History Of Medical Treatment Research Articles

12546 Association Of Quality Of Life And Age At Diagnosis In Women With Turner Syndrome

Abstract Disclosure: G. Julian: None. L.J. Folsom: None. Background: There is a well-documented association between chronic disease and decreased quality of life (QoL), including in women with Turner syndrome (TS). Much of the existing research exploring QoL in women with Turner syndrome primarily establishes the finding of decreased QoL; fewer studies seek to explore potential etiologies for this finding. Health-related QoL (HRQoL) has been evaluated using the HRQOL 14, a validated measure of QoL, since 1995, and in individuals >12 years of age as part of National Health and Nutrition Examination Survey (NHANES). The primary objective of our study was to investigate the relationship between HRQoL in women with TS and age of TS diagnosis (AoD). A secondary aim included identification of correlations between medical treatment history and HRQoL. Methods: After obtaining IRB approval, the electronic medical record (EMR) was queried using the “slicer-dicer” feature using search and limiting criteria based on desired and specified variables. Inclusion criteria encompassed a documented diagnosis of TS, a recorded office visit within the past 2 years, and participant age of at least 18 years at time of study initiation. Exclusion criteria included lack of a confirmed diagnosis of TS, presence of other diseases known to influence stature or pubertal development, inability to understand the survey, lack of ability to read or speak English, and diagnosis of TS within the past year. QoL was assessed using the HRQOL 14. After review for exclusion criteria an opt-out letter was mailed via USPS. Results: Thirty participants completed the study out of 84 qualifying individuals. Early AoD was defined as younger than 13 years; late AoD was defined as >12 years. Twenty-four participants met criteria for early AoD; six met criteria for late AoD. The mean age for early diagnosis was 6 years and the mean age for late diagnosis was 23 years. The early AoD group reported fewer medical problems (3.6 vs. 6.2 other medical problems, p=0.009), was less likely to state days of lack of sufficient sleep (4.5 vs. 30 days, p=0.001), and was less likely to note days of limited physical activity due to pain (1 vs. 15 days, p=0.007). Conclusions: The novel finding of association of earlier AoD of TS and fewer medical problems invites the possibility that other health conditions may be more effectively managed if TS is diagnosed earlier. This finding highlights the opportunity for enhanced care with earlier AoD. Presentation: 6/1/2024

Survival of different caries managements in children with autism and unaffected peers: a retrospective cohort study.

Dental caries is a common oral disease in children with special needs such as those with autism spectrum disorders (ASDs). The aim is to assess whether the type and survival of three caries management, conventional resin restorations (CR), ART technique (ART) and SDF application without caries removal (SDF), in primary teeth carried out at the Pediatric Dentistry Department of San Paolo Hospital (University of Milan) differed between children with ASDs and unaffected peers. Data from a convenience sample of children with and without ASDs, who have received dental care for caries in primary teeth from January 2019 to June 2022, were analysed. Medical history, age, sex, teeth treated, and type of treatment were collected from dental charts. Data on success and minor and major failures of each treatment were also collected. Two survival analysis were performed, one considering both major and minor failures, a second considering only major failures. Cox Proportional Hazards multivariate logistic models were run to assess factors associated with failures. The statistical significance was set at 5% (p< 0.05). In children with autism, the different techniques for approaching caries lesions seem to have the same probability of success. Therefore, the choice of treatment should be patient-oriented rather than lesion-oriented. In unaffected children, the gold standard always seems to be traditional restorative treatment.

Factors associated with anxiety disorders among healthcare workers (HCWS) involved in the first wave of the COVID-19 pandemic.

In a context of reorganization of the activity, of increase of the psychological, emotional and physical constraints of the nursing staff induced by the first wave of the COVID-19 pandemic, an increase of the anxiety disorders could occur. This study aims to assess the prevalence of anxiety disorders in healthcare workers (HCWs) by wards and to investigate medical, personal, and occupational factors associated with anxiety disorder. In France, in May 2020, a monocentric observational cross-sectional study was proposed to 285 HCWs of the University Hospital of Saint Etienne, working in 3 types of randomly selected care wards. Information was collected using an anonymous self-questionnaire offered to eligible HCWs. Validated questionnaires were used to assess anxiety (Hospital anxiety and Depression Scale) and burnout (Maslach Burnout Inventory). Of the 164 HCWs who participated in the study (57% participation rate), 69 (42%) caregivers had anxious symptomatology. The prevalence of anxiety disorders did not differ significantly by type of wards. Anxiety disorders are significantly associated with occupational factors (increased COVID-19 stress level, increased emotional load, increased mental load, high work/life stress during confinement, emotional exhaustion and loss of empathy), with medical factors (medical history of anxiety disorders, psychotropic treatment and impaired sleep quality) and personal factors (concern about working conditions and/or media reports). Preventive actions focusing on organizational factors could be carried out to reduce the emotional and mental load, the level of stress and the burnout of HCWs.

Recurrent symptomatic urolithiasis in a patient with cystic fibrosis.

A 6-month-old girl, previously diagnosed with cystic fibrosis (CF), was admitted to hospital for nephrolithiasis. Her parents were first-degree cousins. The patient underwent endoscopic stone management. Despite no family history of stones and medical treatment with potassium citrate, the patient developed recurrent renal stones and atypical urinary tract infections during follow-up. Basic investigations were all normal. Due to consanguinity and early presentation of nephrolithiasis, metabolic causes such as cystinuria and hyperoxaluria were considered. Cystinuria was excluded due to normal cystine levels. High urinary oxalate excretion was found as expected due to absorptive (secondary) hyperoxaluria in CF patients. An early stone burden in the patient with a history of medical treatment and consanguinity led us to perform a genetic testing. Genetic testing revealed a missense homozygous variant in exon 1 of the AGXT gene. The patient was diagnosed with primary hyperoxaluria type 1. Two rare life-threatening genetic diseases were found together in the same child.

A 2-year longitudinal study examining the change in psychosocial factors under the COVID-19 pandemic in Japan

To examine changes in individuals’ psychosocial variables (e.g., psychological distress, social isolation, and alcohol use) during the prolonged COVID-19 pandemic, a two-year longitudinal survey was conducted at approximately one-year intervals between May 2020 and May 2022, after the first COVID-19-related state of emergency was announced in Japan. The online survey was conducted on May 11-12, 2020 (Phase 1), June 14–20, 2021 (Phase 2), and May 13–30, 2022 (Phase 3). The survey in Phase 1 was conducted during the first emergency declaration period, the survey in Phase 2 was conducted during the third emergency declaration period, and the survey in Phase 3 was conducted at a time when there was no state of emergency but many COVID-19 positive cases. Notably, 3,892 participants responded to all three surveys. In addition to psychosocial inventories often used worldwide, survey items included lifestyle and stress management indicators related to COVID-19 and various sociodemographic items including occupation (e.g., healthcare workers) or income, history of medical treatment for mental problems, severe physical illnesses, and COVID-19.

Consensus reporting guidelines to address gaps in descriptions of ultra-rare genetic conditions

Genome-wide sequencing and genetic matchmaker services are propelling a new era of genotype-driven ascertainment of novel genetic conditions. The degree to which reported phenotype data in discovery-focused studies address informational priorities for clinicians and families is unclear. We identified reports published from 2017 to 2021 in 10 genetics journals of novel Mendelian disorders. We adjudicated the quality and detail of the phenotype data via 46 questions pertaining to six priority domains: (I) Development, cognition, and mental health; (II) Feeding and growth; (III) Medication use and treatment history; (IV) Pain, sleep, and quality of life; (V) Adulthood; and (VI) Epilepsy. For a subset of articles, all subsequent published follow-up case descriptions were identified and assessed in a similar manner. A modified Delphi approach was used to develop consensus reporting guidelines, with input from content experts across four countries. In total, 200 of 3243 screened publications met inclusion criteria. Relevant phenotypic details across each of the 6 domains were rated superficial or deficient in >87% of papers. For example, less than 10% of publications provided details regarding neuropsychiatric diagnoses and “behavioural issues”, or about the type/nature of feeding problems. Follow-up reports (n = 95) rarely contributed this additional phenotype data. In summary, phenotype information relevant to clinical management, genetic counselling, and the stated priorities of patients and families is lacking for many newly described genetic diseases. The PHELIX (PHEnotype LIsting fiX) reporting guideline checklists were developed to improve phenotype reporting in the genomic era.

Relugolix/Estradiol/Norethisterone Acetate: A Review in Endometriosis-Associated Pain.

An oral fixed-dose combination of relugolix/estradiol/norethisterone (also known as norethindrone) acetate [Myfembree® (USA); Ryeqo® (EU)] (hereafter referred to as relugolix combination therapy) has been approved in the USA for the management of moderate to severe pain associated with endometriosis in premenopausal women and in the EU for the symptomatic treatment of endometriosis in adult women of reproductive age with a history of previous medical or surgical treatment for their endometriosis. The gonadotropin-releasing hormone (GnRH) receptor antagonist relugolix decreases estradiol and progesterone levels, while the addition of estradiol/norethisterone acetate mitigates hypoestrogenic effects including bone mineral density (BMD) loss and vasomotor symptoms. In two pivotal phaseIII trials, relugolix combination therapy significantly improved dysmenorrhoea and non-menstrual pelvic pain in premenopausal women with moderate to severe endometriosis. The combination also reduced overall pelvic pain and dyspareunia, reduced analgesic and opioid use, and improved health-related quality of life. The efficacy of relugolix combination therapy was sustained over the longer term (up to 2years). Relugolix combination therapy was generally well tolerated and BMD loss over time was minimal. With the convenience of a once daily oral dosing regimen, relugolix combination therapy is a valuable addition to the options currently available for the management of endometriosis-associated pain.

AYURVEDIC APPROACH IN THE MANAGEMENT OF HYPERPROLACTINEMIA, ALONG WITH A CASE REPORT

Hyperprolactinemia is a condition where the prolactin levels are high, which inhibits ovarian steroidogenesis and is responsible for secondary amenorrhea or oligomenorrhea, followed by infertility in 30% of cases. In this case report, A 28-year lady patient came to OPD of BAPUJI AYURVEDIC HOSPITAL, CHALLEKERE, with a complaint of anxiety to conceive since three years, with a history of hypothyroidism followed by scanty menstruation and weight gain and her reports show that it is a case of hyperprolactinemia for one year, with a medical history of allopathic treatment for the same. This condition is due to the kapha and vata dushti. Deepana, Pachana, Shodhana karma are explained in the ayurvedic classics to treat the stree rogas. Acharya Dalhana mentioned that prefer Vamana than virechana. In this condition, Vamana karma removes vikrutha kapha so that Soumya dhatu is expelled by clearing margavarodha, which increases agneya guna, which is essential for arthava pravutti. The oral medication after Vamana karma helps to restore proper ovulation and regular menstruation.

Challenges in differential diagnosis between obstructive and non‐obstructive azoospermia

AbstractBackgroundSome cases of non‐obstructive azoospermia (NOA) are characterized by normal clinical parameters, including testicular volume and levels of reproductive hormones, mimicking obstructive azoospermia (OA).MethodsWe performed a retrospective review of a consecutive series of 1417 patients undergoing primary surgical sperm retrieval between 2014 and 2023. Follicle‐stimulating hormone (FSH) level below 7.6 IU/l and normal testicular size with a long axis measurement &gt;4.6 cm were used as criteria to suspect OA.ResultsFour hundred and eighteen patients with normal testicular volume and FSH levels had an initial diagnosis of OA. Among them, 243 (58.1%) had histological signs of spermatogenic dysfunction, and 175 (41.9%) had true OA. One hundred eleven patients had long‐standing obstruction (median: 16.5 years) with a median Bergmann–Kliesch score (BKS) of 5 (interquartile range [IQR]: 4–6) and 100% sperm retrieval rate (SRR), though some required microdissection testicular sperm extraction (microTESE). Fifty‐eight patients with a history of epididymo‐orchitis had a median BKS of 4 (IQR: 2–6) and 100% SRR. Twenty patients with a history of unjustified medical treatment for male infertility had a median BKS of 3 (IQR: 1–4) and 80% SRR. Fifty‐four patients had uniform maturation arrest with a 5.5% SRR on microTESE.ConclusionMen with normal testicular volume and FSH level may have evidence of spermatogenic failure on pathology. Patients with complicated seminal tract obstruction commonly have hypospermatogenesis, but true NOA caused by uniform maturation arrest may also be observed. Patient counseling for suspected OA should not be overly optimistic, and couples should be warned about possibility of conversion to microTESE and risks of negative sperm retrieval.

Do men adapt to lower urinary tract symptoms? An 11-year longitudinal study of male urinary urgency and associated bother.

The study objective is to evaluate prognosis and predictors of bother caused by urinary urgency among middle-aged and older men. A population-based sample of men born in 1974, 1964, 1954, 1944, 1934 and 1924 was followed-up from 2004 to 2015. The course of urgency and associated bother was evaluated with the Danish Prostatic Symptom Score at baseline and follow-up. Logistic regression was utilized to explore risk factors of increased bother at follow-up. A total of 2,480 men (39%) who had responded at baseline and follow-up were included in the study. Of them, 1,056 men (43%) had persistent mild urgency and 132 men (5%) persistent moderate or severe urgency at follow-up. The proportions of men experiencing at least moderate bother due to persistent urgency at follow-up were 6% (95% confidence interval 4.5-7.3) of those with mild and 79% (71.7-85.9) of the men with moderate or severe urgency. In multivariable-adjusted logistic regression, moderate to severe urgency was strongly associated with bother (odds ratio, OR 55.2, 95% CI 32.1-95.2). Other predictors of bother included cardiac disease (OR 1.8, 95% CI 1.0-31.1), pulmonary disease (OR 1.9, 95% CI 1.1-3.5) and medical treatment (OR 2.7, 95% CI 1.6-4.6). Most men with urinary urgency have mild symptoms and bother. Only one out of five men with persistent moderate or severe urgency adapt to the symptoms. Men with a history of medical treatment for lower urinary tract symptoms (LUTS) or impaired cardiopulmonary health are more likely to experience bother from urinary urgency.

Data resource profile of an online database system for forensic mental health services

This paper introduces a forensic psychiatry database established in Japan and discusses its significance and future issues. The purpose of this Database, created under the Medical Treatment and Supervision Act (MTSA) Database Project, is to improve the quality of forensic psychiatry treatment. It can collect monthly data on “basic information,” “Orders and hospitalizations under the MTSA,” “Treatment process,” “Criminal and medical treatment history,” and “problematic behavior in the unit.” The online system has accumulated data on more than 8,000 items in 24 broad categories. Medical data are exported from the medical care assisting system of 32 designated inpatient facilities in XML format and then saved on USB memory sticks. The files are imported into the Database system client, which sends the data to the Database server via a virtual private network. This system minimizes errors and efficiently imports patient data. However, there is a limitation that it is difficult to set items that need to be analyzed to solve everyday clinical problems into the database system because they tend to change over time. By evaluating the effectiveness of the Database, and collecting appropriate data, it is expected to disseminate a wide range of knowledge that will contribute to the future development of mental health and welfare care.

Evaluating the Effect of the Demographic, Trichoscopic and Laboratory Characteristics on The Recurrence of Alopecia Areata.

Alopecia areata (AA) has diverse disease characteristics and multiple factors may interfere with the prognosis of the disease. In this study, the factors affecting the AA recurrence were evaluated. A total of a hundred patients diagnosed with AA between June 2022 and March 2023 were included in this retrospective, cross-sectional study. The patients were divided into two groups according to the presence of outbreaks. Both groups were compared in terms of age, gender, disease duration, number of outbreaks, family history of AA, previous medical treatment history for AA, clinical type, disease severity, presence of accompanying nail findings, and trichoscopic and laboratory characteristics. Among 100 patients, male dominance was found (N = 69). Most of the patients had patchy disease (90/100), mild disease severity (88/100), and a solitary outbreak (65/100). Male gender, longer disease duration, family history, presence of S2 severity of alopecia tool score, trachyonychia, short vellus hairs in trichoscopic examination, hypothyroidism, and folic acid deficiency were factors for AA outbreaks. Male gender and the presence of a family member with AA in the family were defined as the independent prognostic factors for disease recurrence. While demographic, laboratory, and clinical findings are factors for AA outbreaks in the follow-up, male gender and family history should be considered independent predictors.

Kolşisin ile Tedavi Edilen Çocukluk Çağı FMF Hastalarında COVID-19'un Hafif Klinik Seyri

Aim: Clinical trials continue for several medical protocols for COVID-19. Colchicine is an anti-inflammatory agent that is highly used medicament for autoimmune disorders, including Familial Mediterranean Fever (FMF). Based on immunity disrupting the pathogenesis of SARS-CoV-2, we aimed to describe the clinical course of SARS-CoV-2 infection in patients with childhood-onset FMF on colchicine treatment.&#x0D; Material and Methods: We prepared a survey investigating contact histories, and clinical presentation of childhood-onset FMF patients treated with colchicine and questioned their parents via phone calls or during outpatient visits. In addition, medical record history, treatment, and medication history were obtained from the hospital database.&#x0D; Results: A total of 171 patients, 99 (57.9%) male and 72 (42.1%) female, diagnosed with FMF and who have been under colchicine treatment for at least one month were included in the study. Among patients, 56 (32.7%) have contact with a confirmed COVID-19 case; 43 (25.1%) have suspected family member contact and 13 (7.6%) have non-family contact. Only 15 (8.8%) FMF patients treated with colchicine were PCR diagnosed with COVID-19 disease; all had mild symptoms, none required antiviral treatment, and none were hospitalized. The dose and duration of colchicine use did not significantly differ between the patients with confirmed COVID or not (p=0.112, and p=0.344, respectively).&#x0D; Conclusion: We concluded that pediatric patients with FMF receiving colchicine treatment may not be at increased risk for being infected with SARS-CoV-2 or the severe symptoms of COVID-19.

Clinical profile and growth pattern of children with congenital adrenal hyperplasia attending endocrine clinic, in a tertiary care center, South India

Background: Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders that result from the deficiency of one of several enzymes involved in the steroidogenic pathway for cortisol or aldosterone biosynthesis. Glucocorticoid replacement therapy, though largely effective in managing crises and limiting virilization, is far from perfect. Aims and Objectives: The aims and objectives of the study are to study the clinical profile and association between type of disease and glucocorticoid dosage with the growth of children with CAH attending pediatric and endocrinology outpatient department in a tertiary care hospital. Materials and Methods: This is a prospective observational study. All children who were newly diagnosed and old cases of CAH were consecutively recruited. Background details of the patient including sociodemographic data were obtained by a structured pro forma. Medical history and details of treatment were obtained from previous records. Patients were then followed up 6 monthly for 1 year and height and height velocity were obtained. Results: This study included 33 children (23 salt wasting [SW] and 10 simple virilizing [SV] CAH). Mean age was 6.3 ± 4.3 years. Among SW CAH, while 83.3% of male babies presented with adrenal crises while only 20% of the female babies went for a crisis, because most of them were diagnosed by the presence of ambiguous genitalia. Among SV patients, all females presented with ambiguous genitalia and males presented with precocious puberty. The overall height standard deviation was 0.8 ± 1.2 with a greater growth faltering in those taking higher doses of hydrocortisone. Growth was compromised more in SW CAH than in SV CAH. Conclusion: Growth in CAH is less compared to normal population and many factors including glucocorticoid dose and type of disease determine the growth and final height.

Why Do Physicians in Japan Use e-Cigarettes and/or Heated Tobacco Products? A Cross-Sectional Survey

Background: The tobacco industry has actively advocated for electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) as harm-reduction alternatives to traditional cigarettes. Around 40% of smoking physicians have adopted HTPs. This study aimed to uncover the motivations behind Japanese physicians’ e-cigarette and HTP use while analyzing the associations between product use, physician demographics, lifestyles, and smoking preferences. Methods: A mail-based survey was conducted in 2020, targeting 6000 male and 1500 female physicians. From the 5492 survey participants, 346 physicians aged 28 to 98 who were current smokers were selected. The survey assessed their usage of e-cigarettes and HTPs and explored the reasons for initial adoption. A multivariate logistic regression analysis examined the relationships between product use, physician characteristics, and behaviors. Results: Approximately 33.8% of smoking physicians had experimented with e-cigarettes and HTPs. E-cigarette and HTP use correlated with youthfulness, nicotine addiction, and a history of medical treatment. The primary drivers for adopting e-cigarettes and HTPs were reduced odor (74.4%), perceived harm reduction (48.7%), and decreased exposure to secondhand smoke (29.1%). Conclusions: Physicians, when transitioning from conventional cigarettes to HTPs or e-cigarettes, are primarily motivated by a desire to reduce the odor of conventional cigarettes rather than health-related concerns.

Influencing Factors of Treatment Outcomes Among Patients with Pulmonary Tuberculosis: A Structural Equation Model Approach.

Pulmonary tuberculosis (PTB) is a serious infectious disease, and the factors and pathways that influence final treatment outcomes are unclear. Here, we aimed to assess the factors that influence treatment outcomes in patients with PTB using a structural equation model. Participants completed a questionnaire covering demographics, understanding of PTB, psychological status, and history of medical treatment. Exploratory factor analysis and reliability testing were performed, and a structural equation model was constructed using the SPSS and Amos software. A total of 251 participants were enrolled. Symptoms of depression were observed in 94.4% of participants, whereas 6% showed mild or greater anxiety. Through factor rotation, four common factors were extracted with a total variation of 66.15%. The structural equation model indicated that regular tuberculosis-related follow-up behaviour had a direct and positive effect on the final treatment outcome, with a path coefficient value of 0.20; the level of PTB understanding had a direct positive effect on the testing behaviour for PTB, with a path coefficient of 0.26; patients' psychological characteristics had a direct negative impact on regular testing behaviour, with a path coefficient of -0.13. The psychological characteristics and level of disease understanding of patients exerted indirect effects on the treatment outcome by affecting the way patients approached tuberculosis detection behaviour. Interventions aimed at improving the treatment outcomes of patients with PTB should mainly focus on financial support and improvements in psychological status in addition to a greater understanding and knowledge of PTB. Furthermore, patients should be encouraged to undergo regular PTB testing during the follow up period, as this mediates the effect of other factors on treatment outcomes and also helps in achieving favourable treatment outcomes.

Preoperative D-dimer Value and Lower Limb Venous Ultrasound for Deep Venous Thrombosis Prevents Postoperative Symptomatic Venous Thromboembolism in Patients Undergoing Colorectal Surgery: A Retrospective Study.

Preoperative deep venous thrombosis (DVT) can cause potentially life-threatening postoperative venous thromboembolism (VTE). Lower limb venous ultrasound (LLVU) is a modality that can detect DVT. However, the threshold for performing preoperative LLVU in the population undergoing colorectal resection is controversial. In this context, we evaluated whether a preoperative D-dimer value can identify patients who benefit from LLVU from the perspective of preventing postoperative symptomatic VTE. Patients undergoing colorectal resection in our institute from 2013 to 2020 were retrospectively enrolled (n=2071). We divided the patients into two groups: the clinical indication group (CG: including patients from 2013 to 2016, n=875) and the D-dimer-orientated group (DG: including patients from 2017 to 2020, n=1196). In the CG, LLVU was performed when DVT was clinically suspected; in the DG, preoperative LLVU was performed in patients with a preoperative D-dimer>1.0 μg/ml. In the surveyed period, 277 LLVUs were performed, among which DVT was detected in 34 cases (12.3%). In the CG, DVT was detected in 0.7% of patients, whereas in the DG, it was detected in 2.3% of patients. Postoperative symptomatic VTE was significantly reduced in the DG at both 3 and 6 months after surgery (p=0.041 and 0.020, respectively). Moreover, Multivariate analysis showed that a past medical history of PE and treatment following the CG protocol were independent risk factors for postoperative symptomatic VTE within 6 months of surgery (p<0.0001 and =0.036, respectively). LLVU in patients with a preoperative D-dimer>1.0 μg/ml is a useful method to prevent postoperative symptomatic VTE.

P-338 Preliminary results of the DINE Study (Dienogest vs. Norethindrone Acetate in Endometriosis Treatment)

Abstract Study question How do the two-progestin type NETA and dienogest affect on pain and recurrence in patients with endometriosis? Summary answer NETA and dienogest are progestin derivatives that have similar effects on pain and recurrence in treating endometriosis and canbe safely preferred for treatment. What is known already Although surgical treatment significantly improves pain symptoms in endometriosis, it may be associated with significant urinary, intestinal and vascular complications; In addition, postoperative pain and recurrence rates of endometriotic lesions are high. Medical treatment gains importance, and progestins are mainly used in treatment. NETA is one of the most researched progestins for the treatment. It has a good safety profile and efficacy in curing endometriosis-related pain, making NETA a viable medical option among first-line treatments. Study design, size, duration The study was designed as a single-center, prospective, randomized study. Patients were randomly assigned to one of the two treatment protocols, with the single digit 'NETA' and double 'dienogest' according to the last digit of their protocol number. Patient recruitment started in February 2022. The patients were evaluated at 6-month visits for one year. Participants/materials, setting, methods Seventy patients aged 18-40 years were included. Patients with contraindicated progestins and pelvic inflammatory disease were excluded from the study. Demographic data, medical and surgical treatment histories were recorded. Patients were evaluated with detailed physical examination, ultrasound, and laboratory tests. They were questioned because of their chronic pain symptoms, they were asked to give a score between 1 and 10 with the numerical scoring system and recorded. They were re-evaluated at 6 and 12 months. Main results and the role of chance 40 dienogest and 30 NETA patients were included in the study. There were eight patients (one headache, one orthostatic hypotension, five metrorrhagia, one pregnancy request) in the NETA group and 11 patients (1 headache, one decreased sexual desire, one surgery, eight metrorrhagia) in the dienogest group. In the final analysis, 48 patients were included in the study. There was no significant difference between the two groups regarding initial laboratory, ultrasonographic and demographic parameters. (p &amp;gt; 0.5) There was no significant difference between the two groups in dropout rates at six months. (p = 0.65) Dysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain scores were similar both at the beginning of treatment and at the 6th-month follow-up, and no significant difference was observed in both group. (p &amp;gt; 0.5) Significant improvement was observed in all scores in both groups.(p &amp;lt; 0.001) In the 6th month, the most common side effects in the dienogest group were emotional lability (26%), and metrorrhagia (15%), while the NETA group were metrorrhagia (40%) and weight gain (20%). No significant effect was observed on the lipid profile and bone mineral density at the 6th-month control. Limitations, reasons for caution Our study is the first study in the literature to compare NETA and dienogest in the medical treatment of endometriosis. The strongest aspect is that it is a randomized control study. The small number of study population and the high dropout rates are the limitations. Wider implications of the findings NETA and dienogest are two progestin derivatives that are effective on pain and recurrence in the medical treatment of endometriosis and can be safely preferred for treatment. An analysis of our long-term data and further studies are needed to evaluate which progestin preparation is more effective and safe in treatment. Trial registration number NCT05476172

Paths towards parenthood after repeated treatment failures: a comparative study on predictors of psychological health outcomes in infertile couples persisting in treatments or opting for adoption.

Infertility literature suggests widespread recourse to long-term medical treatments despite evidence of high stress, costs, and adverse effects of repeated treatment failures. However, there is a lack of research comparing predictors of stress and psychological health outcomes between members of infertile couples who - after repeated failures - persist in pursuing medical treatments (PT) with those who opted for quitting treatments and adopting (QTA). Basing on a transactional and multidimensional approach to infertility-related stress and health, the present study aims at exploring individual (socio-demographics; coping strategies) and situational (infertility-related parameters; infertility-related stressors; couple's dyadic adjustment dimensions) predictors of state-anxiety and depression in male and female partners of PT-infertile couples and of QTA-infertile couples. Participants were both members of 176 couples with duration of infertility and a history of medical treatments for at least 3 years (76 PT-infertile couples, 100 QTA-infertile couples). The study variables were compared by study group across genders. Structural equation models (SEM) were used to test main and moderating effects of study variables on state-anxiety and depression by study group and across genders. Members of infertile couples quitting treatments and adopting (QTA) reported significantly lower levels of state-anxiety and depression, higher stress related to need for parenthood and rejection of childfree-lifestyle and lower stress related to social and couple's relationship concerns than those who persist in pursuing medical treatments (PT). Members of infertile couples quitting treatments and adopting (QTA) recurred to a greater extent to active coping strategies (problem-solving/social-support) and to a lower extent to passive coping strategies (avoiding/turning-to-religion), and they reported higher levels of dyadic adjustment. Specificities in main and moderating factors related to state-anxiety and depression by study group and across genders were found. Findings should be addressed to provide a comprehensive assessment of both members of infertile couples facing repeated treatment failures to identify risks and resources and develop tailored evidence-based interventions.

Does bariatric surgery change the risk of acute ischemic stroke in patients with a history of transient ischemic attack? A nationwide analysis.

Stroke is the second leading cause of death worldwide and fifth in the United States, and it represents the major cause of disability in older adults. We aimed to determine the risk of acute ischemic stroke (AIS) in individuals with obesity with a history of transient ischemic attack (TIA) compared with patients with a history of bariatric surgery. Academic hospital, United States. Using the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, we retrospectively identified patients with obesity and past medical history of TIA and divided them into 2 groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity. We compared incidence of new AIS in both groups using a univariate analysis and multivariate regression model. Covariates included were lifestyle (smoking status, alcohol habits, cocaine use), family history of stroke, co-morbidities (diabetes, hypertension, hyperlipidemia, atrial fibrillation) and long-term medical treatment (antiplatelet/antithrombotic treatment). A total of 91,640 patients met inclusion criteria, of which treatment patients were 12.3% (n = 11,284) and control patients 87.6% (n = 80,356). The average age of the treatment group was 62.9 ± 17.08 years, and the average of the control was 59.6 ± 12.74 years. The rate of AIS in the treatment group was significantly lower compared with the control group (2.8% versus 4.2%, P < .0001). After adjusting for covariables, the risk difference of AIS was still significant between groups (odds ratio = 1.33, P < .0001), showing that patients in the treatment group were less likely to have AIS compared with the control group. After analyzing nationwide information, we conclude bariatric surgery helps decrease risk of AIS in patients with a history of TIA. However, this comparison is limited by the nature of the database; further studies are needed to better understand these results.