseline and during follow-up through a series of questions on the specific type of activity and the average time per week spent on the activity over the previous year. Additionally, at baseline, women were asked the number of months per year they participated in strenuous exercise or sports during high school and ages 18–22. During 20 years of follow-up, we documented 518 new cases of non-fatal MI and fatal CHD. After adjusting for age and other cardiovascular risk factors, the rate ratios (RR) (95% confidence intervals [CI]) corresponding to 0, 0.1 – 3.5, 3.6 – 8.8, 8.9 – 21.0, and &gt; 21 MET-hours/week of physical activity were 1.0, 0.93 (0.71, 1.21), 0.73 (0.56, 0.95), 0.67 (0.52, 0.88), and 0.63 (0.49, 0.83) (p for trend = 0.001). There was no evidence of effect modification by age or body mass index. Specifically in women less than 50 years of age, the corresponding RR were 1.0, 0.97 (0.70, 1.35), 0.75 (0.53, 1.04), 0.69 (0.50, 0.96), and 0.63 (0.45, 0.88) (p for trend = 0.008). Brisk walking alone was also associated with significant reductions in CHD risk. In contrast to physical activity during adulthood, frequency of participation in strenuous activity in high school or during ages 18–22 was not associated with risk of CHD when adjusted for current physical activity. Conclusions: These prospective data suggest that physical activity is associated with substantial risk reductions in the incidence of coronary heart disease in young women.

Prevalence of cervical Chlamydia trachomatis infection in sexually active adolescents from Salvador, Brazil

The incidence of sexually transmitted diseases among adolescents is increasing worldwide. Genital Chlamydia trachomatis infection is one of the most prevalent sexually transmitted diseases in young women, and undetected disease is highly associated with long-term complications in women. Our goal was to determine the prevalence of cervical Chlamydia trachomatis infection in a sexually active population of female adolescents from Salvador, Brazil, and to describe their socio-demographic, behavioral, and clinical characteristics. 100 sexually active adolescents (10–19 years) were included in this study, between 2008 and 2010. Endocervical samples were obtained during gynecological examination. Inhouse polymerase chain reaction of cervical specimens was used for Chlamydia trachomatis detection. The overall prevalence of cervical Chlamydia trachomatis infection was 31% (95% CI 22–40). There were no statistically significant differences in the age at first sexual intercourse, number of sexual partners, and frequency of condom use between Chlamydia infected and uninfected adolescents. The prevalence of cervical Chlamydia trachomatis infection among adolescents from Salvador was the highest in Brazil up to the present date. These results demonstrate an urgent need for continued and comprehensive prevention strategies along with proper screening for Chlamydia in high-risk populations in order to decrease the rates of infection.

Breast cancer among Yemeni women using the National Oncology Centre Registry 2004–2010

Background: In developing countries including Arab countries breast cancer is one of the most common cancers found in women. Even though breast cancer incidence is lower in Arab developing countries than in western countries, Arabic women are more likely to be diagnosed at an earlier age than the women in western countries. Method: A descriptive study was undertaken to investigate the type of breast cancer, lymph node involvement, side of breast and, region and age distribution of breast cancer patients registered in the National Oncology Centre in Yemen. Results: From September 2004 to December 2010, 2654 women across Yemen diagnosed with breast cancer were registered in the National Oncology Centre for treatment. Between the years 2004 and 2010, breast cancer represented 22% of all cancers registered in women. Seventy-one per cent of the women were aged 50 or younger at the time of diagnosis. The most common age group affected was women aged 41–50 years, with (35%) of cases occurring in this age. Invasive ductal carcinoma was the most common pathology (76%) and 79% of the patients had lymph node involvement at the time of diagnosis. Approximately 2% had bilateral disease and the frequency of left (44%) and right breast cancer (42%) were similar. Conclusion: This study has shown that breast cancer is a disease of young women in Yemen. The majority of women presented with lymph node involvement. Hence efforts are needed to increase breast cancer awareness in Yemen for early detection at all age groups, and to target women living in areas that have lower access to health care services.

Long-Term Dietary Potential Renal Acid Load During Adolescence Is Prospectively Associated with Indices of Nonalcoholic Fatty Liver Disease in Young Women 3

Nonalcoholic fatty liver disease (NAFLD), frequently already present in young subjects, has been linked to reduced growth hormone levels and signaling. Similar hormonal changes occur during metabolic acidosis (MA), which may thus contribute to an increased NAFLD risk. Because subclinical MA can be diet induced, we aimed to examine whether a higher diet-dependent acid load during adolescence is prospectively associated with several currently used NAFLD surrogates in young adulthood. Dietary acidity during adolescence (boys:10–15 y, girls: 9–14 y) was calculated as potential renal acid load (PRAL) from at least three 3-d weighed dietary records according to a published algorithm considering dietary protein and minerals in 145 healthy participants. Routine measurements derived from blood analysis and anthropometric data in participants’ young adulthood (18–25 y) were used to determine the NAFLD surrogates alanine-aminotransferase (ALT), hepatic steatosis index (HSI), and fatty liver index (FLI). Sex-stratified linear regression models, adjusted for dietary fiber, saturated fat, protein, and adolescent BMI SD scores, were run with PRAL as the independent variable. Dietary PRAL during puberty was positively associated with ALT (P= 0.02), HSI (P= 0.002), and FLI (P= 0.005) in adult females but not males. Females with an adolescent dietary acid load in the highest tertile had 3.5, 4.4, and 4.5 higher values of ALT, HSI, and FLI as adults, respectively, compared to females with the lowest PRAL. The present findings suggest that higher dietary acidity in adolescence may be prospectively associated with hepatic lipid accumulation in females. Whether this relationship is due to the higher proton load or rather represents an unhealthy dietary pattern requires further investigation.

Impact of Methotrexate and Leucovorin on Hormonal Regulated Enzymes of Carbohydrate Metabolism in Accessory Reproductive Tissues of Ovariectomized Rats

Background: Female reproductive tract cells are fast proliferating like cancer cells. Methotrexate (MTX), an anticancer drug when used to treat non-neoplastic diseases in young women results in deleterious effects leading to infertility. Oviduct, uterus, cervix and vagina depend on ovary for their structural and functional sustenance. Ovarian ablation followed by chemotherapy in premenopausal women is a common practice in the treatment of cancer. Hence, methotrexate effect on reproductive organs in Ovariectomized (OVX) rats was investigated. Objective: To reveal the direct influence of MTX on estradiol and progesterone in OVX rats. Also, the protective role of leucovorin (LCN) an antidote to MTX, estradiol (E2) and progesterone (P) replacement was investigated. Methods: Animals were randomly divided into the following groups (n=6): group 1: OVX, group 2: OVX+MTX, group 3: OVX+MTX+LCN, group 4: OVX+E2, OVX+MTX+LCN+E2, group 5: OVX+P, group 6: OVX+MTX+LCN+P, treated once/day intramuscularly (im) for 4 days and sacrificed on day 5. At the end of the experiment reproductive 24 tract tissues oviduct, uterus, cervix and vagina were used for total protein, glycogen, Glucose-6-Phosphate Dehydrogenase (G6PD), Lactate Dehydrogenase (LDH) and Alkaline Phosphatase (ALP) enzyme activities. Results: MTX treatment reduced protein, glycogen, G6PD, LDH and ALP activities in oviduct, uterus, cervix and vagina of OVX rats. However, LCN supplementation was partially protective on some enzymes, which was tissue dependent. Hormonal replacement improved protein and enzyme levels in all the tissues. Estradiol treatment showed a distinct enhancement over progesterone in elevating such levels. However, MTX and LCN in a combination treatment with steroids reversed the activities of enzymes in all the tissues.

Abstract ED01-01: Preventing multiple types of cancer through HPV vaccination.

Abstract ED01-01: Preventing multiple types of cancer through HPV vaccination.