Female Age Research Articles

E063 Discussion of contraception and family planning in the lupus clinic

Abstract Background/Aims Females with a diagnosis of systemic lupus erythematosus (SLE) have a higher risk of adverse pregnancy outcomes. Many medications used to treat SLE are teratogenic. Contraception counselling and discussion around family planning are essential to reduce pregnancy risks. This service evaluation aimed to evaluate the appropriateness of contraceptive advice given to females of childbearing age with SLE in accordance with international guidelines and assess patient adherence to recommendations provided. Methods A retrospective evaluation of electronic medical records was undertaken. All females with a diagnosis of SLE seen in the preceding 12 months were identified. Any who were menopausal or trying to conceive were excluded. Based on BSR and EULAR guidance, five standards relating to contraceptive advice were assessed, primarily focusing on frequency of contraceptive discussions and the level of adherence to recommendations provided. For analysis of the established parameters, patients were stratified into different clinic groups; tertiary lupus clinic, vs. general clinic and whether the consultation was clinician or nurse led. Results 42 females aged 16-55 were identified. 39/42 (93%) of patients had discussions regarding contraception and conception. 39/39 (100%) of females were recommended appropriate contraception methods. Only 3/42 (7.1%) received written information on family planning. Adherence to contraceptive advice was low. Only 10/39 (25.6%) of patients recommended non-barrier contraception were complying with advice. 29/42 (69%) patients were on teratogenic medication. 8/29 (27.6) were using long acting reversible contraceptives (LARC). Of those who were not, 2/29 (6.8%) were not sexually active, 1/29 (3.4%) relied on their partner’s vasectomy, 3/29 (10.3%) had alternative contraception preference and in 15/29 (51.7%) the reasons were unclear. Conception and family planning advice was given in all clinics, however those attending the tertiary lupus clinic were significantly more likely to receive follow up advice on contraception and conception advice compared to those attending general clinics (U = 44, P < 0.001). There was no difference between the frequency of nurse or clinician led advice. Conclusion Contraceptive advice in line with current guidelines is being delivered routinely in lupus clinics. There appears to be barriers to the uptake of LARC. To better understand this, exploration of patient experiences of contraception and conception discussions is underway. Disclosure K. Mashida: None. R. Benson: None. A. Redfern: None. C. Burton: None. Z. Mclaren: None.

E008 Review of rheumatology care for women of childbearing age

Abstract Background/Aims Autoimmune rheumatic diseases are frequently diagnosed in women of childbearing age. Managing these conditions during pregnancy is complex because commonly used disease-modifying antirheumatic drugs (DMARDs) can pose risks. Specialized care for this patient group is crucial, necessitating adherence to established rheumatology practice standards and British Society for Rheumatology (BSR) guidelines. Our main objective is to review management of childbearing age females with rheumatic diseases attending Basildon hospital as per BSR guidelines. Methods The data for this retrospective study was collected from the electronic records of female patients attending the rheumatology outpatient clinic at Basildon Hospital between September and December 2022. We reviewed age, the specific rheumatological diagnosis, disease duration, disease activity, current medications, and whether general advice or pregnancy-specific advice was provided. Results Out of the initial cohort of 63 female patients, 48 (76%) aged between 18-55 years were selected as women of childbearing age, The median age was 46 years, with 65% in the age groups of 31-50 years, 25% in group 51-55 years and 10% 18-30 years age group. 58% of patients had inflammatory arthritis, 18.7% had connective tissue disease, 18.7% had other conditions such as hypermobility, osteoarthritis, and regional pain syndrome, 2.3% were diagnosed with vasculitis and 2.3% with polymyalgia rheumatica. Breakdown of inflammatory arthritis patients revealed rheumatoid arthritis in 64%, psoriatic arthritis 15% and ankylosing spondylitis 12%. Axial spondyloarthropathy, palindromic rheumatism, and juvenile idiopathic arthritis, each accounted for 3%. Regarding prescribed medications, 66% of the individuals were on conventional DMARDs, biologics 24%, corticosteroids 6% and 4% were on other treatments. The DMARDs prescribed were methotrexate 27%, hydroxychloroquine 19%, sulfasalazine 13%, mycophenolate 3% and leflunomide 1%. The majority of patients had disease activity in remission or mild, each accounting for 23%. Moderate and severe disease activity were reported in 21% each of the audited sample. Patients received advice specifically related to pregnancy 29%, while 71% did not have documented pregnancy-related guidance. 70% of females of reproductive age received general advice. Conclusion The study highlights a gap in pregnancy-related advice among the childbearing age patients as only 29% received guidance on pregnancy. This underpins the need for proactive counselling and education for female patients in routine practice, work in partnership with obstetric teams, and primary care to reduce potential pregnancy related complications and improve outcomes. Disclosure M. Mohareb: None. S. Ahmed: None. A. Bharadwaj: None. A. Nandagudi: None.

OA24 Age-associated T-bet+ B cells in healthy and autoimmune pregnancy

Abstract Background/Aims Inflammatory rheumatic diseases (IRD), including systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), affect females of reproductive age and are characterised by loss of immune tolerance and an increased burden of adverse pregnancy outcomes (APO). Mechanisms by which IRD may affect immune adaptations of healthy pregnancy to maintain host and fetal defence whilst tolerating male fetal antigens are poorly characterised. This study aimed to investigate B cell subpopulations in healthy and IRD in pregnancy, with a focus on IgD-CD27- (double negative, DN) T-bet+ B cells, considered pathogenic in IRD. Given disparate relationships between disease activity and risk of APO in SLE and RA pregnancy, the objective of this pilot study was to determine if pregnancy alters the frequency and/or the phenotype of DN T-bet+ B cells in IRD compared with healthy control pregnancies. Methods Peripheral blood mononuclear cells were obtained from IRD pregnancy (SLE n = 5; RA n = 8), IRD non-pregnancy (SLE n = 12; RA n = 10), and healthy pregnant (n = 8) people at University College London Hospital by informed consent. Cells were analysed by flow cytometry to identify B cell subpopulations and their expression of multiple markers including T-bet, IFN-γR, TLR7, TLR9, Ki67, CD38 and CD19 was assessed. Results There were no significant differences in B cell subpopulations, categorised based on the expression of IgD and CD27, between the cohorts. In healthy pregnancy, the median frequency (%) of CD19+T-bet+, IgD-CD27+T-bet+, DNT-bet+ cells was 5, 1.3 and 2, respectively. In contrast, the median frequency of CD19+T-bet+ cells was significantly elevated in SLE pregnancy at 13% compared with 5% (p < 0.05) in healthy pregnancy[GI3] [RV4] . Similarly, the median frequency of DNT-bet+ B cells was elevated in SLE pregnancy at 6% compared with 2% (p = 0.009) in healthy pregnancy. RA pregnancy, but not SLE pregnancy, had significantly lower frequency of Ki67+ DN T-bet+ cells compared to non-pregnant RA (p=0.04) and SLE (p=0.07). ROC analysis demonstrated that for both RA (p = 0.016, AUC = 0.84, 95% CI [0.65, 1.00]) and SLE (p = 0.015, AUC=0.88) the frequency of DN T-bet+ Ki67+ B cells can discriminate between pregnancy and non-pregnancy samples. In pooled analysis (n = 43), but not in single cohorts, DN T-bet+ cells had significantly high TLR7 and TLR9 expression. High frequencies of CD19hi DN T-bet+ cells were found but were unaffected by pregnancy. Clustering revealed canonical DN T-bet+ clusters and CD38hi T-bet+ clusters enriched in SLE and pregnancy-altered. Conclusion We have immunophenotyped B cell populations in healthy pregnancy and identified different patterns of alteration in frequency and proliferation of DNTbet+ cells in IRD compared with healthy pregnancy that are disease specific. This pilot study reveals previously unrecognized immunological changes in disease pregnancy warranting further larger studies of their mechanistic basis and clinical relevance. Disclosure S. Benton: None. C. Raine: None. K. Shah: None. S. Luong: None. A. Venkatkrishnan: None. M. Leandro: None. M. Castelino: None. D. Sen: None. D.A. Isenberg: None. A. Akbar: None. I. Giles: Grants/research support; IG has received an unrestricted research grant, travel and speaker fees from UCB Pharma. V.R. Reddy: None.

Reproductive Cessation and Post-Reproductive Lifespan in Honeybee Workers

The post-reproductive lifespan is an evolutionary enigma because the cessation of reproduction in animals seems contrary to the maximization of Darwinian fitness. Several theories aim to explain the evolution of menopause, one of which suggests that females of a certain age receive more fitness benefits via indirect selection (kin selection) than they would directly from continuing reproduction. Post-reproductive lifespans are not very common in nature but have been described in humans, nonhuman primates, a few species of toothed whales, guppies, and in some insect societies consisting of clonal colony members, such as aphid and ant societies. Here, we provide evidence that menopause also exists in honeybee societies. Our study shows that workers with a short life expectancy (older and/or injured workers) invest fewer resources and less time in their own reproduction than workers with a long life expectancy (younger and/or uninjured workers), even if their colony is hopelessly queenless. These results are consistent with the kin selection explanation for the evolution of menopause and help us understand the net effects of relatedness and social cooperation in animals.

P051 Trends in consultations for musculoskeletal pain in children and young people presenting to United Kingdom primary care: an electronic health record study

Abstract Background/Aims Musculoskeletal pain in childhood increases the risk of such pain in adulthood but there is an absence of management guidance for this group, not helped by a lack of evidence on the extent and nature of pain in children. The aim was to determine the extent and patterns of consultations for musculoskeletal pain in children and young people (CYP) presenting to UK primary care. Methods Data were obtained from an anonymised nationally representative UK primary care electronic health record database (Clinical Practice Research Datalink, CPRD). The study population was patients aged 8-18 years between 2005-2021 with consultations for musculoskeletal pain. Consultation prevalence was calculated per 10,000 registered population for each calendar year, and by age (8-11, 12-15 and 16-18 years), gender and body site (prevalence presented for 2019 prior to COVID-19 pandemic). Results 1.12 million children and young people (48% female; median age 14 years) were recorded with musculoskeletal pain, with an annual consultation prevalence of over 9% (932/10,000, 95% CI 928-937). Consultation prevalence increased until 2015, stabilised until 2019, and was lower during 2020 due to the COVID-19 pandemic, but climbed slightly in 2021. Consultation prevalence in 2019 was highest for those aged 12-15 years (1105/10,000 vs 8-11 years 736/10,000 and 16-18 years 984/10,000) and for females. Age and gender differences were observed by body site with foot/ankle the most common site of pain in younger children (ages 8-11: females 277/10,000, males 229/10,000,), back the most common site in older females (ages 16- 18: 247/10,000) and knee the most common site in older males (ages 16-18: 178/10,000). Conclusion Musculoskeletal pain in CYP is common with almost one in ten consulting primary care annually, but pain sites vary by age and gender. Understanding the extent and nature of musculoskeletal pain in CYP presenting to primary care can help inform targeted and effective care, and underpin much needed intervention studies, potentially reducing risk of continued pain into adulthood. Disclosure K.J. Mason: None. K.P. Jordan: None. J. Bailey: None. A. Jöud: None. S. Jowett: None. J. Protheroe: None. F. Mughal: None. K.I.E. Snell: None. M. Thomas: None. K.M. Dunn: None.

SARS-CoV-2 infection in IVF-conceived early pregnancy and the risk of miscarriage: a matched retrospective cohort study

Abstract STUDY QUESTION Is SARS-CoV-2 infection in IVF-conceived early pregnancy associated with a higher risk of miscarriage? SUMMARY ANSWER Infection with SARS-CoV-2 during early pregnancy in women conceiving by IVF may not associated with an increased rate of miscarriage. WHAT IS KNOWN ALREADY In naturally conceived pregnancies, most findings have shown that SARS-CoV-2 infection does not increase the risk of miscarriage, while some studies have shown that SARS-CoV-2 infection is associated with a higher risk of miscarriage. STUDY DESIGN, SIZE, DURATION A matched retrospective cohort study was conducted in a tertiary hospital-based reproductive medicine centre. The infection group included women who contracted COVID-19 before 20 weeks gestation from December 6, 2022 to January 10, 2023. Each infected woman was matched with three historical control subjects from January 1, 2018 to May 31, 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS The infection group was matched with historical control subjects based on female age (±1 year), number of gestational sacs, number of previous miscarriages, BMI (±2 kg/cm2), main causes of infertility, gestational week, and fresh versus frozen embryo transfer. MAIN RESULTS AND THE ROLE OF CHANCE A total of 150 pregnant women infected with COVID-19 before 20 weeks of gestation were included in the infection group, which was matched at a 3:1 ratio with 450 historically pregnant controls. There were no significant differences in age, BMI and endometrial thickness between the two groups. The overall incidence of miscarriage was not significantly different between the infection group and the control group (4.7% versus 5.8%, p = 0.68). When the infection group was stratified into three subgroups based on the gestational age at the onset of infection (0-7 + 6 weeks, 8-11 + 6 weeks and 12-19 + 6 weeks), no significant differences were observed in the incidence of miscarriage between the infection group and the matched control group in any of the subgroups (9.8% versus 13.8%, p = 0.60; 5.4% versus 4.5%, p = 1.00; and 1.4% versus 1.9%, p = 1.00, respectively). LIMITATIONS, REASONS FOR CAUTION The major limitation of this study is the relatively small sample size; therefore, caution is suggested when drawing any definitive conclusions. Nonetheless, our study is the largest sample study of the influence of COVID-19 infection on the miscarriage rate in early pregnancy after IVF. WIDER IMPLICATIONS OF THE FINDINGS Our findings may provide important insights for reproductive physicians and obstetricians during preconception and early pregnancy counselling. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Natural Science Foundation of Guangdong Province (No. 2023A1515010250). The authors report no conflicts of interest. TRIAL REGISTRATION NUMBER None.

Real life experience on the use of Remdesivir in patients admitted to COVID-19 in two referral Italian hospital: a propensity score matched analysis

Remdesivir (RDV) was the first Food and Drug Administration (FDA)-approved medication for COVID-19, with discordant data on efficacy in reducing mortality risk and disease progression. In the context of a dynamic and rapidly changing pandemic landscape, the utilization of real-world evidence is of utmost importance. The objective of this study is to evaluate the impact of RDV on patients who have been admitted to two university referral hospitals in Italy due to COVID-19. All patients older than 18 years and hospitalized at two different universities (Bari and Palermo) were enrolled in this study. To minimize the effect of potential confounders, we used propensity score matching with one case (Remdesivir) and one control that never experienced this kind of intervention during hospitalization. Mortality was the primary outcome of our investigation, and it was recorded using death certificates and/or medical records. Severe COVID-19 was defined as admission to the intensive care unit or a qSOFAscore ≥ 2 or CURB65scores ≥ 3. After using propensity score matching, 365 patients taking Remdesivir and 365 controls were included. No significant differences emerged between the two groups in terms of mean age and percentage of females, while patients taking Remdesivir were less frequently active smokers (p < 0.0001). Moreover, the patients taking Remdesivir were less frequently vaccinated against COVID-19. All the other clinical, radiological, and pharmacological parameters were balanced between the two groups. The use of Remdesivir in our cohort was associated with a significantly lower risk of mortality during the follow-up period (HR 0.56; 95% CI 0.37–0.86; p = 0.007). Moreover, RDV was associated with a significantly lower incidence of non-invasive ventilation (OR 0.27; 95% CI 0.20–0.36). Furthermore, in the 365 patients taking Remdesivir, we observed two cases of mild renal failure requiring a reduction in the dosage of Remdesivir and two cases in which the physicians decided to interrupt Remdesivir for bradycardia and for QT elongation. Our study suggests that the use of Remdesivir in hospitalized COVID-19 patients is a safe therapy associated with improved clinical outcomes, including halving of mortality and with a reduction of around 75% of the risk of invasive ventilation. In a constantly changing COVID-19 scenario, ongoing research is necessary to tailor treatment decisions based on the latest scientific evidence and optimize patient outcomes.

V736A (rs855791) polymorphism in the TMPRSS6 gene is associated with iron deficiency anemia in females of reproductive age: A meta-analysis

BackgroundSeveral studies suggested that mutations in the TMPRSS6 gene affect hepcidin production, which may lead to iron deficiency anemia (IDA). Hence, this meta-analysis explored the association of the V736A or the rs855791 polymorphism in the TMPRSS6 gene with IDA development. MethodsRelated studies were searched as of December 24, 2023. Two authors screened the resulting studies, and data were extracted and collated in a customized spreadsheet. Review Manager 5.4 and Meta-Essentials were used to compute the odds ratios (ORs) and 95% confidence intervals (CIs). ResultsA total of 187 studies were screened. From this, only six studies satisfied the inclusion criteria and were included in the meta-analysis. Analysis of the allelic model showed a high degree of inter-study heterogeneity, which prompted us to determine the cause through sub-group analysis. Sub-groups were conceptualized based on the participant characteristics. Based on this, homogenous findings were observed for the allelic, co-dominant, and dominant models of the association between the polymorphism and the development of IDA among females of reproductive age still experiencing menstruation. Non-significant and highly heterogeneous outcomes were noted for the other sub-groups. ConclusionOverall, based on the pooled findings, the V736A polymorphism is associated with IDA development in females of reproductive age still experiencing menstruation. However, further studies are needed to verify these claims.

Gut Microbes in Polycystic Ovary Syndrome and Associated Comorbidities; Type 2 Diabetes, Non-Alcoholic Fatty Liver Disease (NAFLD), Cardiovascular Disease (CVD), and the Potential of Microbial Therapeutics.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine anomalies among females of reproductive age, highlighted by hyperandrogenism. PCOS is multifactorial as it can be associated with obesity, insulin resistance, low-grade chronic inflammation, and dyslipidemia. PCOS also leads to dysbiosis by lowering microbial diversity and beneficial microbes, such as Faecalibacterium, Roseburia, Akkermenisa, and Bifidobacterium, and by causing a higher load of opportunistic pathogens, such as Escherichia/Shigella, Fusobacterium, Bilophila, and Sutterella. Wherein, butyrate producers and Akkermansia participate in the glucose uptake by inducing glucagon-like peptide-1 (GLP-1) and glucose metabolism, respectively. The abovementioned gut microbes also maintain the gut barrier function and glucose homeostasis by releasing metabolites such as short-chain fatty acids (SCFAs) and Amuc_1100 protein. In addition, PCOS-associated gut is found to be higher in gut-microbial enzyme β-glucuronidase, causing the de-glucuronidation of conjugated androgen, making it susceptible to reabsorption by entero-hepatic circulation, leading to a higher level of androgen in the circulatory system. Overall, in PCOS, such dysbiosis increases the gut permeability and LPS in the systemic circulation, trimethylamine N-oxide (TMAO) in the circulatory system, chronic inflammation in the adipose tissue and liver, and oxidative stress and lipid accumulation in the liver. Thus, in women with PCOS, dysbiosis can promote the progression and severity of type 2 diabetes, non-alcoholic fatty liver disease (NAFLD), and cardiovascular diseases (CVD). To alleviate such PCOS-associated complications, microbial therapeutics (probiotics and fecal microbiome transplantation) can be used without any side effects, unlike in the case of hormonal therapy. Therefore, this study sought to understand the mechanistic significance of gut microbes in PCOS and associated comorbidities, along with the role of microbial therapeutics that can ease the life of PCOS-affected women.

Prevalence of Polypharmacy and Potentially Inappropriate Medications Prescribed among Elderly Inpatients in a Primary Care Setting of Pokhara, Nepal

Introduction: Polypharmacy, referred to as prescription several medications is major concern in the elderly population. Potentially inappropriate medications (PIMs) are those medications that should be avoided due to their adverse clinical effects. This study aimed to estimate the prevalence of polypharmacy and identify PIMs in primary care practice using Beer’s criteria and the Screening Tool of Older People’s Potentially Inappropriate Prescription (STOPP) criteria. Methods: This was an observational cross-sectional study. A total of 102 elderly patients aged ≥ 65 years were enrolled in the study from a primary care centre in Pokhara, Nepal. A questionnaire comprising sociodemographic and prescribed medication information was used for data collection. Potentially inappropriate prescriptions were assessed using Beer’s and STOPP criteria. Results: The majority of the study population were females (53%) age group 65-74 years (74.5%). Comorbidities were common in 69% of the elderly, and major polypharmacy was prevalent in approximately 73% of the elderly. PIM prevalence rates of 36.12% and 6.86% were identified using the Beer’s criteria and STOPP criteria, respectively. Conclusion: This study reports the prevalence of polypharmacy and PIM prescriptions among elderly patients. Appropriate drug therapy can be achieved by using appropriate tools for the detection of PIM use in elderly patients. Further research on interventions related to PIMs is warranted to prevent adverse drug events in the elderly.

Leukocytospermia does not negatively impact outcomes in in vitro fertilization cycles with intracytoplasmic sperm injection and preimplantation genetic testing for aneuploidy: findings from 5435 cycles.

To investigate whether leukocytospermia (defined as the presence of ≥ 1 × 106 white blood cells/mL) affects clinical and embryologic outcomes in in vitro fertilization (IVF) cycles with intracytoplasmic sperm injection (ICSI) and preimplantation genetic testing for aneuploidy (PGT-A). This was a retrospective cohort study including 5425 cycles between January 2012 to December 2021 at a single large university-affiliated fertility clinic. The primary outcome was live birth rate (LBR). The prevalence of leukocytospermia was 33.9% (n = 1843). Baseline characteristics including female age, BMI, AMH, Day 3 FSH, and male partner's age were similar in cycles with and without leukocytospermia. The LBR after the first euploid embryo transfer was similar in those with and without leukocytospermia (62.3% vs. 63% p = 0.625). Secondary outcomes including clinical pregnancy rate (CPR), sustained implantation rate (SIR), fertilization (2PN) rate, blastulation rate, and aneuploidy rate were also evaluated. The CPR (73.3% vs 74.9%, p = 0.213) and SIR (64.6% vs. 66%, p = 0.305) were similar in both groups. The 2PN rate was also similar in both groups (85.7% vs. 85.8%, p = 0.791), as was the blastulation rate per 2PN (56.7% vs. 57.5%, p = 0.116). The aneuploidy rate was not significantly different between groups (25.7% vs 24.4%, p = 0.053). A generalized estimation equation with logistic regression demonstrated that the presence leukocytospermia did not influence the LBR (adjusted OR 0.878; 95% CI, 0.680-1.138). Leukocytospermia diagnosed just prior to an IVF cycle with PGT-A does not negatively impact clinical or embryologic outcomes.

Economic burden of patients with post-surgical chronic and transient hypoparathyroidism in the United States examined using insurance claims data.

Hypoparathyroidism (HP) is a rare endocrine disease commonly caused by the removal or damage of parathyroid glands during surgery and resulting in transient (tHP) or chronic (cHP) disease. cHP is associated with multiple complications and comorbid conditions; however, the economic burden has not been well characterized. The objective of this study was to evaluate the healthcare resource utilization (HCRU) and costs associated with post-surgical cHP, using tHP as a reference. This analysis of a US claims database included patients with both an insurance claim for HP and thyroid/neck surgery between October 2014 and December 2019. cHP was defined as an HP claim ≥ 6 months following surgery and tHP was defined as only one HP claim < 6 months following surgery. The cHP index date was the first HP diagnosis claim following their qualifying surgery claim, whereas the tHP index date was the last HP diagnosis claim following the qualifying surgery claim. Patients were continuously enrolled at least 1 year pre- and post-index. Patients' demographic and clinical characteristics, all-cause HCRU, and costs were descriptively analyzed. Total all-cause costs were calculated as the sum of payments for hospitalizations, emergency department, office/clinic visits, and pharmacy. A total of 1,406 cHP and 773 tHP patients met inclusion criteria. The average age (52.1 years cHP, 53.5 years tHP) and representation of females (83.2% cHP, 81.2% tHP) were similar for both groups. Neck dissection surgery was more prevalent in cHP patients (23.6%) than tHP patients (5.3%). During the 1-2 year follow-up period, cHP patients had a higher prevalence of inpatient admissions (17.4%), and emergency visits (26.0%) than the reference group -tHP patients (14.4% and 21.4% respectively). Among those with a hospitalization, the average number of hospitalizations was 1.5-fold higher for cHP patients. cHP patients also saw more specialists, including endocrinologists (28.7% cHP, 15.8% tHP), cardiologists (16.7% cHP, 9.7% tHP), and nephrologists (4.6% cHP, 3.3% tHP). This study demonstrates the increased healthcare burden of cHP on the healthcare system in contrast to patients with tHP. Effective treatment options are needed to minimize the additional resources utilized by patients whose HP becomes chronic.

Management of Polycystic Ovarian Syndrome: A Qualitative Inquiry among Complementary and Alternative Medicine Practitioners in South Africa.

Polycystic ovarian syndrome (PCOS) is a complex reproductive endocrinopathy affecting 4-20% of females of reproductive age. PCOS and its consequent complications such as infertility, diabetes mellitus and cardiovascular disease significantly impact clinical management. Complementary and alternative medicine (CAM), including homeopathy, is gaining recognition in PCOS management. There remains a paucity of formal protocols for managing PCOS within homeopathy and other CAM systems. This study aimed to explore and document existing therapeutic practices in the management of PCOS from diagnosis to treatment used by practitioners within various disciplines of CAM: viz., homeopathy, ayurveda, unani tibb, traditional Chinese medicine (TCM) and naturopathy, in the context of their unique philosophical background. In this explorative, descriptive study, data were collected from CAM practitioners in eThekwini Municipality, KwaZulu Natal, South Africa, using semi-structured interviews and analysed using Tesch's and Creswell's methods for qualitative analysis. Four themes emerged from the data, namely: CAM philosophical perspectives on PCOS, contributing factors, diagnosis of PCOS, and management of PCOS. Five sub-themes emerged: clinical diagnosis of PCOS, CAM-specific characterisation of PCOS, CAM-specific treatment of PCOS, adjunctive therapies, and lifestyle interventions. Homeopathic management comprised several prescribing methods, the most common ones being miasmatic/constitutional, keynote and clinical, alongside adjunctive therapies and lifestyle interventions. Other CAM modalities adopted similar holistic approaches. This paper offers a comprehensive exploration of the perceptions, clinical investigations and management practices in PCOS by homeopaths and four other CAM modalities - ayurveda, unani tibb, TCM and naturopathy - as documented in the study. Homeopaths and other CAM practitioners employed CAM-specific therapies, along with adjunctive therapies and lifestyle interventions, adopting holistic approaches. Enhancing the quality of life through emotional counselling, stress reduction and lifestyle improvements emerged as shared objectives across modalities. Our findings underscore the need to further explore inter-disciplinary collaboration in PCOS management among registered CAM practitioners, with the potential to expand the scope of comprehensive care for PCOS patients.

Analysis of the uterine artery pulsatility index on the day of endometrial transformation and pregnancy outcomes of patients undergoing frozen-thawed embryo transfer.

The objective was to analyze the impact of the uterine artery pulsatility index (PI) on pregnancy outcomes by measuring uterine artery blood flow on the day of endometrial transformation in patients undergoing frozen-thawed embryo transfer (FET). This was a case-control study. In total, 2,036 patients who underwent FET at the Third Affiliated Hospital of Zhengzhou University from October 2019 to September 2020 were included. The patients were divided into a clinical pregnancy group and a nonclinical pregnancy group according to pregnancy outcome. A multivariate logistic regression model was used to analyze the factors affecting the clinical pregnancy rate. The receiver operating characteristic (ROC) curve was used to determine the optimal mean PI cutoff value of 1.75. After 1:1 propensity score matching (PSM), 562 patients were included. For statistical description and analysis, the patients were divided into two groups: a group with a mean PI > 1.75 and a group with a mean PI ≤ 1.75. The clinical pregnancy group included 1,218 cycles, and the nonclinical pregnancy group included 818 cycles. There were significant differences in female age (P<0.01), infertility type (P=0.04), baseline follicle-stimulating hormone level (P=0.04), anti-Müllerian hormone (AMH) level (P<0.01), antral follicle count (P<0.01), number of transferred embryos (P=0.045) and type of transferred embryo (P<0.01). There was no significant difference in the mean bilateral PI (1.98 ± 0.34 vs. 1.95 ± 0.35, P=0.10). The multivariate analysis results showed that maternal age (AOR=0.95, 95% CI=0.93-0.98, P<0.01), AMH level (AOR=1.00, 95% CI=1.00-1.01, P=0.045), number of transferred embryos (AOR=1.98, 95% CI=1.47-2.70, P<0.01), and type of transferred embryo (AOR=3.10, 95% CI=2.27-4.23, P<0.01) were independent factors influencing the clinical pregnancy rate. The mean PI (AOR=0.85, 95% CI=0.70-1.05; P=0.13) was not an independent factor influencing the clinical pregnancy rate. Participants were divided into two groups according to the mean PI cutoff value of 1.75, and there was no significant difference between the two groups (P > 0.05). In this study, we found that the uterine artery PI on the day of endometrial transformation in patients undergoing FET is not a good predictor of pregnancy outcomes.

Investigation of neutering status and age of neutering in female Dachshunds with thoracolumbar intervertebral disc extrusion.

To evaluate neutering status and age of neutering in female Dachshunds with thoracolumbar intervertebral disc extrusion. We hypothesised that neutered Dachshunds presented with intervertebral disc extrusion at an earlier age, with a higher grade of neurological deficits and with more extensive extrusion of disc material compared with intact females. Retrospective multi-centre study of client-owned female Dachshunds with surgically confirmed thoracolumbar intervertebral disc extrusion. Dogs were classified as early, late or not neutered (intact). Age, body condition score, duration of clinical signs before presentation, modified Frankel score at presentation, length of extruded disc material, maximum spinal cord compression and whether dogs presented for a subsequent intervertebral disc extrusion were recorded. One hundred and fifty-four dogs were included: 36 early neutered, 69 late neutered and 49 intact. No significant difference was found between early neutered, late neutered and entire female Dachshunds in any of the variables studied. In this cohort of female dogs, neuter status and age of neutering were not found to affect age at onset nor severity of thoracolumbar intervertebral disc extrusion.

Clinical Implications of Over- and Under-Triage Using Need for Trauma Intervention and Cribari Indices.

Need for Trauma Intervention (NFTI) score was proposed to help identify injured trauma patients while minimizing under (UT) and over triage (OT). Using a national database, we aimed to describe UT and OT of NFTI vs standard Cribari method (CM) and hypothesized triage sensitivity remains poor. The 2021 Trauma Quality Improvement Program (TQIP) database was queried. Demographics, mechanism, verification level, interfacility transfer (IF), and level of activation were collected. Patients were stratified by both NFTI [+ vs -] and CM [Injury severity score (ISS) < 15 vs > 15]. UT was defined as NFTI + or ISS >15 without full trauma activation. 1,030,526 patients were identified in TQIP. 84,969 were UT and 97,262 were OT using NFTI while 94,020 were UT and 108,823 were OT using CM. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NFTI is 49%, 89%, 45%, and 90%, respectively vs 43%, 87%, 39%, and 89% of CM, respectively. Age was higher in the UT group using both scores (52 vs 42, P < .0001 and 54 vs 42, P < .0001, respectively). Using MLR, level 2 and 3 verification, blunt mechanism, female, IF, and older age were associated with UT in both NFTI and CM. Level 1 verification, penetrating mechanism, male, no IF, and younger age were associated with OT. Current prehospital triage criteria have poor sensitivity for identifying severely injured trauma patients by both NFTI and CM. UT increases as age of the patient increases. Further studies are needed to improve triage.

Iron Insights: Exploring Age-Specific Variations In Anaemia Prevalence In Islamabad

Background &amp; Introduction: Blood, a specialized connective tissue, facilitates the vital transport of oxygen, carbon dioxide, minerals, hormones, and salts throughout the body. Anemia, characterized by reduced oxygen-carrying capacity, often stems from factors such as diminished red blood cell (RBC) synthesis or excessive blood loss. Notably, iron deficiency stands out as a prominent cause, particularly among females of reproductive age, due to factors like inadequate dietary iron intake and menstrual blood loss. Objectives: This study aims to assess the prevalence of iron deficiency anemia (IDA) in both males and females across different age groups. Specifically, we seek to determine the frequency of IDA and its distribution among age cohorts spanning 6-12 years, 13-19 years, and 20-50 years. Methodology: Employing a cross-sectional study design, we surveyed a population of 2071 individuals, selecting a sample of 3[1]24 participants through non-probability convenient sampling methods. Descriptive statistics, facilitated by SPSS, guided our analysis. Hematological parameters including hemoglobin (HB) levels, RBC count, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) were evaluated to ascertain the hematological status of the study cohort. Results: Our findings reveal notable trends in IDA prevalence across age groups. Among participants aged 16-30 years, IDA incidence stood at 51%, whereas the 31-35 years age group exhibited a 26% prevalence, and the 46-60 years age group recorded a 23% incidence of IDA. Additionally, our analysis indicates a higher prevalence of IDA among females, constituting 65% of all IDA cases, particularly pronounced in the reproductive age bracket of 16-30 years. Conclusion: The study underscores a gender-based discrepancy in IDA prevalence, with females exhibiting a higher incidence compared to males. Notably, females within the reproductive age range of 16-30 years emerge as a particularly vulnerable demographic. These findings emphasize the importance of targeted interventions to address iron deficiency, especially among at-risk populations.

Same day discharge following mastectomy and immediate tissue expander reconstruction: The effect of patient expectations

Background and PurposeWithin, we compare the short-term outcomes of patients receiving same day mastectomy and tissue expander reconstruction for those discharged on postoperative day one versus those discharged immediately following surgery to explore the safety, efficacy, and potential impact on hospital processes. MethodsThis was a retrospective review of patients undergoing mastectomy with immediate TE reconstruction from March 2019 to March 2021. Patients were stratified into two cohorts; observation overnight (OBS), and discharge on same day of surgery (DC). ResultsIn total, 153 patients underwent 256 mastectomies with immediate TE reconstruction. All patients were female and mean age was 48 years old. The DC cohort contained 71 patients (125 mastectomies) and there were 82 Patients (131 mastectomies) within the OBS cohort.On average the DC cohort had a lower BMI than the OBS group (mean ± SD; DC 26.8kg/m2 ± 5.3kg/m2, OBS 28.7kg/m2 ± 6.1kg/m2, p = 0.05), the DC cohort had higher rates of adjuvant chemotherapy (DC 40.1%, OBS 23.2%, p=0.02), and were more likely to undergo bilateral TE reconstruction (DC 76%, OBS 60%, p=0.03) than the OBS group. No differences were observed between cohorts in complication rates regarding primary or secondary outcomes. ConclusionThese findings indicate that it is safe and effective within the immediate 7-day post-operative period to immediately discharge patients undergoing mastectomy with immediate TE reconstruction. Additionally, alteration of patient management practices can have a profound impact on the operational flow within hospitals.

Examining pain, function, behavioral symptoms and associations with engagement in meaningful activity for residents with dementia in assisted living

Objectives The purpose of this study was to examine factors associated with engagement in meaningful activity among residents with dementia in assisted living. We hypothesized that greater functional independence, less pain, and lower behavioral and psychological symptom severity would be associated with higher engagement in meaningful activity after controlling for residents’ age, gender, comorbidities, and cognition. Understanding factors associated with engagement in meaningful activity can help to inform strategies for optimizing engagement among residents with dementia in assisted living. Method This descriptive study used baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). Linear regression was used to examine factors associated with engagement in meaningful activity. Results A total of 71 residents from 5 assisted living settings were included in the sample. Most participants were female (n = 52, 73%), White (n = 62, 87%), and mean age was 85 years old (SD = 8.2). Controlling for age, gender, comorbidities, and cognition, pain was significantly associated with engagement in meaningful activity (b= −2.09, p < 0.05). There were no associations found between function and behavioral symptoms with engagement in meaningful activity. Conclusion Findings from this study show that pain is a significant factor that is negatively associated with residents’ engagement in meaningful activity. Ongoing research is needed to help improve pain management for residents with dementia in assisted living and support their engagement in meaningful activity.

Ketogenic diet for ovarian disorders - promising nutritional approach in polycystic ovarian syndrome and ovarian cancer

Introduction and purpose:&#x0D; Polycystic ovary syndrome (PCOS) is the most common endocrine disease in the female reproductive age. As treatment guidelines include lifestyle changes, various diet types are being evaluated in terms of efficacy among them ketogenic diet (KD) which was also assessed in terms of its influence on another ovarian related disease - ovarian cancer. The aim of this paper is an analysis of the available scientific data in respect of the role of the KD as a part of the therapy of ovarian related disorders. The search was conducted using PubMed and Google Scholarship databases.&#x0D; Brief description of the state of knowledge:&#x0D; Ketogenic diet demonstrates favorable effects in the hormonal profile of  PCOS-affected women. It was also noticed that its administration results in the reduction of BMI and the improvement in glycemic parameters. Most of the research was conducted by linking the ketogenic diet with the caloric restriction. In the matter of ovarian cancer the results are unclear; some of the research states the improvement of the quality of life of the participants, but there is some alarming data of the possible role of KD in enhancing the tumor growth.&#x0D; Conclusions:&#x0D; Ketogenic diet merits further research as a possible factor in the treatment of PCOS as foregoing results are pointing to its efficacy. Nevertheless, still more data is needed to determine its role as studies were conducted within a short period of time with relatively small research groups. There are also other limitations such as the lack of comparison with other dietary patterns with the caloric deficit which makes it difficult to deduce the main profitable factor. When it comes to ovarian cancer the results of the current data are also unclear and unambiguous with the possible negative effects.