Adult Female Patients Research Articles

Association Between Delayed/Forgone Medical Care and Resource Utilization Among Women with Breast Cancer in the United States.

Although high treatment costs of breast cancer care are well documented, the relationship between delayed/forgone (D/F) care and resource utilization among patients with breast cancer is unknown. This study sought to investigate the relationship between D/F care, resource use, and healthcare expenditures among patients with breast cancer. Data on adult female patients with breast cancer were obtained from the Medical Expenditure Panel Survey to assess resource utilization and expenditures in the United States from 2007 to 2017. Weighted proportions of patients with ≥1 emergency department, ≥1 inpatient, ≥1 outpatient, and >5 office-based encounters were compared between those experiencing D/F care versus those who did not using Rao-Scott adjusted chi-squared tests. Annual, per capita total, out-of-pocket, emergency department, inpatient, outpatient, office-based visit, and prescription medication expenditures were compared by using two-part econometric models. Five percent of patients with breast cancer experienced D/F care, and 42.9% of patients cited financial barriers as the primary reason for D/F care. In unweighted estimates, there were higher proportions of patients with ≥1 hospitalizations (37% vs. 16%, P<0.001) among those experiencing D/F care versus those who did not. Patients with D/F care had $5372 (95% CI $35-$10,709, P=0.04) higher per capita inpatient expenditures than patients without D/F care. Delayed/forgone care is associated with increased resource utilization and healthcare spending among breast cancer patients. Further work is needed to address the root causes of D/F breast cancer care, with a view to mitigating disparate outcomes and increasing costs.

Pregnancy outcomes in adolescent and young adult patients with multiple sclerosis: A case series.

While there is increasing understanding of the effect of pregnancy on the clinical course of multiple sclerosis (MS), there are limited studies focused on younger populations. We report neurologic and obstetric outcomes for 14 pregnancies from 11 adolescent and young adult female patients with pediatric-onset MS who delivered live births prior to age 26, and describe their relevant social determinants of health. Neurologic and obstetric outcomes in this cohort were generally good. Many of the pregnancies in our cohort appeared unplanned, underscoring the importance of discussing family planning with all MS patients of childbearing potential.

A depressed patient in outpatient settings

Depression is a clinically significant and growing public health issue. As a major global disease burden, its prevalence has been steadily increasing over the years, affecting different demographic groups. Depressive disorder is characterized by a low mood, loss of strength, sadness, insomnia, and inability to feel pleasure. In outpatient settings, up to one-third of patients with depressive symptoms may have a comorbidity. Many different diseases have been associated with depressive symptoms. Cardiovascular, metabolic, inflammatory, oncological, and neurological disorders are associated with an increased risk of depression, potentially due to chronic inflammation, neurochemical dysregulation, and emotional and social issues. As different drugs can cause depressive symptoms, the patient's medical history should include an assessment of the use of such drugs. Primary care physicians play an important role in identifying and treating depression. It is recommended to perform depression screening in all adult female patients in primary care facilities. There are general recommendations for the initial treatment of mild to moderate depressive disorder in adults. In mild depression, initial preference should be given to psychotherapy and symptom monitoring, and if improvement is insufficient, pharmacotherapy is to be used. Psychotherapy, pharmacotherapy or a combination of both should be considered for patients with moderate depression. Psychiatric consultation is recommended for patients with severe depression and urgently for any patient with psychotic symptoms or suicidal thoughts and behaviour. Antidepressants are the basic therapy for depression. Selective serotonin reuptake inhibitors are considered the first-line drugs to treat depression.

Prevalence of measurable residual disease in patients with refractory/relapsed multiple myeloma who reached complete response: a cross-sectional multicentric study

BackgroundMultiple myeloma (MM) is an incurable hematologic malignancy, and even though the complete response (CR) rate has been growing, a high percentage of patients continues to relapse. Recent research showed that most relapses may be related to the persistence of measurable residual disease (MRD). In this study, we intended to evaluate the MRD status in MM patients who reached CR in their second or third lines of treatment.MethodsThis was a cross-sectional, multicentre, non-interventional study to describe the MRD status in patients with relapsed or refractory MM (rrMM), with documented CR; adult male and female patients, from 11 Portuguese sites, in their second or third line of treatment were included. Bone marrow MRD was assessed through next-generation flow cytometry (NGF) technology.ResultsAmong the 68 subjects who gave informed consent, 48 were considered eligible for the study. Of the 48 subjects with confirmed CR, 31 (64.6%) had undetectable MRD levels. The incidence of undetectable MRD was lower in International Staging System (ISS) III patients compared with ISS I/II patients (60% vs. 70.8%; p = 0.45), and lower in patients treated without daratumumab-containing regimens compared with those treated with daratumumab-containing regimens (57.1% vs. 75.0%; p = 0.30). Notably, despite the small sample size, the incidence of undetectable MRD was significantly lower in patients with high-risk cytogenetics compared to those with standard risk (33.3% vs. 76.0%; p = 0.04).DiscussionOur results highlight the possibility of achieving undetectable MRD in the rrMM setting, especially in earlier stages and with highly effective protocols. We expect that this work leverages the implementation of larger real-world evidence studies in rrMM patients, in which MRD may also be defined as a primary endpoint.

Analysis of BRCA1 Exon 2 Mutations in FFPE Tissues of Bangladeshi Bangali Females with Breast Cancer

Background: Among all breast cancers, 5 to 10% are hereditary and related to mutation of BRCA1 and BRCA2 gene. To date, extensive researches have been carried out for detection of mutations in the exon2 of BRCA1 gene. Genetic study on these two genes from formalin-fixed paraffin-embedded tissue in Bangladeshi population has not been reported so far. Objective: To identify mutation in exon2 of BRCA1 gene from formalin-fixed paraffin-embedded tissue of adult Bangladeshi Bangali female patients with breast cancer. Methods: The research was cross-sectional descriptive type of study. The study was conducted on Adult Bangladeshi Bangali female patients with breast cancer aged more than 18 years. A questionnaire was developed to record information on socio-demographic and reproductive characteristics. The data was analyzed by SPSS (Statistical package for the social sciences) version 23.0. The whole sequence of exon2 of chromosome 17 was amplified by short range PCR using the Gotaq master mix and primer sequence. The amplicons were confirmed by 2% agarose gel electrophoresis and sequencing was done by Sanger sequencer. Data analysis was performed using Chromas® software version 2.33 and Mega 7 software. The quary sequences were compared with the NCBI database. Results: Average age of the breast cancer patients was 45.46 (± 11.52) and the mean age at menarche was 12.46 (± 0.646). In this study, new mutations along with known mutations were found in exon2 of BRCA1 gene of eight adult female breast cancer patients. The mutations are insertions (C&gt;A, C&gt;T, T&gt;A, G&gt;T, G&gt;C, T&gt;C, A&gt;T, C&gt;G), deletion (C_) and single nucleotide substitution (T-C, G-A, T-G, C-G, T-A, G-C, C-A) in types. Conclusions: The aim of the research was to identify mutation in exon2 of BRCA1 gene. Eight patients have mutation in their DNA sequence revealed from formalin-fixed paraffin-embedded tissue. Further studies are required to evaluate whether these mutation contribute to breast cancer or not. Identification of known mutation along with new mutation with this small sample size emphasizes the importance of exploration the genetic makeup of Bangladeshi population to develop a database for proper screening and genetic counseling of the disease.

Disability and Patient-Reported Satisfaction in Women with Idiopathic Intracranial Hypertension: A Comparative Study of Venous Sinus Stenting and Medical Management.

Patients with chronic idiopathic intracranial hypertension (IIH) commonly experience a high level of disability and low satisfaction with medical treatment. We aim to evaluate long-term functional improvement and patient satisfaction in IIH patients with similar symptoms by comparing venous sinus stenting (VSS) to standard medical therapy. We conducted a cross-sectional questionnaire study of 111 IIH patients, comparing 37 adult female patients who underwent venous sinus stenting with 74 patients treated medically. Propensity score matching was used to balance age and presence of papilledema at presentation between groups. Headache-related disability was evaluated using the Migraine Disability Assessment Scale (MIDAS), while general function and treatment satisfaction were assessed using custom questionnaires. Electronic medical records and the results of imaging upon diagnosis were reviewed retrospectively. The stented group reported significantly better outcomes in physical well-being (median 4.0 vs. 1.0, p < 0.001), task completion (4.0 vs. 1.0, p < 0.001), work/school persistence (5.0 vs. 1.0, p < 0.001), and mental well-being (4.0 vs. 1.0, p < 0.001). Additionally, the stented group had a lower proportion of patients with severe MIDAS (MIDAS > 4, 24.3% vs. 47.9%, p = 0.017). Logistic regression suggested venous stenting as a protective factor against severe MIDAS scores (OR = 0.174, p = 0.004). Cerebral venous stenting in patients with IIH is associated with lower disability and higher patient satisfaction from medical treatment compared to those treated with medications only. These findings suggest that venous sinus stenting may be a valuable treatment option for selected IIH patients. However, larger prospective studies are needed to further validate our results.

Evaluation of the safety of T-DXd in the Treatment of HER2-positive breast cancer

Abstract. Breast cancer (BC) is one of the most common diseases in women today, and HER2-positive BC has attracted the attention of researchers. Anti-her2 targeted therapy is an important tool in the treatment of HER2. In recent years, antibody-coupling drugs have entered people's field of vision and triggered a boom, and the research on T-DXd targeted therapy for HER2-positive BC is also gradually advancing and improving. This paper mainly discusses the mechanism of HER2-positive BC, explores the mechanism of action of T-DXd against HER2-positive BC, analyzes the side effects and safety evaluation of T-DXd targeted therapy for adult female patients with HER2-positive BC, and concludes that T-DXd is a relatively safe drug. However, it can be found that the pulmonary interstitial disease after treatment is a serious side effect that should not be ignored. Future studies can focus on discussing the principle of the side effect, ways to reduce the probability of its occurrence and more accurate and safe medication programs.

Comparative analysis of comorbidity indexes in implant-based breast reconstruction

Recent studies have used comorbidity indexes to stratify postsurgical complication risk across multiple surgical fields, including plastic surgery. However, such studies are lacking in implant-based breast reconstruction (IBBR). Understanding how comorbidity scores affect postsurgical outcomes in IBBR can help identify patients who may require additional medical surveillance after surgery. We conducted a retrospective analysis of adult female patients who underwent IBBR between January 2017 and December 2022 using the Merative™ Marketscan® Research Databases. ICD-10 diagnosis codes were used to calculate patients' scores on four different comorbidity indexes. Chi-squared tests were performed for demographic analysis, and multivariable logistic regression controlling for demographic and surgical variables, was conducted to determine associations between comorbidity indexes and adverse outcomes. Among 16,287 IBBR patients, 3145 (19.3%) experienced a complication within 90 days. On regression analysis, the Modified Frailty Index 5-Item (mFI-5) demonstrated the strongest associations with complications (odds ratio=1.25 [1.18, 1.32]), compared to the Charlson Comorbidity Index, Elixhauser Comorbidity Index, and Modified Frailty Index 11-Item. Further regression analysis revealed that four out of the five mFI-5 comorbidities were independent risk factors for postsurgical complications. This study highlights important associations between comorbidity indexes and adverse postoperative outcomes in IBBR. mFI-5 demonstrated superior performance in postoperative risk stratification compared to the other indexes analyzed. These findings suggest that using mFI-5 in clinical settings may help identify high comorbidity patients who may benefit from additional monitoring and prophylactic measures. Further research is needed to understand how to mitigate the increased postoperative complication risk in these patients.

Intramedullary nailing for concomitant extra-articular ulnar head fractures in distal radial fractures.

Four adult female patients were treated with an intramedullary Steinmann pin for an unstable extra-articular distal ulnar fracture associated with a distal radial fracture treated with plate osteosynthesis. All showed good radiographic and functional outcomes. One patient required removal of the Steinmann pin.

Smaller is better? Compact vs. Conventional gamma camera for sentinel lymph node localization in patients with breast cancer.

Sentinel lymph node biopsy (SLNB) has been recognized as "the gold standard" for axillary staging in early breast cancer patients with clinically negative lymph nodes, resulting in significant morbidity decrease and quality of life improvement. This study aims to validate the performance of a newly developed handheld portable gamma camera (PGC) produced by Imagensys (Italy), in detecting and locating sentinel lymph nodes (SLNs) during the preoperative and intraoperative phases in breast cancer patients compared to conventional lymphoscintigraphy. Adult female patients with histologically confirmed breast cancer, candidates for surgery and SLNB, were prospectively enrolled in this open-label, pre-marketing clinical trial. All patients underwent pre- operative assessment using both the PGC and conventional lymphoscintigraphy. The performance of the two devices was compared using the Poisson regression model for incidence rate ratios (IRRs). The intrinsic sensitivity of the devices was compared using the Wilcoxon Ranked Sign Test. The utility of PGC during intra-operative procedures was also evaluated. The manoeuvrability of the devices was evaluated using operator-satisfaction questioner. Sixty-eight patients (median age 50 years, BMI 21.4) were enrolled, including two patients with bilateral breast cancer, who underwent SLNB on both axillae. The PGC demonstrated superior preoperative lymph node detection rate (IRR 8.01, 95% CI 6.11-10.50; p < 0.0001) and intrinsic device sensitivity (mean counts per second 409 ± 286 vs. 255 ± 1173 for conventional device, p = 0.0003) compared to the conventional gamma camera. Intra-operative assessment with PGC was performed in 62 patients and no additional lymph nodes were visualised. However, the conventional gamma camera demonstrated superior manoeuvrability (p < 0.0001). The PGC handheld gamma camera showed promising results for preoperative SLN assessment in patients with breast cancer. The limited manoeuvrability may be related to the operator's experience leading to higher inter-operator variability. Appropriate training and frequent use of nuclear medicine and surgical equipment could overcome this limitation.

Vulvar lichen sclerosus in girls and adult females: A single-center retrospective study of 744 patients in China.

Vulvar lichen sclerosus (VLS) is a chronic, inflammatory disease which is accompanied by itching and pain, affecting the patient's daily life and sexual activity. However, the disease characteristics of children and adults are not completely the same. Currently, there are few studies in China that compare the characteristics of VLS between girls and adult female patients. The aim of this study was to compare the epidemiology, clinical features, and combined autoimmune diseases of VLS patients between girls and adult females, and to help clinicians better understand VLS in different age groups. We enrolled 744 female patients for analysis, divided by age into a child group (<18 years) and an adult group (≥18 years). Among girl patients, 94.6% had preadolescent onset, while among adult female patients, only 4.6% had preadolescent onset, which was a statistically significant difference. The highest percentage of adult female patients had onset during their child-bearing period (75.4%), while 20% had postmenopausal onset, with a significant difference when the three onset states were compared. White patches were equally common in both girl and adult female patients' external genital area, while mossy lesions and labia minora atrophy were more common in adult female patients. Involvement of the clitoris, labia minora, and vaginal opening area were more common in adult patients. The perianal area was more commonly involved in girl patients. We found eight cases (1.2%) of secondary squamous cell carcinoma in adult female patients. We also found that 13 patients had concurrent lichen sclerosus lesions on the vulva and extragenital region, including two girls and 11 adult females. Extragenital lichen sclerosus (EGLS) occurred mostly in the torso. Clinicians should be aware of these differences so that early diagnosis and treatment of the disease can be achieved, to avoid irreversible anatomical alterations and the risk of cancer.

Effect of Ketamine on the Bispectral Index, Spectral Edge Frequency, and Surgical Pleth Index During Propofol-Remifentanil Anesthesia: An Observational Prospective Trial.

Ketamine administration during stable propofol anesthesia is known to be associated with an increase in bispectral index (BIS) but a "deepening" in the level of hypnosis. This study aimed to evaluate the association between the effect-site concentration of ketamine (CeK) and 2 electroencephalogram (EEG)-derived parameters, the BIS and spectral edge frequency (SEF95), after the administration of a ketamine bolus. Secondary aims included investigating the BIS and SEF95 variations with time and changes in the surgical pleth index (SPI). We conducted an observational, prospective, single-center study analyzing intraoperative data from 14 adult female patients undergoing breast oncologic surgery. During stable propofol-remifentanil target-controlled infusion (TCI) anesthesia, a ketamine analgesic bolus was delivered with the target CeK set to 1 μg.mL-1 (Domino model) corresponding to a dose of 0.57 mg.kg-1 (interquartile range [IQR] 0.56-0.57 mg.kg-1). Once the CeK reached a value of 1 μg.mL-1, the target CeK was set to 0 μg.mL-1. We determined the median BIS, SEF95, and SPI trends with time and as a function of the modeled CeK. BIS and SEF95 showed no significant change from when ketamine was administered to when CeK=1 μg.mL-1, but a significant increase was observed at lower CeKs. The maximum BIS was reached at 16.0 minutes [10.2-22.7 minutes] after CeK=1 μg.mL-1, at CeK=0.22 μg.mL-1 [0.12-0.41 μg.mL-1]. The peak SEF95 value was observed at 10.0 minutes [8.62-14.1 minutes] after CeK=1 μg.mL-1, at CeK=0.43 μg.mL-1 [0.25-0.50 μg.mL-1]. No significant association was found between CeK and the registered SPI values. Our results show that BIS and SEF95, but not SPI, follow a CeK-dependent trend after administering a ketamine bolus. Interestingly, their peak values were not reached at CeK=1 μg.mL-1, but after several minutes after the drug infusion at CeKs in the 0.2 to 0.5 μg.mL-1 range. This may be explained by the specific pharmacodynamics of ketamine and its varying effects at different concentrations, as well as by the time delay associated with the calculation of the BIS.

Trends in Urinary Tract Infection Management in Women.

Urinary tract infections (UTIs) are a common cause of health care utilization in the United States. The coronavirus disease 2019 (COVID-19) pandemic accelerated virtual care for UTIs. This retrospective cohort study analyzes more than 1.2 million encounters for UTI based on diagnosis codes, examining temporal trends focusing on virtual compared with in-person encounters, antibiotic dispensation rates, and culture-confirmed UTIs. From 2015 to 2022, UTI encounters increased by 325.9%, with a majority occurring at virtual visits. The rate of UTI encounters per 1,000 adult female patients increased by 241.6%. Antibiotic dispensation rates increased, surpassing the rise in rate of positive urine cultures, suggesting increasing use of empiric antibiotics. Our findings underscore the importance of balancing telemedicine's accessibility with maintaining antibiotic stewardship and highlight the need for updated guidelines.

Impact of Psoriasis on Pregnancy Desire and Possible Consequences on Fertility.

Approximately half of patients affected by psoriasis are women, and the management of female patients of childbearing age is an under-investigated topic. Some studies have shown a significant decrease in births in psoriatic patients due to intimacy and pregnancy avoidance and to potential birth complications. We sought to evaluate data on reproductive health in a cohort of female patients, to compare them with similar data in the general population and to assess the impact of psoriasis, especially genital psoriasis, on pregnancy desire and the prevalence of psoriasis in the children of patients with psoriasis. This retrospective observational study involved adult female patients with a diagnosis of psoriasis made during or before childbearing age. The enrolled patients were asked questions concerning fertility and previous pregnancies in relation to their dermatologic disease. Of 100 women enrolled, 73 reported a history of pregnancy, for a total of 170 pregnancies. The average number of pregnancies to term and the average number of children per woman (1.2 ± 1) were lower than the national average. The percentage of miscarriages was 18.2%, higher than the national average; in particular, women with psoriatic arthritis had a greater percentage of miscarriages (27.4%). During the pregnancies, psoriasis was mainly stable (36.1%) or improved (29.2%), even though most patients (91.5%) did not follow any treatment. Psoriasis impacts pregnancy desire and course. The management of psoriasis in women of childbearing age is crucial to minimize its burden on this vulnerable population.

Lack of oral involvement in a large cohort of women with vulvar lichen sclerosus - a multicenter prospective study.

We assessed the prevalence of oral lichen sclerosus in a cohort of women affected with vulvar lichen sclerosus (VLS). This prospective, observational study included adult female patients with a histologically proven VLS who attended the Vulva Clinics of three Dermatology Units from January 2020 to July 2023. During this period, all VLS patients were asked to be examined in their oral cavities in order to detect any possible sign of oral diseases, which were then biopsied. Three hundred women (mean age 64.5 ±13.0years) were included, of whom 21 (7%) had a concurrent extragenital LS. In six (2%) patients, white, non-removable lesions were found at oral inspection and biopsied. All cases were histologically lichen planus. No other clinically relevant oral lesions were found. The six women with histologically proven oral lichen planus had more frequent periodontal and autoimmune diseases than the other included subjects. Our findings confirm the absolute rarity of oral involvement in patients with VLS. They suggest that the oral mucosa, unlike the genitals, is a setting which weakly leads to development of LS, also in predisposed subjects.

Adherence and uncertainty during rehabilitation for urinary incontinence: Validation of a scale

AbstractWe sought to create an Italian version of Mishel's Uncertainty in Illness Scale, dedicated to people undergoing conservative rehabilitation for urinary incontinence, for studying uncertainty as a determinant of therapeutic adherence. Urinary incontinence has a high prevalence worldwide, ranging from 25% to 45%. Incontinence is often treatable with conservative interventions but demands a long and intensive commitment from the patient. Results are not immediate, and relapses are possible. These patients can experience uncertainty and difficulty complying with rehabilitation programs, hence the importance of the therapeutic relationship with a healthcare professional. Mishel's theory of uncertainty can be used to measure uncertainty and the effects of such a relationship, but no instrument currently exists for this purpose. Prospective observational study enrolling all male and female adult patients admitted to a nurse‐led outpatient pelvic clinic for non‐neurogenic urinary incontinence, excluding puerpera. A scale named MUIS‐PF (pelvic floor) was created, based on previous versions of Mishel's scale, and administered during the first consultation and at the end of the rehabilitation program. Internal consistency was assessed, and exploratory factor analysis was conducted. A total of 109 patients enrolled (54 M, 55 F) aged 64 ± 5 years, medial initial leakage 245 grams/day, IQR [90; 370]. Seventy‐nine percent obtained continence; there were no dropouts during the study. Internal consistency of the MUIS‐PF was high (93%), and structure analysis yielded a clear separation of the factors. Patient uncertainty decreased significantly at the end of the program compared to the first consultation (p &lt; 0.001). The MUIS‐PF is valid and reliable. Utilizing the correct approach, the nurse could significantly reduce the uncertainty of persons with incontinence by listening, giving clear information and searching for the best solution for their continence issues.

Assessment of Depression, Anxiety, Stress, Quality of Life, and Fatigue in Patients After a Cerebrovascular Accident.

Background A cerebrovascular accident, or stroke, is a neurological disorder. Those who suffer from a stroke not only face physical disabilities but also a range of psychological issues resulting from concerns about their current situation. The purpose of this study was to assess depression, anxiety, stress, and fatigue after a stroke, along with its effects on quality of life (QoL), degree of disability, and prevalence of various risk factors of stroke. Materials and methods Adult male and female patients who had experienced a stroke and came to the psychiatry or neurology outpatient departments were evaluated. A detailed stroke history was taken for them. The Stroke-Specific Quality of Life Scale (SSQOL) Scale, Depression Anxiety Stress Scale 21, Alcohol Use Disorders Identification Test C (AUDIT C) scale, Suicide Behaviors Questionnaire-Revised (SBQ-R) scale, Fatigue Severity Scale (FSS), and Modified Rankin Scale (mRS) were applied to assess the QoL, depression, anxiety, stress, alcohol use, suicidal behavior, fatigue, and the degree of disability, if any, after stroke. Results The study involved 100 stroke patients aged 18-60 years, with 82 males and 18 females. The mean age was 45.76 ± 8.54 years. 88% experienced an ischemic stroke, and 12% a hemorrhagic stroke. 68% had comorbidities, and alcohol use was present in 48% of patients. The QoL was lowest in the domains of social roles, upper extremity, family roles, and productivity. The study revealed that 67% of patients experienced depression, 63% anxiety, and 62% stress, with 40% having a high risk of suicidal behavior, 57% experiencing fatigue, and 67% disability. There was a significant positive correlation between lower QoL scores, higher depression, anxiety, stress, disability, suicidal ideation, fatigue, and factors such as increased age, female gender, recurrent stroke, psychiatric illness history, multiple comorbidities, and substance use. Conclusion Neuropsychiatric problems following a stroke are common and have serious consequences that significantly influence stroke survivors' QoL and ability to recover.

Anti-Müllerian Hormone Serum Levels as Biomarker of Ovarian Reserve in Adult Women with Juvenile Idiopathic Arthritis Treated with csDMARDs and/or bDMARDs: A Pilot Study

Background/Objectives: Juvenile idiopathic arthritis (JIA) is a chronic childhood disease that often persists into the reproductive years. JIA may impact long-term fertility due to the prolonged exposure to immunosuppressive therapies. Methods: A total of 35 adult JIA female patients of childbearing age and 20 age-matched healthy controls were studied to test their anti-Müllerian hormone (AMH) serum levels as a biomarker of ovarian reserve. Demographic characteristics, disease duration, previous and current treatments, disease activity (DAS44), and a health assessment questionnaire (HAQ) were recorded. Results: JIA patients had a mean age of 22.3 ± 2.9 years, a disease duration of 12.3 ± 6.1 years, and a DAS44 of 1.24 ± 0.61. No differences were found in AMH serum levels between JIA and controls (5.78 ± 2.37 ng/mL vs. 6.60 ± 2.68 ng/mL, respectively; p = 0.17). Among the patients, 22 (62.9%) were receiving a stable dose of methotrexate (MTX) and 19 (54.3%) a dose of TNFα inhibitors. No difference in AMH serum levels was observed between JIA patients who were or were not exposed to MTX (p = 0.29) or to TNFα inhibitors (p = 0.50). Conclusions: Ovarian reserve as assessed by AMH serum levels appears to be comparable between those with JIA and age-matched controls and does not appear to be influenced by disease characteristics or prior/concomitant exposure to immunosuppressive drugs.

Sexual function and fertility in young female adults surgically treated for anorectal malformations

PurposeThe aim was to investigate sexual function and fertility in female adults operated on for anorectal malformations (ARM).MethodsThis was a cross-sectional questionnaire-based study including female adult patients treated for ARM at our institution between 1994 and 2003. Sexual function in females was assessed using the Profile of Sexual Function (PFSF). Additional questions regarding fertility were answered by the participants. Patient characteristics were retrospectively retrieved from the medical records and descriptive statistics were used for analysis. Sexual function outcomes were compared to a control group from a previously published group of females. Composite outcome analysis was performed using previously published data to determine the potential impact of bowel function and health-related quality of life on sexual function. The ethics review authorities approved the study.ResultsA total of 14 of 30 (46.7%) females responded to the questionnaires and had a mean age of 21.1 years (range 18–26). No association was found between PFSF and age or bowel function (Bowel Function Score), however, a strong correlation was found between PFSF and health-related quality of life (HRQoL) with a Spearman correlation of ρ 0.82 (p = 0.0011). The general satisfaction question was strongly associated with their total PFSF score (ρ = 0.71, p = 0.0092). Except for the “desire” item, the females in this cohort did not have significantly worse sexual function than the control population(p = 0.015). Ten of fourteen (71.4%) females had had their sexual debut at a mean age of 16.3 years and two of these women (20%) have been pregnant. All females had had menarche at a mean age of 12.7 years.ConclusionSexual function in adult females was comparable to healthy controls except for the “desire” item where the cohort reported poorer outcomes. The cohort’s sexual function had a direct association with their reported HRQoL where individuals with worse HRQoL also reported poorer sexual function.Level of evidenceIII

The repressed life of adult female patients with mild ADHD.

The repressed life of adult female patients with mild ADHD.