Females Of Childbearing Age Research Articles

Lupus nephritis is associated with poor pregnancy outcomes in pregnant SLE patients in Cape Town: a retrospective analysis.

IntroductionSystemic lupus erythematosus (SLE) is a multi-system auto-immune disease common in females of child-bearing age. The effect of pregnancy on SLE and vice versa have not been well characterised in Africans. The aim of this study is to describe the pregnancy outcomes of patients with SLE presenting to the maternity department of Groote Schuur Hospital, Cape Town.MethodsThis study was designed as a retrospective review of records of pregnant women known with SLE and followed-up at the maternity section of Groote Schuur Hospital. The duration of survey was from the 1st January 2003 to 31st December 2013.ResultsThere were 61 pregnancies reviewed in 49 patients; 80.3% of the pregnancies were in patients of mixed ancestry and the rest (19.7%) in black African patients. The mean age at presentation of the current pregnancy was 27.2±5.0 years. Mean gestational age at presentation and delivery was 13.0 ± 6.0 weeks and 28.9 ± 9.8 weeks respectively and 47.5% of the pregnancies were in patients with lupus nephritis (LN). Thirty nine (63.9%) pregnancies reached the third trimester and 11.5% of all pregnancies ended in the first trimester. There was a lower number of live births to mothers of African ancestry than to those of mixed ancestry (p=0.001). In 55.7% of the pregnancies, no flare was reported while a renal flare was reported in 23%. Pregnancies in patients with LN had higher frequencies of flares (58.6% vs 31.3%; p=0.032), pre-eclampsia (34.5% vs 12.5%; p=0.041), longer stay in hospital (12.0 ± 9.1 days vs 6.1 ± 5.1 days; p=0.004) and low birth weight babies (1.94 ± 1.02 kg vs 2.55±0.95 kg; p=0.046) than in patients without LN. Only 36 (59%) of the neonates were discharged home alive and of these 2 (5.6%) were to mothers of black African ancestry (p=0.001).ConclusionIncreased lupus activity in pregnant SLE patients may account for the increased deaths of neonates born to SLE mothers. Patients of black African descent and those with LN tend to have a poorer outcome. A multi-disciplinary approach to the management of SLE patients (of child-bearing age or pregnant) needs to be further assessed for better outcomes.

Respiratory symptoms as an initial presentation of choriocarcinoma

Chronic dyspnea, chest pain, cough, and hemoptysis for more than 2 weeks often indicate a diagnosis of infective etiology of the respiratory tract in a tropical country. However, in a young reproductive female, these complaints with an episode of hemoptysis may rarely be the presenting symptomatology of pulmonary metastasis of choriocarcinoma. A young female of reproductive age group presented with hemoptysis, cough, and breathlessness. Chest X-ray revealed bilateral lower lobe opacities. Fine-needle aspiration cytology of the lung lesions depicted choriocarcinoma metastasis. Ultrasonography and magnetic resonance imaging revealed endomyometrial mass lesion suggestive of invasive gestational trophoblastic disease. β hCG levels were high. Dilatation and curettage and histopathological analysis of the mass confirmed the diagnosis of choriocarcinoma. This young female who presented with respiratory complaints was finally diagnosed to be a case of choriocarcinoma with lung metastasis. Therefore, choriocarcinoma metastasis must be considered as a differential diagnosis in a female of childbearing age presenting with respiratory complaints and hemoptysis.

Influence of goitrogenic foods intake on thyroid functions in healthy females of childbearing age with low habitual iodine intake

Influence of goitrogenic foods intake on thyroid functions in healthy females of childbearing age with low habitual iodine intake

Screening of Toxoplasma Gondii Infection among Childbearing Age Females and Assessment of Nurses' Role in Prevention and Control of Toxoplasmosis

Toxoplasmosis, caused by Toxoplasma gondii is an obligate intracellular zoonotic protozoan parasite, with a worldwide distribution particularly in Arab countries including Egypt. The study evaluated toxoplasmosis infection among childbearing age Egyptian females and assessed the military nursing staff knowledge, attitude and compliance to toxoplasmosis prevention and control measures. The study was conductedin a general military hospital. CROSS-section descriptive research design was used to conduct this study. The subjects consisted of 14 young females (11 were in-patients undergoing gynecological treatment in a military hospital and 3 were staff nurses. On the other hand, 44 staff nurses were available for assessment who met the inclusion criteria. 4 tools were used for data collection: first consisted of self-administered questionnaires to assess nurses' socio-demographic data and knowledge, second rating scale to assess nurses' attitude towards toxoplasmosis infection and its prevention, third performance check list to measure nurses' compliance to infection control measures, and fourth measured the anti-Toxoplasma antibodies by commercial indirect hemagglutination test (IHAT). The results showed that almost half of the nurses had satisfactory levels of knowledge, attitude, and compliance to toxoplasmosis infection control measures. 22.2% of the pregnant women and 20% of non-pregnant ones showed antibodies against T. gondii. Thus health education about toxoplasmosis should be tailored to women whether married or single to help in avoiding the risk of infection. Frequent periodic IHAT should be done for people who continuously contact with cats. Adherence to strict infection prevention measures is a must to eliminate exposure to toxoplasmosis infection. Training intervention should be implemented to achieve successful improvement in knowledge, attitude, and compliance of toxoplasmosis control measures.

Emerging trends in pediatric idiopathic intracranial hypertension (IIH): is the childhood obesity epidemic affecting the prevalence and patient characteristics of pediatric IIH?

Idiopathic intracranial hypertension (IIH) commonly presents in obese females of child-bearing age. Our multicenter study investigates epidemiologic trends in children with specific regard to age and sex.

Corticosteroid treatment in the management of idiopathic granulomatous mastitis to avoid unnecessary surgery.

Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast. It can mimic breast carcinoma clinically and radiologically, and usually affects females of childbearing age. There is no commonly accepted optimal treatment for IGM. In this study, we present the clinical and histopathological features and outcomes of the therapeutic management of IGM, as well as the clinical course of the disease when patients were treated with oral corticosteroids. This retrospective study included 49 of 87 patients who met the required histological criteria for IGM who were followed up between January 2009 and December 2011. All patients had a disease-free follow-up period of at least 6 months. The data regarding the clinical features at presentation, laboratory values and the treatment modalities were obtained from the medical records of the patients. The mean age of the patients was 34.3 ± 4.37 years. Forty patients were treated with prednisolone, five were started on antituberculosis treatment, two received non-steroidal anti-inflammatory drugs, one received antibiotics and one underwent wide excision. All patients who received steroids responded well to the therapy. Systemic therapy with corticosteroids is an effective and appropriate treatment option for IGM. It can provide complete disease resolution and prevent recurrence in the long term. A multidisciplinary approach including specialists in the fields of both general surgery and infectious diseases is essential for the diagnosis, treatment and follow-up of IGM.

The incidence of idiopathic intracranial hypertension in Israel from 2005 to 2007: results of a nationwide survey

Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a disorder related to increased intracranial pressure without clinical, laboratory or radiological evidence of an intracranial space occupying lesion or cerebral sinus vein thrombosis, predominantly affecting obese women of childbearing age. Our aim was to determine the incidence and clinical features of IIH in Israel. In a cross-sectional study, all medical records of patients discharged from the hospital with a primary diagnosis of IIH during 2005-2007 were reviewed. Four hundred and twenty-eight patients with a new onset of IIH were diagnosed. The average annual incidence rate was 2.02 per 100,000 with an incidence of 3.17 per 100,000 for women and 0.85 per 100,000 for men. The incidence rate in females of childbearing age (18-45) was 5.49 per 100,000. The female to male ratio for >17 years old was 6.1:1 (252 females and 41 males) and 2.1:1 (60 females and 28 males) for ages 11-17. Obesity was documented in 83.4% of patients. Body mass index (BMI) data were available for 159 (37.1%) patients; of these, 59.1% had a BMI ≥ 30. The incidence of IIH in Israel has increased during the last decade. This finding could be related to the increasing rates of obesity. The association of IIH and obesity should be further explored especially with regard to the effect of weight reduction for primary prevention.

Validation of a short food frequency questionnaire specific for iodine in UK females of childbearing age

Widespread subclinical iodine insufficiency has recently been reported in Europe, based on urinary iodine using World Health Organization/Food and Agriculture Organization criteria, in particular among young women. Although urinary iodine concentration (UIC) is a useful measurement of the iodine status in a population, it does not provide an insight into the habitual iodine intake of this population. This is compounded by the fact that very few iodine-specific food frequency questionnaires (FFQ) have been validated so far. The present study aimed to develop and validate a new, simple, rapid survey tool to assess dietary iodine exposure in females of childbearing age. Iodine was measured in a duplicate 24-h urine collection. Iodine intake was measured with duplicate 4-day semi-quantitative food diaries and the FFQ. Correlation, cross-classification and Bland-Altman analyses were used to estimate agreement, bias and the reliability of the method. The triangular (triad) method was used to calculate validity coefficients. Forty-three women, aged 19-49years, took part in the validation of the 17-items FFQ. Median (interquartile range) UIC was 74(47-92) μgL(-1) , which is indicative of mild iodine insufficiency. The FFQ showed good agreement with food diaries with respect to classifying iodine intake (82% of subjects were classified in the same or adjacent quartile). The FFQ was moderately correlated with the food diaries (rs =0.45, P=0.002) and urinary excretion in μgL(-1) (rs =0.34, P=0.025) but not in μgday(-1) (P=0.316). The validity coefficients were 0.69, 0.66 and 0.52 for the food diaries, FFQ and urinary iodine excretion, respectively. The FFQ provides a rapid and reliable estimate of dietary iodine exposure to identify those population subgroups at risk of iodine deficiency.

Drug treatment of hypertension in pregnancy

This review evaluates the guideline recommendations for the management of hypertension in pregnancy as presented by 25 national/international guidelines developed for the management of arterial hypertension in adults. There is a general consensus that oral α-methyldopa and parenteral labetalol are the drugs of choice for nonsevere and severe hypertension in pregnancy, respectively. Long-acting nifedipine is recommended by various guidelines as an alternative for first-line and second-line therapy in nonsevere and severe hypertension. The safety of β-blockers, atenolol in particular, in early and late stages of pregnancy is unresolved; their use is contraindicated according to several guidelines. Diuretic-associated harmful effects on maternal and fetal outcomes are controversial: their use is discouraged in pregnancy. It is important to develop specific guidelines for treating hypertension in special groups such as adult females of childbearing age and sexually active female adolescents to minimize the risk of adverse effects of drugs on the fetus. In several guidelines, the antihypertensive classes, recommended drug(s), intended drug formulation, and route of administration are not explicit. These omissions should be addressed in future guideline revisions in order to enhance the guidelines' utility and credibility in clinical practice.

Suicide Ideation and Acceptability Among Females Aged 15 to 34 Years in Rural China

The suicide rate of females is very close to that of males in China, in contrast to Western societies, in which the rates of male suicide outnumber those of females by three to four times. This study investigated the prevalence of suicidal ideation and prosuicide attitude (acceptability) among females of childbearing age. With the Chinese version of the Scale for Suicide Ideation and the General Social Survey questionnaire, we examined the demographic and psychological risk factors of suicide among Chinese rural young females aged 15 to 34 years. Logistic regression analysis was performed to explore the factors related to suicidal ideation and suicide acceptability. The prevalence rates of suicidal ideation and suicide acceptability among the sampled females are 22.5% and 3.8%, respectively. Education, depression, social support, hopelessness, and negative life events were significantly associated with suicidal ideation. Ethnicity, education, abortion, and depression were significantly associated with suicide acceptability. There is statistical difference between suicide ideation and acceptability. The results indicate that mental disorder remains a major risk factor of suicidal ideation. Sociodemographic and psychological characteristics are associated with suicide acceptability.

Estrogen modulation of endosome-associated toll-like receptor 8: An IFNα-independent mechanism of sex-bias in systemic lupus erythematosus

Females of child-bearing age are more resistant to infectious disease and have an increased risk of systemic lupus erythematosus (SLE). We hypothesized that estrogen-induced gene expression could establish an immunoactivated state which would render enhanced defense against infection, but may be deleterious in autoimmune development. Using peripheral blood mononuclear cells (PBMCs), we demonstrate enhanced responses with immunogen stimulation in the presence of 17β-estradiol (E2) and gene array analyses reveal toll-like receptor 8 (TLR8) as an E2-responsive candidate gene. TLR8 expression levels are up-regulated in SLE and PBMCs stimulated with TLR8 agonist display a female sex-biased, E2-sensitive response. Moreover, we identify a putative ERα-binding region near the TLR8 locus and blocking ERα expression significantly decreases E2-mediated TLR8 induction. Our findings characterize TLR8 as a novel estrogen target gene that can lower the inflammatory threshold and implicate an IFNα-independent inflammatory mechanism that could contribute to higher SLE incidence in women.

Which tools may help physicians in female fertility prediction after autologous bone marrow transplantation for lymphoma? A pilot study

Objective(s):The report of our experience on fertility preservation and the validation of some tools useful to predict fertility in young females who underwent haematopoietic cell transplantation for their lymphoma.Study design:A retrospective study involving 17 consecutive women of child-bearing age affected by lymphoma and submitted to haematopoietic cell transplantation in our centre.Results:We described a high rate of parenthood in our patient series: 5 out of 17 (29%) patients became pregnant and 1 out of 5 had two pregnancies. It is suggestive that only patients who received gonadotropin-releasing hormone (GnRH) analogues co-treatment conceaved. Antral follicles number or ovarian volume, ascertained through transvaginal ultrasound before starting treatment, more than anti-Mullerian hormone (AMH) value, are tools that may help physicians to better predict fertility in young females of child-bearing age affected by lymphoma who desire to get pregnant after cancer cares.Conclusion(s):The high rate of maternity we recorded may lead to comfort the young women who hope to become pregnant after cancer cares because pregnancy is possible in a certain percentage of cases even after highly toxic treatments to the ovaries. A higher ovarian volume or a higher number of antral follicles, before treatment start, ensures a greater chance of successful pregnancies. AMH value in lymphoma survivors is not sufficient to guide physicians in fertility predictions.

Heart Surgery Practice in Sub Saharan Africa: Single Nigerian Institutional Midterm Results and Challenges

Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth and challenges with sustainability. Methods: Records of patients undergoing heart surgery at LASUTH from December 2004 to March 2006 were retrospectively reviewed for clinical and outcome data. Results: Twenty four patients age 10-50, mean 28.0 +/? 10.49 years and 13 (54.2%) males underwent surgery. 12 (50.0%) patients had mechanical valve replacements, 11 (45.8%) closure of septal defects and 1 (4.2%) left atrial myxoma resection. Logistic euroscore for valve patients was 5.81 +/? 4.74 while observed mortality was 8.3% (1/12). Overall 30 days operative mortality was 8.3% (2/24) and major morbidity 4.2% (1/24). Patients with septal defects closure stopped clinic visits within a year. Valve patients follow up was complete in 90.1% with mean duration of 55.2 +/? 15.3 months. Late events occurred only in females with mitral valve replacements. The 5-year freedom from thromboembolism and bleeding was 74.0% and survival 82.0% in valve patients. Conclusion: Despite limited resources heart surgery can safely be performed with good outcomes by trained local personnel under supervision of visiting foreign teams until they are proficient to operate independently. Patients with less complex congenital defects have excellent postsurgical outcomes, while patients with rheumatic valve replacement are subject to ongoing valve related morbidity and mortality therefore require lifetime follow up. Choice of prosthetic valve for the mostly indigent and poorly educated population remains a challenge. We now prefer stented tissue valve despite its known limitations, in child bearing age females desirous of childbirth and others unlikely to comply with anticoagulation regimen. Barriers to sustainability include poor infrastructures, few skilled manpower, inadequate funding and restricted patient access due to inability to pay without third party insurance or government Medicaid.

Cost-effectiveness evaluation of gender-based vaccination programs against sexually transmitted infections

The ultimate goal of a vaccination program is to interrupt pathogen transmission so as to eradicate the disease from the population in the future, and/or to decrease morbidity and mortality due to the disease in the short term. For sexually transmitted infections (STI) the determination of an optimal vaccination program is not straightforward since (1) the transmission probabilities between two different sexes are normally unequal (weighted to a greater probability from males to females than vice versa), (2) demographic parameters between the two sexes are unequal, (3) the prevalence of disease in one sex may have a greater impact on the morbidity and mortality of the next generation (transmission to the neonate) and, (4) the existence of pathogens closely related to the STI in question (i.e. herpes - HSV-1 vs. HSV-2, different strains of Chlamydia trachomatis, different strains of Neisseria which cause Gonorrhea, and others) may induce immunity in individuals that render a vaccine ineffective.  &nbsp We have developed two models of sexually transmitted infections (with and without age structure) to evaluate the cost-efficacy of gender-based vaccination programs in the context of STI control. The first model ignores age structure for qualitative analysis of points (1-3), while the second refined one incorporatesthe age structure, reflecting the effects of immunity gained from infection of closely related strains (point 4), which is important for HSV-2 vaccination strategies. For both models, we find that the stability of the system and ultimate eradication of the disease depends explicitly on the corresponding reproduction number. We also find that vaccinating females is more cost-effective, providing a greater reduction in disease prevalence in the population and number of infected females of childbearing age. This result is counter-intuitive since vaccinating super-transmitters (males) over sub-transmitters (females) usually has the greatest impact on disease prevalence. Sensitivity analysis is implemented to investigate how the parameters affect the control reproduction numbers and infectious population sizes.

Anatomical characterisation of the cricothyroid membrane in females of childbearing age using computed tomography

BackgroundIn the event of failure to secure the airway by conventional means, it may be necessary to perform invasive airway access via the cricothyroid membrane. No studies have addressed anatomy of this structure in the obstetric population. We aimed to review the anatomical variation of this structure in a population of childbearing age. MethodsWe searched the radiology database for computed tomography studies of the neck performed in a 13-month period in consecutive patients aged 15–55years. Studies on 18 females and 22 males were reviewed. Male patients were included for comparison. Data were reconstructed using a high spatial frequency algorithm to optimise spatial resolution. Five parameters were measured: distance from the skin to the membrane, maximum midline height of the membrane in the vertical plane, maximum transverse diameter of the membrane, neck diameter and cartilaginous calcification. ResultsThe distance (mean range) from skin to the membrane was similar in females and males (16.2 [3–33] vs. 13.9 [3–37] mm, P=0.42). The vertical height (9.9 [7–17] vs. 11.4 [8–15] mm, P=0.04) and maximum width of the membrane (14.5 [10–17] mm vs. 12.5 [10–15] mm, P<0.01) were greater in males. Cartilaginous calcification was low and did not differ between genders. ConclusionsThe cricothyroid membrane is not necessarily a superficial structure and consequently may be difficult to palpate. The smallest dimensions of the membrane indicate that smaller than recommended cricothyroidotomy devices may be required in some patients as the external diameter of commercial trocar devices and tracheal tubes may exceed 7mm.

Fox–Fordyce disease treatment with fractional CO2 laser

Fox–Fordyce disease treatment with fractional CO₂ laser

Survival following out-of-hospital cardiac arrest in relation to gender

Purpose: Data on gender related differences in survival after out-of-hospital cardiac arrest (OHCA) are limited. 1 Kim C. Fahrenbruch C.E. Cobb L.A. Eisenberg M.S. Out-of-hospital cardiac arrest in men and women. Circulation. 2001; 104: 2699-2703 Crossref PubMed Scopus (181) Google Scholar , 2 Herlitz J. Engdahl J. Svensson L. Young M. Angquist K.A. Holmberg S. Is female sex associated with increased survival after out-of-hospital cardiac arrest?. Resuscitation. 2004; 60: 197-203 Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar , 3 Adielsson A. Hollenberg J. Karlsson T. et al. Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective. Heart. 2011; 97: 1391-1396 Crossref PubMed Scopus (118) Google Scholar , 4 Johnson M.A. Haukoos J.S. Larabee T.M. et al. Females of childbearing age have a survival benefit after out-of-hospital cardiac arrest. Resuscitation. 2013; 84: 639-644 Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar We examined gender specific differences in outcome after OHCA in a nationwide register.

Prevalence of Rubella virus-specific immunoglobulin-g and -m in pregnant women attending two tertiary hospitals in southwestern Nigeria

Background: Rubella is a self-limiting disease that causes congenital rubella syndrome (CRS) when rubella virus (RV) infects women in the first trimester of pregnancy.Objective: To assess a population of pregnant women attending antenatal clinics in two tertiary hospitals in southwestern Nigeria for anti-RV IgG and IgM in order to determine the proportions susceptible to the viral infection and infectious to their fetuses.Method: Ninety consenting pregnant women were consecutively recruited and aseptically bled for the study. The sera were screened with commercial ELISA kits for anti-rubella virus IgG and IgM. Due to the controls and calibrators included in the tests, the IgG test was performed on 89 sera while all 90 samples were screened for IgM.Results: Of the 89 pregnant women tested for anti-RV IgG, 86 (96.6%) were positive with protective serum concentrations of the antibody. Only six (6.7%, 95% CI: 1.5-11.8%, n = 90) women were positive for anti-RV IgM with 5 (5.6%, 95% CI: 0.8-10.3%) having both anti-RV IgG and IgM. Overall, three (3.4%) of the women were susceptible to RV infection, one (1.1%) of these in the first trimester of gestation was probably infectious.Conclusion: Majority of the pregnant women had protective levels of anti-RV IgG antibody although susceptibility to rubella as well as level of infectiousness were low. Intensification of rubella immunization of all females of child-bearing age in Osun and Oyo States is advocated.Keywords: Prevalence, Rubella, Antibodies, Pregnant women, Southwestern Nigeria.

County-level characteristics as predictors of dentists’ ECC counseling in the USA: a survey study

BackgroundTransmission of Streptococcus mutans from mother-to-child can lead to Early Childhood Caries. A previous study identified characteristics and beliefs of general dentists about counseling pregnant women to reduce risk of infection and Early Childhood Caries. This study extends those findings with an analysis of county level factors.MethodsIn 2006, we surveyed 732 general dentists in Oregon, USA about dental care for pregnant women. Survey items asked about individual and practice characteristics. In the present study we matched those data to county level factors and used multinomial logistic regression to test the effects of the factors (i.e., dentist to population ratio, percentage of female dentists, percentage of females of childbearing age, and percentage of individuals living in poverty) on counseling behavior.ResultsCounty level factors were unrelated to counseling behavior when the models controlled for dentists' individual attitudes, beliefs, and practice level characteristics. The adjusted odds ratios for no counseling of pregnant patients (versus 100 percent counseling) were 1.1 (95% CI .8-1.7), 1.0 (1.0-1.1), 1.2 (.9-1.5), and 1.1 (1.0-1.2) for dentist/population ratio, percent female dentists, percent females of childbearing age, and percent in poverty, respectively Similar results were obtained when dentists who counseled some patients were compared to those counseling 100 percent of patients.ConclusionsCommunity level factors do not appear to impact the individual counseling behavior of general dentists in Oregon, USA regarding the risk of maternal transmission of Early Childhood Caries.

Effect of gender on clinical presentation in systemic lupus erythematosus

The incidence of SLE is markedly increased in females of child-bearing age. Although males are protected in terms of incidence of disease, it is unclear whether a distinct phenotype of male lupus exists in those who do develop SLE. We sought to explore through a detailed literature review whether gender exerts an influence on the clinical presentation and outcome of SLE. We found that males experience less of the typical mucocutaneous and musculoskeletal symptoms commonly present at diagnosis in women. On the other hand, there is limited evidence to support a negative prognostic association between male gender and disease activity or mortality.