Healthy Woman Research Articles

Exposures to Dental Products, Stomatological Preparations, and in Dental Care and Toothache reported to the PIC Erfurt (1997 to 2017)

We examined human exposures to dental products (EDP), stomatological preparations (ESP), and in the context of dental care (EDC) or toothache (ETA) registered by the Poisons Information Centre (PIC) Erfurt from 1997 to 2017. Dental products like dental technical and filling materials belong to medical devices. Stomatological preparations were classified according to the ATC code and symptom severity to the Poisoning Severity Score (PSS). In total, 156 cases of EDP (136 cases with different tooth filling materials), 1167 cases of ESP (55.6% fluoride containing products), 979 cases of EDC, and 331 cases of ETA were registered. Symptom severity in EDP and ESP were asymptomatic or mild. In ETA and EDC, however, 35 cases with moderate and 5 cases with severe symptoms were detected. 5 moderate and 3 severe cases were caused by prolonged paracetamol overdose. Severe bleeding occurred following tooth extraction in a 41 year-old phenprocoumon treated patient after self-medication with acetylsalicylic acid and metamizole. Gingival injection of lidocaine plus epinephrine in a 37 year-old healthy woman resulted in severe bradycardia and cardiac arrest. Acute toxicity of EDP and ESP appears to be low. Prolonged paracetamol overdose because of toothache, and some dental treatment can result in severe symptoms.

Skin bacterial structure of young females in China: The relationship between skin bacterial structure and facial skin types.

Skin microbiota are involved in the skin physiological functions and are also affected by the skin physiological characteristics. To better understand the skin microbial characteristics of facial cheek skin and the relationship with skin physiological characteristics. By bacterial 16S rRNA gene sequencing, the authors studied the facial cheek skin microbial characteristics of 85 cases of young women aged 18-25years. Healthy young woman's cheek skin bacterial composition was relatively stable. Dry skin has high bacterial diversity and richness, and oily skin has low bacterial diversity and richness. Cutibacterium was significantly enriched in oily skin and was significantly negatively correlated with other genera such as Streptococcus (r>0.5). There were significant positive correlations among other genera of enrichment in dry and neutral skin such as Streptococcus and Rothia (r>0.8). Skin sebum level was significantly negatively correlated with bacterial alpha diversity index. The combined abundance of Cutibacterium acnes and Staphylococcus epidermidis was significantly positively correlated with sebum secretion (r>0.5). The skin sebum secretion and bacterial interaction were the important factors driving the young females' cheek skin bacterial community structure.

SUN-521 Hyperemesis Gravidarum Resulting in Wernicke’s Encephalopathy and Abnormal Thyroid Function Tests

Background: Wernicke’s encephalopathy (WE) is a potentially fatal consequence of thiamine deficiency that must be considered in patients with poor nutrition and altered mentation. We report a case of a female with hyperemesis gravidarum (HG), nystagmus, clonus, and abnormal thyroid function tests associated with WE. Clinical Case: A 23 year-old healthy G2P0010 woman was admitted for rehydration at 15 weeks gestation after four weeks of intractable vomiting. She denied medications, supplements and alcohol use. Vitals were normal. Exam showed a fatigued ill appearing female with no thyromegaly, tremor, lid lag, or stare. She had a gravid uterus but otherwise normal exam. Fetal heart rate was normal. Laboratory findings included hyponatremia, hypokalemia, elevated creatinine and transaminases, and normocytic anemia. Hepatitis panel, vitamin B12, ammonia, urinalysis and ultrasound of the appendix and gallbladder were unremarkable. She was treated with intravenous fluids and potassium. Electrolyte abnormalities and renal dysfunction resolved. On hospital day three, she became lethargic, tachycardic, unable to follow commands, and exhibited nystagmus and clonus. Thyroid studies showed TSH 0.06 uIU/mL (0.34 - 5.66 µIU/mL), and free T4 3.59 ng/dL (0.52 - 1.21 ng/dL). Methimazole and propranolol were started while awaiting repeat thyroid studies. MRI brain was not obtained due to aspiration risk. EEG showed diffuse slowing but no epileptiform activity. She returned to baseline mentation within hours of intravenous thiamine, with resolution of dysphagia and nystagmus. Thiamine level returned low (51 nmol/l; normal 67–200 nmol/L). Methimazole and propranolol were stopped and thyroid function tests normalized. She was discharged and delivered a healthy baby at term. Conclusion: WE is an acute neuropsychiatric condition caused by thiamine deficiency. Early recognition and treatment are critical to prevent irreversible damage; the classic signs are ataxia, ophthalmoplegia, and encephalopathy. Historically considered in patients with a history of alcohol use, WE is increasingly recognized in other conditions associated with dietary deficiency, since body stores of thiamine last only 18 days. WE has been reported in HG due to prolonged vomiting and increased thiamine requirements in pregnancy. WE has been associated with thyrotoxicosis, possibly due to increased metabolic demands. Both gestational transient thyrotoxicosis and HG are associated with markedly elevated HCG and present in the first 16 weeks of pregnancy. Initial thyroid studies were concerning for thyrotoxicosis, but normal repeat studies argue against that as a contributor. WE is a life threatening complication of poor oral intake, which should be empirically treated with thiamine prior to glucose. WE may be associated with thyrotoxicosis.

MON-337 Peripheral Neurological Complications in Pregnancy- Is Idiopathic Transient Osteoporosis of Pregnancy Concerning?

Idiopathic transient osteoporosis of pregnancy (ITOP) is a rare and under-reported condition that has affected healthy pregnancies. ITOP usually presents in the final trimester of a normal pregnancy. Radiographic studies detect drastic loss of bone mass, elevated rates of turnover in the bone, and edema in the affected portion.We present a 26-year-old previously healthy woman, who was admitted at 39 weeks of gestation with severe left hip pain and inability to walk for one month.The pain was constant, progressive, involving left lower limb, and associated with numbness and weakness. Neurological exam revealed diminished power in the left hip (motor power was 2/5), and inability to stand and walk due to pain in the left hip. She was unable to stand by herself. Investigations revealed anemia, low vitamin B12, low vitamin D and magnesium. Bilateral hip MRI showed increased T2WI signal in the left femoral head consistent with idiopathic transient osteoporosis of the left hip (ITOP). DXA scan showed bone mass density (BMD) below expected for age.The patient had induced vaginal labor without complication. The left hip pain improved after delivery. She was treated conservatively with Calcium, Magnesium and vitamin D. The patient symptoms completely resolved in 3 months post-delivery. DXA scan and Hip MRI at 1 year interval showed normal BMD and complete resolution of previous bone marrow edema and changes seen in MRI hip.This case report serves to highlight the effect of pregnancy on bone mass during third trimester which may result in transient osteoporosis of pregnancy leading to weakness and gait disturbance. Clinical symptoms can be misdiagnosed as a peripheral neurological complications instead of bone metabolism changes of pregnancy.

A melting, encapsulated, calcified pulmonary nodule in a healthy 51-year-old woman: a case report

BackgroundForeign body aspiration is less common in healthy adults, which makes diagnosis difficult. Early detection of smaller/sharp foreign bodies in the distal airway is more difficult because patients might have no symptoms and imaging studies could appear normal.Here we describe the course of a small, sharp foreign body (chicken bone) lodged in the distal airway of a healthy middle-aged woman. The chicken bone was initially thought to be an old calcified tuberculoma. However, it was encased in a dilated bronchus without obvious surrounding lymphadenitis or parenchymal infiltration, and it melted with time. Two years later, histopathological examination revealed that the calcified lesion was an aspirated chicken bone with a concomitant tuberculoma.Case presentationA 51-year-old woman showed an old calcified tuberculoma in the upper right lung lobe during routine examinations. It was “encased” in a dilated bronchus, although it was not raised from the surrounding lung parenchyma. The size of the calcified part decreased (“melted”) with time, and the surrounding inflammation progressed 2 years later, a phenomenon never described in association with tuberculosis. Bronchoscopy revealed a fragment of chicken bone lodged in the next two branches of the upper right posterior bronchus. Surgical segmentectomy was performed, and histopathological examination revealed that the calcified lesion was formed by a fragment of chicken bone as well as a tuberculoma. Eventually, the patient recalled an episode of choking on a chicken bone 5 years ago; she believed that she had coughed it out completely at that time.ConclusionsThe “melting” and “encased” phenomena observed in the present case could be useful imaging findings for early detection of small foreign body aspiration in the distal airway.

Antenatal and postpartum comparison of HD-OCT findings of macula, retinal nerve fiber layer, ganglion cell density between severe preeclampsia patients and healthy pregnant woman

ABSTRACT Aim To investigate the effects of severe preeclampsia on the retinal nerve fiber layer (RNFL), macula thickness and ganglion cell density in pregnancy and postpartum, using High Definition Optical Coherence Tomography (HD-OCT). Material and Method The study group included 28 stable pregnant patients diagnosed with severe preeclampsia and the control group, 28 age and gestational week-matched healthy pregnant women. HD-OCT measurements were taken by the same researcher using a Cirrus HD-OCT device and were repeated at 8 weeks postpartum. Results The mean systolic pressure, diastolic pressure, and intraocular perfusion pressure (IPP) values measured in pregnacy were determined to be higher in the preeclampsia group than in the control group (158.4 ± 7.3 vs.113.6 ± 6.8, 97.0 ± 5.7vs.73.8 ± 5.9 and 68.1 ± 3.9 vs.48.8 ± 3.3 mm Hg, respectively) (p < 0.05 for all). The mean RNFL, macula thickness, ganglion cell analysis, and intraocular pressure (IOP) values during pregnancy were determined to be similar in both groups (p > 0.05 for all). No significant difference was determined postpartum between the groups in respect of mean systolic pressure, diastolic pressure, RNFL, macula thickness, ganglion cell analysis, and IOP values (114.3 ± 5.0 vs 114.6 ± 5.9 mm Hg, 74.6 ± 5.1 vs.74.5 ± 5.5 mm Hg, 96.0 ± 7.3 vs. 95.9 ± 6.7 µm, 228.2 ± 18.9 vs.234.5 ± 15.4 µm, 81.8 ± 8.0 vs. 84.2 ± 4.6 µm, 14.1 ± 2.4 vs.13.8 ± 2, respectively) (p < 0.05 for all). Mean IPP during pregnancy was higher than the mean postpartum IPP in the severe pre-eclampsia group (68.1 ± 3.9 vs 49.1 ± 3.1 mm Hg) (p < 0.001). Conclusion This is the first study to have evaluated ganglion cell density of the retina, macula thickness, and RNFL using HD-OCT in severe pre-eclampsia cases, both during pregnancy and postpartum.

Rare anaplastic sarcoma of the kidney: A case report

BACKGROUNDAnaplastic sarcoma of the kidney (ASK) is a rare and newly recognized renal neoplasm. The tumor usually is extensive and cystic, characterized by pleomorphic spindle cells with marked atypia and associated with multinucleated cells. To date, only 27 cases have been reported in the literature. The authors present an additional case and summarize the relevant knowledge in the literature.CASE SUMMARYA 27-year-old previously healthy woman presented with a palpable mass over the abdomen and right flank soreness for one year. After the computed tomography study, the patient underwent right radical nephrectomy obtaining a 1680-g tumor with a size of 18.4 cm × 14.5 cm × 11 cm. The tumor is chiefly composed of anaplastic spindle cells with marked nuclear atypia admixed with multinucleated cells. Immunohistochemical evaluation of tumor cells exhibited diffuse positivity for CD56, p53, and vimentin, and focally positive for desmin. The diagnosis of ASK was established. Unfortunately, a local tumor recurrence followed by a distant metastasis developed within months. The patient died 26 months after the initial surgery. Comparing to the previously 27 cases of ASK, the current case had a relatively worse prognosis, which might be potentially associated with older patient age, larger tumor size, and the lack of en-bloc resection of adjacent organs during the initial radical nephrectomy.CONCLUSIONThis case points out the featured pathological findings for diagnosing ASK and suggests more aggressive management for patients with ASK.

Isolated abducens nerve palsy secondary to lung metastases

We present a rare case of metastatic lung adenocarcinoma which presented as isolated abducens nerve palsy. A 65-year-old healthy woman presented with horizontal diplopia of three months duration. Her best-corrected visual acuity was 6/18 bilaterally with no relative afferent pupillary defect. Ocular examination showed limited abduction of the right eye. Anterior and posterior segment examination was normal in both eyes. However, she had a non-tender enlarged lymph node at the left supraclavicular area. The systemic review was unremarkable.C-reactive protein, erythrocyte sedimentation rate, and serum alpha-fetoprotein were markedly raised. A chest X-ray revealed right upper lobe opacity with a satellite nodule. Computed tomography of the brain, orbit, thorax, abdomen, and pelvis exhibited a heterogeneously enhancing mass at the right upper lobe of the lungwith metastasis to the left frontal, right occipital, and left parietal lobe as well as multiple bone metastases. With histopathology confirmation of lung tissue biopsy, she was diagnosed as isolated right abducens nerve palsy secondary to metastatic lung adenocarcinoma. She was referred to the respiratory, neuromedical, andoncology units for further management. In conclusion, although this appeared to be an isolated case, lung metastasis should be considered in the differential diagnosis of isolated abducens nerve palsy. Hence, lung examination should be performed when encountering such cases.

Rare homozygous mutation in TUBB8 associated with oocyte maturation defect-2 in a consanguineous mating family

PurposeVariations in many genes may lead to the occurrence of oocyte maturation defects. To investigate the genetic basis of oocyte maturation defects, we performed clinical and genetic analysis of a pedigree.MethodsThe proband with oocyte maturation defect-2 receiving ovulation induction therapy and her parents were selected for clinical detection, whole exome sequencing and Sanger sequencing. One unrelated healthy woman received ovulation induction therapy as control. Mutations were assessed after frequency screening of public exome databases. Then homozygous variants shared by the proband and her parents were selected.ResultsArrest of oocytes maturation was observed. A new missense mutation in TUBB8 (TUBB8: NM_177,987: exon 2: c. C161T: p. A54V) was identified, which was shown to be rare compared with public databases. The variant was highly conserved among primates, and was suggested to be deleterious by online software prediction.ConclusionsThe homozygote of this variant (TUBB8: NM_ 177,987: exon 2:c.C161T: p.A54V) might affect spindle assembly, cause arrest of oocyte maturation and lead to oocyte maturation defect-2.

Melioidosis after a long silence in Sri Lanka: an environmental hazard and dilemma in diagnosis, with recovery and longitudinal follow-up for 13\u2009years: a case report

BackgroundMelioidosis is a potentially fatal bacterial infection caused by Burkholderia pseudomallei. The existence of melioidosis in Sri Lanka was once unheard of, and entertaining it as a diagnosis in clinical practice was extremely rare.Case presentationIn this case report, we describe the clinical, epidemiological, and longitudinal follow-up data of a 58-year-old previously healthy Sinhalese woman who presented to our hospital with protracted febrile illness of 5 weeks’ duration, later developing multiple abscesses at different sites of the body. There was a significant delay in confirming the diagnosis of melioidosis by isolating B. pseudomallei from blood and pus cultures. The patient recovered fully with a prolonged course of antibiotics and has remained in good health over the last 13 years without recurrence. Despite being immunocompetent, she had contracted the infection by a brief contact with mud soil in a footpath.ConclusionsA high index of clinical suspicion along with laboratory support is needed to confirm the diagnosis of melioidosis. Treatment with sensitive antibiotics over a long duration is needed, and longitudinal follow-up is essential to detect recurrences. This case raised awareness and created renewed interest in studies of melioidosis in Sri Lanka.

Optical Coherence Tomography-Angiography of a large retinal microaneurysm

A 63-year-old healthy woman was referred for a retinal examination. Dilated fundus examination of the left eye revealed small retinal hemorrhage with surrounding exudation, most consistent with a large retinal microaneurysm, which was confirmed by fluorescein angiography and optical coherence tomography angiography (OCT-A). OCT-A has the potential to clearly delineate the anatomy of retinal aneurysms and could be used for diagnosis and surveillance, possibly replacing the current gold-standard fluorescein angiography.

A Role of Rasaushadhis in the management of streeroga &amp; sutikaroga: A review

A Healthy woman is the main pillar of the healthy family &amp; society. In the todays era of 21st century due to change in life style of woman, overburden of job increasing mental stress &amp; recurrent urinary tract infections causes physical &amp; psychological disturbances by which woman can develops menstrual abnormalities during reproductive age. This may further result into serious gynaecological disorders like garbhini &amp; sutikaroga.&#x0D; In Ayurveda, rasaushadhis (Herbo mineral preparations) are known for the quick result in very smaller dosages. The main advantages of rasaushadhis is its potency, effectiveness, longevity &amp; also having most influential effect on various chronic disease. This review aims to collect in formation on some resaushadhis used in the management of streeroga like kashtartava, (Dysmenorrhoea) prodaroga (Leucorrhoea &amp; menorrhagia) as well as Garbhini roga &amp; sutikaroga.

Characterising a healthy adult with a rare HAO1 knockout to support a therapeutic strategy for primary hyperoxaluria.

By sequencing autozygous human populations, we identified a healthy adult woman with lifelong complete knockout of HAO1 (expected ~1 in 30 million outbred people). HAO1 (glycolate oxidase) silencing is the mechanism of lumasiran, an investigational RNA interference therapeutic for primary hyperoxaluria type 1. Her plasma glycolate levels were 12 times, and urinary glycolate 6 times, the upper limit of normal observed in healthy reference individuals (n = 67). Plasma metabolomics and lipidomics (1871 biochemicals) revealed 18 markedly elevated biochemicals (>5 sd outliers versus n = 25 controls) suggesting additional HAO1 effects. Comparison with lumasiran preclinical and clinical trial data suggested she has <2% residual glycolate oxidase activity. Cell line p.Leu333SerfsTer4 expression showed markedly reduced HAO1 protein levels and cellular protein mis-localisation. In this woman, lifelong HAO1 knockout is safe and without clinical phenotype, de-risking a therapeutic approach and informing therapeutic mechanisms. Unlocking evidence from the diversity of human genetic variation can facilitate drug development.

The Importance of Diagnosis and Specialized Treatment in Merkel Cell Carcinoma: Case Report in a Young Healthy Woman, Literature Review and Brief Update on Approach

Merkel Cell Carcinoma (MCC) is extremely rare and aggressive, with an overall survival of 40% in 5 years. The non-oncological physician has large difficulty about the correct approach of this pathology. We report the sixth case of MCC in a young healthy patient (woman, 19 years old) described in the medical literature, who was treated twice for sebaceous cyst, evolved with local disease progression, needed a larger resection and, after adjuvant therapy, remains no tumor recurrence. Despite being an extremely rare neoplasm, therapeutics should not be underestimated by non-oncological physician because this cancer is too aggressive, and the correct oncological approach could result in increased progression-free survival for these patients.

Intravenous leiomyomatosis without extrapelvic involvement

A 41-year-old healthy woman, gravida 2 para 2, was referred to our gynaecological outpatient department due to her history of menorrhagia, with 6 months of evolution, and with consequent anaemia...

When the Horse Has Stripes: Central Nervous System Blastomycosis Presenting as a Ring-Enhancing Lesion in an Immunocompetent Patient

Abstract A new, single, ring-enhancing lesion in the cortex of an immunocompetent individual has a broad differential diagnosis, although primary or metastatic malignancies are usually highest on the list. The presence of inflammation without overt malignancy, however, is cause for considerations that may require ancillary testing with fresh tissue and obtaining multiple frozen samples. Central nervous system (CNS) infection with blastomycosis is a rare but potentially fatal complication, with a mortality rate approaching 20% secondary to multiple factors including delay in presentation and diagnosis (Clin Infect Dis 2010;50:797–804). What makes CNS blastomycosis so difficult to diagnose, along with other rare fungal infections, is that it can masquerade as a primary neural tumor. Infectious etiologies should always be considered in ring-enhancing lesions that show inflammation, necrosis, and no significant glial atypia on frozen section. Here we describe a case in an otherwise healthy woman, who presented with seizures and was found to have a peripherally enhancing intraparenchymal lesion on imaging. Differential diagnosis, frozen-section management, histology, and microbiology in the workup of CNS blastomycosis are discussed.

DIAGNOSTIC COMPLEXITIES OF LEFT ATRIAL MASSES AND THE VALUE OF A PULMONARY EMBOLISM RESPONSE TEAM

The difference in managing myxoma and pulmonary embolism (PE) emphasizes the importance of prompt diagnosis of left atrial masses. Diagnosis requires a systematic and multidisciplinary approach to treatment. 47 year old healthy woman presented with acute onset left lower abdominal pain and pre-

TRAUMATIC ST-ELEVATION MYOCARDIAL INFARCTION BY A HORSE

Blunt trauma to the chest causing myocardial infarction (MI) is rare. Mechanisms include atherosclerotic plaque rupture, subintimal hemorrhage, coronary artery dissection or external coronary compression. Optimal management remains unknown. A 33-year-old healthy woman presented after being kicked

Transient Sigmoidorectal Intussusception Simulating Submucosal Tumor in a Healthy Woman: An Unusual Case and Review of the Literature

A 42-year-old healthy woman underwent scheduled polypectomy. The introduction of colonoscope showed a rectal regular subepithelial mass with an aperture on the top but the passage of the endoscope was impossible. By introducing gastroscope, however, the mass had disappeared. Subsequently, an uneventful colonoscopy was performed with resection of three small polyps located in ascending and transverse colon. Transient sigmoidorectal intussusception was the diagnosis, which is a very rare condition.

Knowledge and attitude towards cervical cancer among reproductive age group women in Gondar town, North West Ethiopia

BackgroundCervical cancer is the second most commonly diagnosed cancer and the third leading cause of cancer death in women worldwide. Nearly 83% of the world’s new cases and 85% of all cervical cancer-related deaths occur in developing countries. It is primarily caused by human papilloma virus (HPV); a sexually transmitted pathogen that could be prevented with safe sexual practice and using vaccines among others.The aim of the study was to assess the knowledge and attitude of reproductive age group women towards cervical cancer and its prevention in Gondar town.MethodsA descriptive community based cross-sectional study was carried out. An interviewer-administered questionnaire was employed for data collection. A multistage sampling technique was employed to select the study participants. Descriptive statistics like frequency, mean and percentage were computed using SPSS version 20 software program.ResultsSeven hundred and seventy women (n = 770) participated with a response rate of 100%. More than half, (65.1%) of the participants claim hearing of cervical cancer. However, majority (> 80%) of them lack knowledge that HPV is a causative agent of cervical cancer which is extremely worrying as the most important way to prevent cervical cancer is blocking HPV infection. Of those who had heard of it, only 107 (21.4%) said they have heard about Pap smear test. From them, less than half, 47 (43.9%) said that an apparently healthy woman should undergo the test at least three times in her life. This means in addition to the lack of information about the test, majority of those who had heard about it didn’t know how many times they should have the test in their life. Overall, only 153 (19.87%) of the participants were found having a good knowledge of cervical cancer and its prevention.ConclusionThe overall knowledge of women towards cervical cancer was inadequate. On the other hand, those who had heard about it had a somewhat encouraging attitude. Mass media was the major source of information. But, any public health problem cannot be solved in isolation. Hence, initiating large-scale awareness campaigns is recommended.