Females Of Childbearing Age Research Articles

Frequency of Histopathological patterns of Lupus Nephritis according to classification by WHO among Pakistani patients

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder, multisystemic in nature more common in females of childbearing age. There are certain risk factors which predispose to this disease. It affects various organs, kidney is among them. Almost 60% patients having SLE ultimately leads to kidney dysfunction at some stage of the life. Aim: To find out pattern of histopathological findings of lupus nephritis as per WHO classification on kidney biopsy in Pakistan. Methodology: This cross-sectional study was completed in department of Medicine, Fatima Memorial Hospital, Lahore, from March 2016 to May, 2018. Total sample size was 165 patients. Only patients who fulfilled the 2012 SLICC (Systemic Lupus International Collaborating Clinics) criteria were included in the study. SPSS version 25.0 was used data analysis. Results: Age of the patients was between 31-50 years i.e. 114(69.09%), mean and SD was 43.96±4.84 years, females were more commonly affected by calculating 99(59.70%). Patterns of lupus nephritis as per WHO classification and renal biopsy were noted which shows 18(10.91%) had Class I, 53(32.12%) Class II, 43(26.07%) Class III, 35(21.20%) Class IV, 10(6.06%) Class V and 6(3.64%) had Class VI. Conclusion: Class II and Class III Lupus Nephritis are the most common modalities found in patients of SLE. Every patient with Lupus Nephritis should undergo a Renal Biopsy for correct diagnosis of the class of this disease and further management accordingly. Keywords: Lupus Nephritis, SLE, renal biopsy

Which antiseizure medications are effective for absence seizure in children and adolescents? A Cochrane Review summary with commentary.

The aim of this commentary is to discuss the published Cochrane Review ‘Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents’ by Brigo et al.,a under the direct supervision of the Cochrane Epilepsy Group. This Cochrane Corner is produced in agreement with Developmental Medicine & Child Neurology by Cochrane Rehabilitation. Absence seizures account for 10% to 17% of all seizures in children and adolescents.2 Absence seizures present as short sudden episodes of loss of awareness and can be divided into typical absence seizure, atypical absence seizure, and absence seizures with special features.3, 4 Sodium valproate, ethosuximide, and lamotrigine are three antiseizure medications commonly used to treat absence seizures. Ethosuximide is indicated only for the treatment of generalized absence seizure, whilst valproate and lamotrigine are used in other types of seizures. Non-systematic reviews have suggested that ethosuximide and sodium valproate are equally effective, while lamotrigine is considered as a second-line drug, reserved for intractable absence seizure.5 Accidental injury is a common complication of absence seizure; around 20% of adolescents with absence seizure were reported to suffer an injury during an absence seizure.6 This could impact their rehabilitation process and thus prescribing antiseizure medication based on evidence is important. The aim of this Cochrane Review was to determine the best choice of antiseizure medication for children and adolescents with typical absence seizure between ethosuximide, valproate, and lamotrigine compared with placebo and each other. The population addressed in this review were children and adolescents up to 16 years of age with typical absence seizure. The interventions studied were sodium valproate, ethosuximide, or lamotrigine as monotherapy or add-on treatment. The intervention was compared with placebo or with one another. The primary study outcomes were proportion of seizure-free participants at 1 month, 3 months, 6 months, 12 months, and 18 months after randomization; 50% or greater reduction in the frequency of seizures; and incidence of adverse effects. Secondary study outcomes included normalization of electroencephalogram (EEG) and/or negative hyperventilation test. The review authors searched the Cochrane Register of Studies (CRS) and MEDLINE (OVID) up to September 2020. The CRS Web included randomized or quasi-randomized, controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Specialized Registers of Cochrane Review Groups. The authors also contacted Sanofi Winthrop, Glaxo Wellcome (now GlaxoSmithKline), and Parke Davis (now Pfizer), manufacturers of sodium valproate, lamotrigine, and ethosuximide respectively. They also reviewed references of identified studies and retrieved relevant studies. The review authors did not include any new studies in the present review. The review authors assessed five full-text reports for possible inclusion. However, the studies were excluded for the following reasons: three studies were commentaries; one a review; and another one not relevant to the current review. This current review is based on the eight studies (691 participants) from the 2019 review. The review authors did not perform meta-analysis due to the different methodologies used in the included studies. The authors concluded that ethosuximide represents the optimal initial empirical monotherapy for children and adolescents with absence seizure with regards to both efficacy and tolerability. If absence and generalized tonic–clonic seizures coexist, valproate should be preferred, as ethosuximide is inefficacious on tonic–clonic seizures. The conclusions remain the same as the previous update as there was no new study found since the last version of the review was published. The review would influence the choice of antiseizure medication that should be prescribed for children and adolescents with typical absence seizure. Children with absence seizure are also at risk of having behaviour/psychiatric status, and psychosocial and cognitive function issues including attention, memory, and learning disability.7-9 This group of patients will often require multidisciplinary rehabilitation management. Selecting the best treatment for absence seizure is very important to optimize the outcome and improve the quality of life in patients with absence seizure. Poorly controlled absence seizure will lead to accidental injury and may influence the outcome of coordinated multidisciplinary rehabilitation management. Another issue to consider relates to females of child-bearing age, as a proportion of the adolescents will require antiseizure medication beyond the age group studied.10 There is a need to improve the design of randomized controlled trial research in this area to provide more concrete evidence to guide decision-making as most of the trials included in the systematic review are of poor methodological quality. The authors thank Cochrane Rehabilitation and Cochrane Epilepsy Group for reviewing the contents of the Cochrane Corner. The authors have stated that they had no interests that could be perceived as posing a conflict or bias.

Ileoileal knotting: a rare cause of intestinal obstruction: a\xa0case report

BackgroundIleoileal knotting is one of the rarest causes of intestinal obstruction. The pathology involves knotting of the ileum around itself, leading to mechanical intestinal obstruction that can rapidly evolve to gangrene.Case presentationHere we will discuss the case of an 18-year-old Oromo girl who presented with sudden onset of severe abdominal pain and signs of generalized peritonitis.Ultrasound examination showed massive peritoneal and cul-de-sac fluid. Explorative laparotomy was done, with a tentative diagnosis of ruptured ovarian cyst. Intraoperative finding was a gangrenous ileoileal knot. The gangrenous segment was resected and ileotransverse anastomosis done. Postoperative course was uneventful, and the patient was discharged improved on the sixth postoperative day.ConclusionWe present this case to highlight the diagnostic difficulty that one can face in females of child-bearing age and to create awareness of this rare cause of intestinal obstruction, as morbidity and mortality are very high because of rapid progression to gangrene.

Food habits and physical activities of women with hirsute-polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a multisystem disease affecting females of childbearing age. This disease imposes a huge economic, social and psychological burden on the patient. The first line management of PCOS is lifestyle modification. However, there are no Sri Lankan data about the diet and physical activity of these women. This is a case-control study to compare the dietary habits and physical activity between 99 hirsute-PCOS women and 100 age-matched controls. We compared the dietary intake and physical activity of the two groups using a validated food frequency chart and a physical activity questionnaire. The Student t test and Mann-Whitney U test were used for statistical analysis. Food consumption pattern was similar in both groups except for a significantly higher consumption of eggs, refined carbohydrates, pulses and grains in controls. PCOS patents in the BMI category of 18.5 to 24.9 kg/m2 consumed significantly less amounts of fish, eggs, dairy products, pulses and grains. With regard to physical activity, light, moderate and heavy exercise was significantly higher in controls. It is concluded that hirsute PCOS women seem to have different dietary habit and reduced physical activity than controls.

Chamomile flower extract ameliorates biochemical and histological kidney dysfunction associated with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in females of childbearing age and research findings have revealed a potential association between PCOS and renal dysfunction. This study aimed to investigate renal dysfunction that might be associated with PCOS in rats and to evaluate the potential protective effect of chamomile against PCOS complicated by kidney damage. A rat model of PCOS was induced by injecting estradiol valerate (0.2mg/rat×2) into adult virgin female rats. Rats were treated with either ethyl alcohol extract of chamomile flower (75mg/kg/day) or metformin (Met) (500mg/kg/day). Induction of PCOS was associated with increased relative right kidney weight percentage and increased serum levels of urea, lipid peroxide product, and testosterone. PCOS was also associated with increased p53 expression in kidney glomeruli and medullary tubules with decreased Bcl2 expression in kidney glomeruli. Administration of chamomile extract significantly decreased levels of serum urea, testosterone, and lipid peroxide product, and p53 expression in kidney glomeruli and tubules. The extract significantly increased levels of antioxidant markers levels (reduced glutathione, catalase, and superoxide dismutase) and the expression of the anti-apoptotic gene Bcl2. Conversely, administration of Met did not improve serum levels of urea. Met also exerted no pronounced effect on p53 gene expression. The results of this study highlight the importanceofmonitoringkidney function in patients with PCOS and investigating the associated underlying mechanism. Chamomile extract was found to ameliorate kidney damage associated with PCOS through antioxidant, testosterone-lowering, and anti-apoptotic mechanisms.

Compliance to completion of sodium valproate annual risk acknowledgement form among women of child-bearing age prescribed sodium valproate in the intellectual disability (ID) services of an NHS trust

AimsTo determine the proportion of women of child-bearing age prescribed SV who have the SV ARF filled.BackgroundIn 2018, the Medicines and Healthcare products Regulatory Agency (MHRA) gave guidance regarding Sodium Valproate (SV) prescription. It acknowledged the significant risk of birth defects and developmental disorders in women of child-bearing age prescribed SV.Consequently, the MHRA recommendation is that SV must not be used in females of child-bearing age unless: conditions of pregnancy prevention programme are met; other treatments are ineffective or not tolerated; and evidence of discussion of risks with patient or carer and annual review of the risks are documented. The evidences of the above criteria are expected to be documented in an Annual Risk Acknowledgement Form (ARF).MethodRetrospective study involving systematic search of Trust database to identify women with ID, aged 16–50 years prescribed SV from 2018 to 2019.Result18 of 28 patients had ARF filled, a 64% compliance.The main indications for SV prescription were epilepsy; challenging behaviour; and mood stabilization.The distribution showed neurology and psychiatrist led prescription initiation equally distributed at 50%.The ARF compliance was higher in the neurology group (93%) compared to 36% in psychiatrist group.A review across the 5 ID teams (A,B,C,D and E) of the trust shows variable compliance to ARF compliance (17%,81%,100%,60%,0% respectively) with teams having higher proportion of neurology led SV prescription initiation also having higher proportion of ARF completion compliance (0%,55%,80%,80%,0% respectively).ConclusionConclusion / RecommendationARF compliance is below standard at 64%.Despite the SV prescription being equally distributed between neurology led and psychiatry led, patients whose prescription of SV is neurology led (prescription indication as epilepsy) had better ARF compliance outcome (93%) compared with patients whose prescription is psychiatry led (prescription indication as challenging behaviour or mood stabilization) with 36% ARF compliance.Organizational difference with dedicated epilepsy nurse in the ID service means patients with epilepsy had reviews of medication and compliance to MHRA guidance in completing the ARF.There is need to increase doctors’ awareness to review ARF status during patients’ appointment. Information Technology design to flag up out of date ARF may be helpful.The review of ARF may also flag up consideration of other alternatives: behavioural, psychological, functional and environmental interventions as well as alternative medications like Risperidone for challenging behaviours and other mood stabilizing options. This will minimize SV prescription, which is the original goal of the MHRA guidance.

Incidence of idiopathic intracranial hypertension in Southern Tasmania, Australia

IntroductionAnecdotally, the incidence of idiopathic intracranial hypertension (IIH) is increasing, linked to an increase in the obesity rate in Australian society. However, formal incidence and prevalence studies are rare. We...

A quality improvement (QI) project to ensure females on valproate in a CMHT outpatient clinic, eput are registered on the valproate pregnancy prevention programme

AimsRecent MHRA guidelines, state that Valproate medicines must no longer be used in women or girls of childbearing potential due to its highly teratogenic effects unless a Pregnancy Prevention Programme is in place. We carried out a service evaluation to determine if there was any way of identifying such patients with the aim of setting one up if required.BackgroundValproate is highly teratogenic and evidence supports that use in pregnancy leads to physical birth defects in 10 in every 100 babies (compared with a background rate of 2 to 3 in 100) and neurodevelopmental disorders in approximately 30 to 40 in every 100 children born to mothers taking Valproate. Data from a previous inpatient audit identified 35 females of childbearing age and none was on a pregnancy prevention plan. Audits done thereafter confirmed there was no system available for identifying such patients. Availability and accessibility to a synchronised IT system, which alerts when the yearly review is due is consistently identified as a contributory factor.MethodA request via the Medicines management team was sent to the GP surgeries within the catchment area to assist in identifying female patients on their records on Valproate registered on the Pregnancy Prevention Programme.The Plan-Do-Study-Act (PDSA) Quality Improvement (QI) model was used to bring about change. The target set to achieve was a 50% reduction in the prescriptions of Valproate in such patient groups.ResultWe had 10 out of the 50 GP surgeries contacted responded with a list of female patients on Valproate, a total of 25 patients’ altogether. In total, 4 patients out of the 25 were registered on the Pregnancy Prevention Programme and the overall non-compliance rate was 86%. . Factors believed to contribute to the low numbers include a lack of a system for registering women of childbearing age on the pregnancy protection plan and the recent introduction of GDPR regulation.ConclusionThere are ongoing discussions with various stakeholders like the Medicines management team, Pharmacists, electronic records team (IT) and other clinicians regarding inserting an alert in the electronic system that reminds clinicians to register all such women on the Pregnancy Prevention Programme, while automatically creating a yearly reminder for completion of the annual risk acknowledgement form.

Subhepatic Appendicitis: A diagnostic conundrum

One of the most common presentations of acute abdominal pain in the emergency setting is appendicitis. Although it can occur in both genders, when it comes to females with appendicitis, reaching a definite diagnosis can be challenging as it can mimic other diseases such as ovarian cysts/torsions, pelvic inflammatory diseases, endometriosis, and urinary tract infection or physiological reasons like menstrual pain which are exclusive to females and can occur as frequently as appendicitis. Therefore, it is crucial to make an accurate diagnosis as early as possible with the right diagnostic tools to reduce morbidity and mortality in females of child-bearing age. This is a summarized case report of an adolescent female who experienced two atypical attacks of appendicitis 1 year apart. Since the patient had mainly right upper flank pain associated with nausea, vomiting, and fever with a largely non-tender abdomen, various diagnoses such as chronic cholecystitis, biliary colic, peptic ulcer, gastroenteritis, mesenteric lymphadenitis, renal colic, mittelschmerz, and torsion of ovarian cyst were considered and treated for. The patient had no relief and underwent numerous investigative procedures in the 2 years she suffered from her illness. The final diagnosis was only obtained when exploratory laparoscopy was performed. This article aims to remind clinicians to have a high index of suspicion for acute appendicitis in all atypical presentations of acute appendicitis. The latest WSES Jerusalem guidelines for the workup for patients at risk of acute appendicitis should be meticulously followed.

Anti-D alloimmunization after platelet transfusion

Human platelets do not express any antigens of the Rhesus system. However, platelet concentrates contain the variable volume of contaminating RBCs, which may induce RhD alloimmunization when transfused in a RhD negative subject. Though low rate of anti-D alloimmunization related to platelet transfusion, the development of RhD and non-RhD antibodies cannot be ignored. Thus, transfusion practices could allow the transfusion of RhD positive platelet units to RhD negative patients, with the exception of females of childbearing age. Keywords: Platelet, Transfusion, Alloimmunization, Donor, Antibody, Antigen.

A Million Reasons for Hyperthyroidism. Reporting a Case of Thyrotoxicosis in a Setting of Metastatic Choriocarcinoma

Background: Human chorionic gonadotropin (hCG) induced transient hyperthyroidism is often seen during pregnancy. Other rare causes of beta hCG induced hyperthyroidism include trophoblastic tumors (hydatidiform mole and choriocarcinoma) and in men, germ cell tumors. The mechanism for hCG induced thyrotoxicosis lies in the structural similarity between TSH and hCG molecules leading to the direct stimulation of the TSH receptors. In regard to treatment, while gestational thyrotoxicosis is usually mild, self-limited and does not need medications, the hyperthyroidism of trophoblastic tumors may require antithyroid medications in addition to treating the underlying tumor. Thionamide use is reserved for moderate to severe cases of hyperthyroidism and for presurgical optimization. In our case report, we present a 22-year-old African American female with choriocarcinoma induced thyrotoxicosis requiring thionamide therapy. Clinical Case: A 22-year-old African American female presented to our emergency room after a witnessed generalized tonic-clonic seizure. Her brain CT scan showed a 4 CM mass concerning for AVM malformation with a subsequent brain MRI confirming parenchymal hematoma with surrounding vasogenic edema. Past medical history was significant for molar pregnancy managed with dilation and curettage followed by laparotomy to remove the pelvic mass. Given her history of molar pregnancy, pelvic ultrasound was performed which showed complex heterologous structure of uterine origin concerning for malignancy. Additional imaging studies of the lung, brain, abdomen and pelvis were performed, which showed possible metastasis to the lung, adnexa, and to the brain. Her clinical exam showed heart rate of 130 beats/min with a normal rhythm, fine tremors, aphasia, and a decrease grip strength in her right upper extremity. Her thyroid gland was slightly enlarged with no tenderness. Laboratory tests showed hCG of >1,000,000 mIU/mL, TSH of < 0.01mcU/mL, free T4 of 5.1ng/dL. Her TPO and TSI were negative. With a diagnosis of hyperthyroidism due to trophoblastic disease, she was treated with methimazole and propranolol resulting in rapid clinical and biochemical improvement. Later, left frontal craniotomy and hematoma evacuation was performed with histology confirming the diagnosis of metastatic choriocarcinoma. She was later transferred to a specialized center where she received chemotherapy. Her hCG subsequently dropped down to 699 mIU/mL. Conclusion: We report a rare case of metastatic choriocarcinoma causing symptomatic hyperthyroidism. The diagnosis is made by excluding other common causes of hyperthyroidism and it should be considered in females of childbearing age. Methimazole is an effective agent to control the hyperthyroidism while waiting for treatment of the underlying cancer.

Antihypertensive prescribing patterns and hypertension control in females of childbearing age.

The use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to treat hypertension (HTN) during pregnancy presents well-established risks to a developing fetus. A cross-sectional study was conducted to evaluate the current state of antihypertensive prescribing and contraceptive use in females of childbearing age within a large safety-net health system. The retrospective cross-sectional study focused on females aged 18-49 years with a documented diagnosis of HTN. The proportion of patients prescribed an ACE inhibitor or ARB and using a documented form of contraception was calculated. Documented forms of contraception included oral contraceptives, intrauterine devices, injections, implants, and surgical intervention. A total of 4,187 patients were identified from the HTN registry; after application of exclusion criteria 3,045 patients were included in the study population. The mean age was 39 years (range, 18-49 years). The most frequently prescribed classes of antihypertensive medications were ACE inhibitors and ARBs (one or the other was used by 1,146 patients [37.6%]), followed by thiazide diuretics (n = 710, 23.3%) and calcium channel blockers (n = 599, 19.7%). Of the 1,146 patients prescribed an ACE inhibitor or ARB, 553 (48%) were using a documented form of contraception. Rates of ACE inhibitor or ARB prescribing to females of childbearing age were high despite the teratogenic risks, and fewer than half of patients had documented protection from pregnancy. Provider and patient education and potential creation of best practice alerts in the electronic medical record regarding the risks of using ACE inhibitors and ARBs in females of childbearing age are warranted.

Seroprevalence of rubella virus among pregnant women: A 4-year registered-based study from family medicine and obstetric clinics in Saudi Arabia.

This study aimed to determine rubella virus infectivity and immune status in pregnant females who visited the family medicine and obstetrics clinics at a large hospital in Saudi Arabia, and to identify the possible predictors of rubella susceptibility. This registered-based, cross-sectional study included pregnant, aged between 18 and 50years old, who presented for the first antenatal visit between 2017 and 2020. Data on sociodemographic, antenatal characteristics and serological results were collected. Chi-Squared or Fisher's Exact test and t tests were used for bivariate analysis followed by the multivariable logistic regression model. A total of 4328 pregnant were included in the study. Seroprevalence of rubella immunity was 76.41%. Positive rubella IgM antibody was identified in 1.21% of those who performed the test (17/1409). Odds of susceptibility were decreased with an increase in age (OR = 0.96, 95% CI = 0.95-0.97) and in non-Saudis' (OR = 0.44, 95% CI = 0.36-0.54). Approximately 24% of pregnant were susceptible to rubella virus infections in this study. Screening females of child-bearing age and reimmunisation of susceptible cases before pregnancy are suggested. Further studies to investigate the impact of applying this policy in premarital screening are recommended.

Evaluation of the severity and self-management practice in primary dysmenorrhea in medical and dental students: A cross-sectional study in a teaching hospital

Background: Primary dysmenorrhea is the commonest gynecological problem in females of childbearing age. The severity of dysmenorrhea catalyzed females to use home remedies or self-medication to relieve pain.&#x0D; Aims and Objectives: The study aimed to find out the severity of primary dysmenorrhea and self-management practices in medical and dental students.&#x0D; Materials and Methods: Female students who had painful menstrual cycles were included. A self-responding semi-structured questionnaire was used to collect information related to demographic, menstrual characteristics and self-management practices. The severity of primary dysmenorrhea was estimated by using the Verbal Multidimensional Scoring System (VMSS). Descriptive statistics were used to present the study findings using SPSS version 11.5.&#x0D; Results: Out of 143 students, mild severity of primary dysmenorrhea was more common 85 (59.4%), followed by moderate 44 (30.8%) and severe 14 (9.8%) dysmenorrhea. Over two-thirds 124 (86.7%) of respondents used home remedies alone or in combination with analgesic drugs 87 (60.8%). Mefenamic acid 44 (50.6%) was the most common self-medicated drug. Among the respondents who practiced self-medication, the majority had used drugs once a day 68 (78.2%), and more than half of them 57 (65.5%) took medication for one day, and 59 (67.8%) had insufficient knowledge about drug dose.&#x0D; Conclusion: Most of the respondents experienced the mild severity of primary dysmenorrhea. Home remedies were the most commonly used methods of self-management. The majority of the respondents did not receive medical consultation, but they were preferred self-medication. Encouragement for medical consultation along with the implementation of educational awareness programs to control morbidity associated with primary dysmenorrhea is recommended.

Variations in the Profiles of Vascular-Related Factors Among Different Sub-Types of Polycystic Ovarian Syndrome in Northern China.

Recently, a growing body of evidence has suggested that abnormal ovarian angiogenesis, secondary to the imbalance between various angiogenic markers, is involved in the pathogenesis of PCOS, and this has led to the use of various interventions (such as Diane-35) to restore the normal ovarian angiogenesis. Therefore, we conducted the current investigation to determine the role of such markers (endothelial growth factor (VEGF), endostatin (ES), and thrombospondin-1 (TSP-1)) in the pathogenesis of PCOS along with the associated changes in ovarian blood flow in patients with PCOS compared to healthy controls, both before and after a course of oral contraception. A total of 381 patients with PCOS and 98 healthy females of childbearing age were recruited from July 2014 to June 2017 at the Reproductive Center of the Second Affiliated Hospital of Harbin Medical University. The serum levels of VEGF, ES, and TSP-1 were determined by enzyme-linked immunosorbent assay, while ovarian perfusion was measured by the pulsatility index (PI) and resistance index (RI) by using transvaginal color Doppler ultrasound. Repeated analyses were carried out after 3 months of Diane-35 treatment. Post-treatment serum levels of luteinizing hormone (LH)/follicle stimulating hormone (FSH) ratio of patients with PCOS decreased significantly (P <0.05). The RI values of most PCOS patients increased after treatment (P<0.05), while PI was significantly increased in all patients (P<0.05). However, variable changes in the serum levels of TSP-1, VEGF, and ES after treatment were observed. Serum VEGF levels showed a negative correlation with serum LH/FSH ratio, T concentration, and ES (P <0.05), while ES levels were negatively correlated with serum T concentrations only (P<0.05). The markers of angiogenesis (VEGF, ES, and TSP-1) were expressed differently among PCOS patients, who also responded differently to the same course of Diane-35 treatment. This field still warrants further investigation to reach a more definitive conclusion.

Clinical disease activity and flare in SLE: Current concepts and novel biomarkers.

Systemic lupus erythematosus (SLE) is a complex and heterogeneous systemic autoimmune disease associated with innate and adaptive immune dysregulation. SLE occurs primarily in females of childbearing age, with increased prevalence and severity in minority populations. Despite improvements in treatment modalities, SLE patients frequently experience periods of heightened disease activity and flare that can lead to permanent organ damage, increased morbidity, and early mortality. Such outcomes impair quality of life and inflict a significant socioeconomic burden. Predicting changes in SLE disease activity could allow for closer monitoring and preemptive treatment, but existing clinical, demographic and serologic markers have been only modestly predictive. Novel, proactive approaches to clinical disease management are thus critically needed. Panels of blood biomarkers can detect a breadth of immune pathway dysregulation that captures SLE heterogeneity and disease activity. Alterations in the balance of pro-inflammatory and regulatory soluble mediators have been associated with changes in clinical disease activity and are detectable several weeks prior to clinical flare occurrence. A soluble mediator score has been highly predictive of impending flare in both European American and African American SLE patients, and this score does not require a priori knowledge of specific pathway activation in the patient. We review current concepts of disease activity and flare in SLE, focusing on the potential of novel blood biomarkers to characterize and predict changes in disease activity. Measuring the disordered immune response in SLE in this way promises to improve disease management and prevent organ damage in SLE.

Vitamin D status and determinants of deficiency among Palestinian females of childbearing age: A case control study

<h2>Summary</h2><h3>Objective</h3> Vitamin D deficiency is a global public health problem and affecting more people in Middle Eastern countries. We set up the present work to investigate vitamin D status and its deficiency determinants among Palestinian females of childbearing age. <h3>Materials and methods</h3> In this study follow up interventional study we recruited 50 vitamin D deficient adult females (17–40 years) and were assigned to receive, under physician supervision, a daily oral dosages of vitamin D₃ (4000 IU) plus 600 mg of calcium for 3 successive months. Also, we included equal number of apparently healthy individuals as a control for baseline comparisons. Relevant hematological and biochemical parameters were measured, statistically analyzed and compared with control as well as with baseline values. <h3>Results</h3> Baseline comparison reveals significant lower hemoglobin level, red blood cell count and significantly higher white blood cell and platelets counts among vitamin D deficient females (<i>P</i>-value <0.001). Serum vitamin D, total calcium and phosphate showed significant lower values, while parathyroid hormone exhibited significantly higher values among cases compared to controls. Marked elevation in serum ferritin level while, iron and TIBC levels showed significant decreased among cases compared to control (P ≤ 0.001). The daily oral administration of vitamin D3 and calcium for 3 months corrected the deficient status of vitamin D. Some statistically significant correlations were reported and discussed between different parameters. <h3>Conclusions</h3> Vitamin D deficiency is prevailing health threating condition among Palestinian females of childbearing age, justifying the necessity for national vitamin D supplementation strategy to ameliorate such prevalent health condition. The current intervention has successfully restorer the deficient status and replenish the body of subjects with sufficient vitamin D.

Sex differences in the diagnosis of postural tachycardia syndrome: insights from a cross-sectional community based survey

Postural tachycardia syndrome (POTS) is a common form of orthostatic intolerance that primarily affects females of child-bearing age. We compared the diagnostic journey between female and male POTS patients.

Assessment of lower urinary tract symptoms during pregnancy: an observational cross-sectional study from Palestine

BackgroundWomen frequently complain of lower urinary tract symptoms (LUTS) during pregnancy due to multiple physiological and potentially pathological changes. Still, there is limited data on the characteristics of LUTS for pregnant women in Palestine. Therefore, this study was designed to assess LUTS among pregnant women in Palestine, in addition to identifying factors that exacerbate LUTS during pregnancy.MethodsWe devised a cross-sectional, questionnaire-based study that used the Urinary Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ) tools to assess LUTS during pregnancy in an antenatal care clinic setting. Multiple linear regressions were conducted to determine variables that significantly related to LUTS (UDI-6 and IIQ-7 scores as dependent variables).ResultsThe study recruited 306 pregnant women. Regarding LUTS findings, the participants scored a mean of 31.9 ± 24.9 out of 100 points (6.7 ± 5.2 out of 21) for the IIQ-7 scale and a mean of 31.2 ± 19.2 out of 100 points (5.6 ± 3.4 out of 18) for the UDI-6 scale. Regression analysis showed that older women (p = 0.031), women with a higher body mass index (p < 0.001), and women in the third trimester of pregnancy (p = 0.023), were independently associated with high UDI score. Multiple linear regression analysis showed that obese and overweight patients (p = 0.006) and multiparity (p = 0.026) were independently associated with high IIQ score.ConclusionsHigh body mass index is independently associated with both UDI and IIQ scores for LUTS. Several strategies should be arranged to raise the awareness of females of childbearing age in Palestine regarding LUTS during pregnancy and factors which may exacerbate LUTS, such as obesity and multiparity. Thus, preventive measures should be implemented, such as serial assessment of LUTS during antenatal care to respond timely to this frequent problem.

Correlation between Serum Dehydroepiandrosterone Sulfate and LDL Cholesterol in Patients with Polycystic Ovarian Syndrome

Polycystic Ovary Syndrome (PCOS) is the most prevalent endocrine disorder in female of childbearing age. PCOS patients also have metabolic and cardiovascular disorder risks. One of the factors that can affect those disorders is androgen hormone level. Dehydroepiandrosterone, is produced by the adrenal gland, and its metabolite dehydroepiandrosterone sulphate (DHEAS) has a different effect than testosterone. DHEA and DHEAS might have a protective effect to dyslipidemia and cardiovascular disorder. LDL cholesterol is an important parameter for dyslipidemia therapy guide according to The National Cholesterol Education Program Adult Treatment Panel. The aim of this study was to analyze the correlation between DHEAS and LDL cholesterol.This research was a cross sectional observational study. DHEAS and LDL cholesterol were examined in 25 research subjects by chemiluminescent immunoassay (Immulite®, Siemens) and colorimetric enzymatic (Dimension EXL®, Siemens). These subjects were divided into 3 groups according to 2003 Rotterdam's criteria. Spearman and Pearson's correlation statistical analysis were done, with a significance of p-value less than 0.05This study showed a moderate negative correlation between DHEAS and LDL cholesterol (r= -0.441, p = 0.027). Group D PCOS (non-hyperandrogenic) had a strong negative correlation between DHEAS and LDL cholesterol (r=-0.717, p= 0.001). DHEA, in some literatures was shown to activate Peroxisome Proliferator Activated Response γ (PPAR γ) receptors and thereby increasing LDL-cholesterol receptors in adipose tissue and LDL-cholesterol uptake from serum. The rise in DHEAS might indicate a better prognosis for PCOS patients in terms of cardiovascular complications, especially in group D PCOS.