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1.
J Psychosom Obstet Gynaecol ; 45(1): 2354330, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38823418

RESUMEN

This retrospective cohort study identifies differences between rates of selected mental illnesses and sleep disorders according to eight gynecological problems. Analyses utilize medical claims data for adult employees of a large corporation during 2017-2021. Women with a gynecological problem (most notably pain, endometriosis, pelvic inflammation and bleeding) are significantly more likely to experience mental illness. Several gynecological problems are also significantly associated with sleep disorders. Women with a gynecological problem (vs. none) are 50% more likely to have a mental health problem and 44% more likely to have a sleep disorder after adjusting for age, marital status, dependent children and year. The largest differences between higher (%) mental illness and sleep disorders appear for hyperplasia (6% vs. 45%), cancer (11% vs. 68%), pelvic inflammation (46% vs. 79%) and pain (79% vs. 43%), respectively. On the other hand, the rate of having one or more gynecological problems ranges from 7.1% for women with no mental illness or sleep disorder to 20.6% for women with schizophrenia. Understanding the association between gynecological problems, mental illness and sleep disorders can help clinicians more effectively identify and treat patients.


Asunto(s)
Enfermedades de los Genitales Femeninos , Trastornos Mentales , Trastornos del Sueño-Vigilia , Humanos , Femenino , Trastornos del Sueño-Vigilia/epidemiología , Adulto , Trastornos Mentales/epidemiología , Enfermedades de los Genitales Femeninos/epidemiología , Estudios Retrospectivos , Persona de Mediana Edad , Comorbilidad , Adulto Joven
2.
PLoS Med ; 21(5): e1004385, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38768094

RESUMEN

BACKGROUND: Syndromic management is widely used to treat symptomatic sexually transmitted infections in settings without aetiologic diagnostics. However, underlying aetiologies and consequent treatment suitability are uncertain without regular assessment. This systematic review estimated the distribution, trends, and determinants of aetiologies for vaginal discharge, urethral discharge, and genital ulcer in sub-Saharan Africa (SSA). METHODS AND FINDINGS: We searched Embase, MEDLINE, Global Health, Web of Science, and grey literature from inception until December 20, 2023, for observational studies reporting aetiologic diagnoses among symptomatic populations in SSA. We adjusted observations for diagnostic test performance, used generalised linear mixed-effects meta-regressions to generate estimates, and critically appraised studies using an adapted Joanna Briggs Institute checklist. Of 4,418 identified records, 206 reports were included from 190 studies in 32 countries conducted between 1969 and 2022. In 2015, estimated primary aetiologies for vaginal discharge were candidiasis (69.4% [95% confidence interval (CI): 44.3% to 86.6%], n = 50), bacterial vaginosis (50.0% [95% CI: 32.3% to 67.8%], n = 39), chlamydia (16.2% [95% CI: 8.6% to 28.5%], n = 50), and trichomoniasis (12.9% [95% CI: 7.7% to 20.7%], n = 80); for urethral discharge were gonorrhoea (77.1% [95% CI: 68.1% to 84.1%], n = 68) and chlamydia (21.9% [95% CI: 15.4% to 30.3%], n = 48); and for genital ulcer were herpes simplex virus type 2 (HSV-2) (48.3% [95% CI: 32.9% to 64.1%], n = 47) and syphilis (9.3% [95% CI: 6.4% to 13.4%], n = 117). Temporal variation was substantial, particularly for genital ulcer where HSV-2 replaced chancroid as the primary cause. Aetiologic distributions for each symptom were largely the same across regions and population strata, despite HIV status and age being significantly associated with several infection diagnoses. Limitations of the review include the absence of studies in 16 of 48 SSA countries, substantial heterogeneity in study observations, and impeded assessment of this variability due to incomplete or inconsistent reporting across studies. CONCLUSIONS: In our study, syndrome aetiologies in SSA aligned with World Health Organization guidelines without strong evidence of geographic or demographic variation, supporting broad guideline applicability. Temporal changes underscore the importance of regular aetiologic re-assessment for effective syndromic management. PROSPERO NUMBER: CRD42022348045.


Asunto(s)
Úlcera , Excreción Vaginal , Humanos , África del Sur del Sahara/epidemiología , Femenino , Excreción Vaginal/epidemiología , Excreción Vaginal/etiología , Úlcera/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/diagnóstico , Vaginosis Bacteriana/epidemiología , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/complicaciones , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/complicaciones , Infecciones por Chlamydia/diagnóstico , Enfermedades Uretrales/epidemiología , Enfermedades Uretrales/etiología , Enfermedades de los Genitales Femeninos/epidemiología
3.
Int J Gynaecol Obstet ; 166(2): 879-885, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38509749

RESUMEN

OBJECTIVES: The goal of this study was to identify the risk factors associated with puerperal genital hematoma (PGHA) and analyze the management strategies employed and the resulting maternal outcomes. METHODS: This retrospective cohort study examined the pregnant women delivering vaginally with PGHA in Peking University Third Hospital during January 2002 to December 2021. Exploratory data analysis was performed to assess mean, standard deviation (SD), frequency, percentage and percentiles. Independent-samples t-test was performed for continuous variables. Chi-squared test was performed to compare categorical data. RESULTS: A total of 47 women with PGHA were included, and 94 matched controls were enrolled during the same study period. Compared with the control group, labor induction (34.0% vs. 9.6%, P = 0.000) and episiotomy (66.0% vs. 31.9%, P = 0.000) were more frequently performed in PGHA cases. There was a significantly higher incidence of postpartum hemorrhage (PPH) (53.2% vs. 6.4%, P = 0.000) in PGHA patients than in controls. Compared with the patients with <5 cm hematoma, the proportion of prenatal anemia (25.8% vs. 0.0%, P = 0.027) and the incidence of PPH (67.7% vs. 25.0%, P = 0.005) were significantly higher in patients with ≥5 cm hematoma. In comparison, the active period was significantly shorter (3.1 ± 1.9 vs. 5.1 ± 3.0, P = 0.031) in patients with ≥5 cm hematoma. There were significant differences in perineal pain and swelling (31.3% vs. 67.7%, P = 0.017), vulva hematoma (93.8% vs. 48.4%, P = 0.002) and surgical treatment (62.5% vs. 96.8%, P = 0.002). Nearly half of the patients in the ≥5 cm group underwent secondary suture (41.9% vs. 6.3%, P = 0.011). In patients with PGHA detected after more than 2 h, the body mass index was substantially higher (24.5 ± 4.3 vs. 21.4 ± 2.7, P = 0.011), and the weight gain during pregnancy (14.1 ± 4.3 vs. 11.4 ± 3.5, P = 0.021) was significantly lower. Compared with the patients in PGHA without PPH, age (31.7 ± 4.4 vs. 29.4 ± 2.6, P = 0.033) and newborn birth weight (3367 ± 390 g vs. 3110 ± 419 g, P = 0.045) were considerably higher in PGHA cases with PPH, and the platelet count ([182 ± 44] × 109/L vs. [219 ± 51] × 109/L, P = 0.015) was significantly lower. CONCLUSIONS: Pregnant women who underwent labor induction and episiotomy had a higher incidence of PGHA. The PGHA-related PPH rate is significantly increased. Active surgical treatment is recommended for patients with ≥5 cm hematoma.


Asunto(s)
Hematoma , Hemorragia Posparto , Humanos , Femenino , Estudios Retrospectivos , Hematoma/epidemiología , Hematoma/etiología , Hematoma/terapia , Embarazo , Adulto , China/epidemiología , Factores de Riesgo , Hemorragia Posparto/terapia , Hemorragia Posparto/epidemiología , Centros de Atención Terciaria , Episiotomía/efectos adversos , Episiotomía/estadística & datos numéricos , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Femeninos/terapia , Estudios de Casos y Controles , Trastornos Puerperales/terapia , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología
5.
Br Med Bull ; 149(1): 45-59, 2024 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-38220571

RESUMEN

BACKGROUND: Female genital schistosomiasis (FGS) is a chronic gynaecological disease affecting girls and women in sub-Saharan Africa (SSA), caused by the parasite Schistosoma (S.) haematobium. FGS is associated with sexual dysfunction, reproductive tract morbidity and increased prevalence of HIV and cervical precancer lesions. SOURCE OF DATA: Key peer-reviewed published literature. AREAS OF AGREEMENT: FGS screening and diagnosis require costly equipment and specialized training, seldom available in resource-limited settings. FGS surveillance is not included in wider schistosomiasis control strategies. The interplay of FGS with other SRH infections is not fully understood. Integration of FGS within sexual and reproductive health (SRH) control programmes needs to be explored. AREAS OF CONTROVERSY: There are no standardized methods for individual or population-based FGS screening and diagnosis, hindering accurate disease burden estimates and targeted resource allocation. Treatment recommendations rely on public health guidelines, without rigorous clinical evidence on efficacy. GROWING POINTS: Integrating FGS screening with SRH programmes offers an opportunity to reach at-risk women with limited access to healthcare services. Home-based self-sampling coupled with handheld colposcopes operated by primary healthcare workers show promise for FGS diagnosis and surveillance at scale. AREAS TIMELY FOR DEVELOPING RESEARCH: There is growing interest in decentralizing strategies for FGS screening and diagnosis. The accurate predictions on the 'cost-effectiveness' of these approaches will determine their affordability and feasibility within the overburdened health systems in SSA. Clinical trials are needed to optimize FGS treatment. Longitudinal studies can expand on the epidemiological knowledge on co-morbidities and integration within other SRH interventions.


Asunto(s)
Enfermedades de los Genitales Femeninos , Esquistosomiasis , Femenino , Humanos , Esquistosomiasis/tratamiento farmacológico , Genitales Femeninos/parasitología , Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Femeninos/parasitología , Manejo de Especímenes , Prevalencia
6.
Obstet Gynecol ; 143(1): 6-8, 2024 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-37944138

RESUMEN

To describe the incidence of abnormal gynecologic examination findings in asymptomatic compared with symptomatic patients during preventive visits, we conducted a retrospective study of 1,121 visits for patients between the ages of 21 and 35 years from January 2017 to March 2017. Only 1.2% (95% CI, 0.5%,1.9%) of asymptomatic patients had abnormal findings on pelvic examination, compared with 32.4% (95% CI, 27.0%, 37.8%) of those with symptoms ( P ≤.001). In symptomatic patients, the most common symptoms were vaginal discharge (25.1%), pelvic pain (16.4%), and vaginal bleeding (15.7%). In asymptomatic patients, the most common findings were bacterial vaginosis and Candida infection. Asymptomatic patients presenting for a routine preventive visit have low rates of abnormalities detected on examination, and routine pelvic examinations should be re-considered.


Asunto(s)
Enfermedades de los Genitales Femeninos , Vaginosis Bacteriana , Humanos , Femenino , Adulto Joven , Adulto , Examen Ginecologíco , Incidencia , Estudios Retrospectivos , Vaginosis Bacteriana/diagnóstico , Enfermedades de los Genitales Femeninos/epidemiología
7.
J Korean Med Sci ; 38(37): e279, 2023 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-37724492

RESUMEN

BACKGROUND: This study analyzed common gynecologic problems among Korean patients younger than ten years. METHODS: We performed a retrospective analysis of medical records of patients younger than ten years who visited the Pediatric and Adolescent Gynecology Clinic at Samsung Medical Center between 1995 and 2020. RESULTS: Among the 6,605 patients who visited the Pediatric and Adolescent Gynecology Clinic, data from 642 patients younger than ten years were analyzed in this study. The most common chief complaint was genital anomalies, followed by increased vaginal discharge and abnormal findings on clinical examinations. The most common disease entity was agglutination of the labia minora, which was commonly discovered incidentally during routine screenings. Vulvovaginitis, the second most common disease, was identified by symptoms of vaginal discharge, pruritus, and vaginal spotting. Neoplasm, issues with vaginal bleeding, and "other causes" were additional categories of gynecologic problems. 245 patients (38.2%) were referred from primary care sources, 175 patients (27.4%) sought care directly at the clinic, 169 patients (26.3%) were referrals from the institution's pediatric department, and the remainder were referrals from other departments. CONCLUSION: This study provides information about the gynecologic problems most frequently encountered in pediatric patients. The study provides helpful insight for primary care physicians into the proper management and timing of referrals for these gynecologic problems of pediatric patients.


Asunto(s)
Instituciones de Atención Ambulatoria , Enfermedades de los Genitales Femeninos , Excreción Vaginal , Adolescente , Niño , Femenino , Humanos , Pueblo Asiatico , República de Corea/epidemiología , Estudios Retrospectivos , Hemorragia Uterina , Excreción Vaginal/etiología , Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/epidemiología
8.
Obstet Gynecol ; 142(2): 350-359, 2023 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-37473411

RESUMEN

OBJECTIVE: To evaluate whether greater symptom severity can explain higher hysterectomy rates among premenopausal non-Hispanic Black compared with White patients in the U.S. South rather than potential overtreatment of Black patients. METHODS: Using electronic health record data from 1,703 patients who underwent hysterectomy in a large health care system in the U.S. South between 2014 and 2017, we assessed symptom severity to account for differences in hysterectomy rates for noncancerous conditions among premenopausal non-Hispanic Black, non-Hispanic White, and Hispanic patients. We used Poisson generalized linear mixed modeling to estimate symptom severity (greater than the 75th percentile on composite symptom severity scores of bleeding, bulk, or pelvic pain) as a function of race-ethnicity. We calculated prevalence ratios (PRs). We controlled for factors both contra-indicating and contributing to hysterectomy. RESULTS: The overall median age of non-Hispanic White (n=1,050), non-Hispanic Black (n=565), and Hispanic (n=158) patients was 40 years. The White and Black patients were mostly insured (insured greater than 95%), whereas the Hispanic patients were often uninsured (insured 58.9%). White and Black patients were mostly treated outside academic medical centers (nonmedical center: 63.7% and 58.4%, respectively); the opposite was true for Hispanic patients (nonmedical center: 34.2%). Black patients had higher bleeding severity scores compared with Hispanic and White patients (median 8, 7, and 4 respectively) and higher bulk scores (median 3, 1, and 0, respectively), but pain scores differed (median 3, 5, and 4, respectively). Black and Hispanic patients were disproportionately likely to have severe symptoms documented on two or more symptoms (referent: not severe on any symptoms) (adjusted PR [Black vs White] 3.02, 95% CI 2.29-3.99; adjusted PR [Hispanic vs White] 2.61, 95% CI 1.78-3.83). Although Black and Hispanic patients were more likely to experience severe symptoms, we found no racial and ethnic differences in the number of alternative treatments attempted before hysterectomy. CONCLUSION: We did not find evidence of overtreatment of Black patients. Our findings suggest potential undertreatment of Black and Hispanic patients with uterine-sparing alternatives earlier in their disease progression.


Asunto(s)
Enfermedades de los Genitales Femeninos , Histerectomía , Gravedad del Paciente , Femenino , Humanos , Población Negra/estadística & datos numéricos , Etnicidad , Hispánicos o Latinos/estadística & datos numéricos , Histerectomía/efectos adversos , Estados Unidos/epidemiología , Blanco/estadística & datos numéricos , Premenopausia/etnología , Adulto , Sobretratamiento , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Femeninos/etnología , Enfermedades de los Genitales Femeninos/cirugía
9.
J Low Genit Tract Dis ; 27(3): 291-296, 2023 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-37379442

RESUMEN

OBJECTIVES/PURPOSES OF THE STUDY: This study aimed to explore the relationship between female genital schistosomiasis (FGS), sexually transmitted infections, bacterial vaginosis, and yeast among young women living in Schistosoma haematobium-endemic areas. METHODS: In a cross-sectional study of young women, sexually active, aged 16 to 22 years in rural KwaZulu-Natal, South Africa, in 32 randomly selected rural schools in schistosomiasis-endemic areas, the authors performed gynecological and laboratory investigations, diagnosed FGS and other infections, and did face-to-face interviews. RESULTS: Female genital schistosomiasis was the second most prevalent current genital infection (23%), significantly more common in those who had urinary schistosomiasis (35%), compared with those without (19%, p < .001). In the FGS-positive group, 35% had human papillomavirus compared with 24% in the FGS-negative group (p = .010). In the FGS-positive group, 37% were seropositive for herpes simplex virus infection, compared with 30% in the FGS-negative group (p = .079). There were significantly fewer chlamydia infections among women with FGS (20%, p = .018) compared with those who did not have FGS (28%). CONCLUSIONS: Female genital schistosomiasis was the second most common genital infection after herpes simplex virus. Human papillomavirus infection was significantly associated with FGS, but Chlamydia was negatively associated with FGS. Women with FGS may have had more frequent contact with the health system for genital discharge. The results show the importance of the inclusion of FGS in the national management protocols for genital infections in areas endemic for S. haematobium and highlight a more comprehensive approach to diagnosis and genital disease management.


Asunto(s)
Enfermedades de los Genitales Femeninos , Esquistosomiasis Urinaria , Femenino , Adolescente , Humanos , Estudios Transversales , Sudáfrica/epidemiología , Esquistosomiasis Urinaria/complicaciones , Esquistosomiasis Urinaria/epidemiología , Esquistosomiasis Urinaria/diagnóstico , Genitales Femeninos , Genitales , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Femeninos/diagnóstico
10.
J Obstet Gynaecol Res ; 49(1): 314-320, 2023 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-36288970

RESUMEN

AIM: This study aimed to clarify the impact of coronavirus disease 2019 on gynecology practice in Japan, in particular, on surgeries for benign gynecological diseases. METHODS: An online questionnaire was distributed to 966 facilities in Japan, including core facilities, facilities participating in perinatal and gynecologic oncology registries, and facilities certified for training by the Japanese Society of Obstetrics and Gynecology Endoscopy. The number of surgeries performed was compared between 2019 and 2020, when the novel coronavirus disease was prevalent. RESULTS: Five hundred and eighty (58.2%) facilities responded. The total number of surgeries decreased from 129 648 in 2019 to 118 565 in 2020, by 8.5%, for all surgical procedures. However, there was a clear increase in the number of robotic surgeries performed in 2020 compared to that in 2019 for all populations. The number of total hysterectomies decreased markedly from 15 385 in 2019 to 12 531 in 2020, a fall of 10.1%. CONCLUSIONS: The number of surgeries for benign gynecological diseases decreased by 8.5% in 2020 compared to that in 2019. This value is among the lowest in the world.


Asunto(s)
COVID-19 , Enfermedades de los Genitales Femeninos , Ginecología , Obstetricia , Embarazo , Femenino , Humanos , Ginecología/métodos , COVID-19/epidemiología , Japón/epidemiología , Pandemias , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Femeninos/cirugía , Encuestas y Cuestionarios
11.
BMC Womens Health ; 22(1): 270, 2022 07 04.
Artículo en Inglés | MEDLINE | ID: mdl-35787274

RESUMEN

BACKGROUND: Gynecological diseases have been taken attention and studied worldwide. Although, no recent studies have delineated the magnitude of gynecological diseases among Chinese women. This study aims to evaluate the current situation of menstruation and gynecological diseases prevalence among Chinese women. METHODS: A cross-sectional study was conducted at a hospital affiliated with Nanjing medical university in Nanjing, China between September 2021 and February 2022. A sample size of 977 women aged 18-52 years participated in a face-to-face interview questionnaire. Logistic regression was performed to determine whether pubertal timing and menstrual characteristics were associated with gynecological diseases. RESULTS: The most prevalent gynecological disease was dysmenorrhea (45.96%), followed by polycystic ovary syndrome, PCOS (19.04%), uterine fibroids (14.23%), spontaneous abortion (13.20%), trouble conceiving (12.59%), ovarian dysfunction (11.16%) and endometriosis (4.09%). In the adjusted model, heavy bleeding with large clots was associated with an increased risk of dysmenorrhea (odds ratio, OR = 5.01, 95% Confidence interval, CI 2.26, 11.10; p = 0.000), while history of precocious puberty diagnosis was associated with a reduced risk of dysmenorrhea (OR = 0.50, 95%CI: 0.26, 0.94; p = 0.031). Regular menstrual cycle in the past 12 months and regular menstrual periods were associated with decreased risk of PCOS (OR = 0.44, 95%CI 0.30, 0.65; p = 0.000) and (OR = 0.52, 95%CI 0.36, 0.74; p = 0.000), respectively. Histories of early thelarche, early menarche, and precocious puberty diagnosis were associated with increased risk of ovarian dysfunction (OR = 1.96, 95%CI 1.25, 3.08, p = 0.004), (OR = 2.26, 95%CI 1.24, 4.13; p = 0.008) and (OR = 2.79, 95%CI 1.36, 5.74; p = 0.005), respectively. Heavy bleeding and heavy bleeding with large clots were associated with endometriosis (OR = 4.92, 95%CI 1.50, 16.15, p = 0.009) and (OR = 5.67, 95%CI 1.42, 22.56; p = 0.014), respectively. CONCLUSIONS: The prevalence of gynecological diseases is increasing among Chinese women and pubertal timing and menstrual characteristics may be associated with some gynecological diseases, specifically dysmenorrhea, PCOS, ovarian dysfunction, and endometriosis.


Asunto(s)
Endometriosis , Enfermedades de los Genitales Femeninos , Síndrome del Ovario Poliquístico , Pubertad Precoz , China/epidemiología , Estudios Transversales , Dismenorrea/epidemiología , Endometriosis/epidemiología , Femenino , Enfermedades de los Genitales Femeninos/epidemiología , Humanos , Menstruación , Embarazo , Prevalencia
12.
Int J Gynecol Cancer ; 32(3): 446-450, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-35256435

RESUMEN

The COVID-19 pandemic has forever affected healthcare and posed an incredible challenge to our society to care for our sick. Patients with cancer were found early on to have higher rates of complications with COVID-19. Radiation therapy is an integral part of treatment for many types of gynecologic cancer and adaptation on its utilization during the pandemic varied across the globe. In this review, we detail certain guidelines for the use of radiation in gynecologic cancers during the pandemic as well as real world accounts of how different countries adapted to these guidelines or created their own based on individualized resources, staffing, government restrictions, and societal norms. Critically, this review demonstrates the breadth of fractionation schemes and technologies used when resources were limited but highlights the importance of long term follow-up for many of our patients during this time.


Asunto(s)
Países en Desarrollo/estadística & datos numéricos , Enfermedades de los Genitales Femeninos/terapia , Radioterapia/estadística & datos numéricos , Adulto , COVID-19/prevención & control , COVID-19/transmisión , Femenino , Enfermedades de los Genitales Femeninos/epidemiología , Humanos , India/epidemiología , Internet , Persona de Mediana Edad , Radioterapia/normas , Encuestas y Cuestionarios
13.
Front Endocrinol (Lausanne) ; 12: 784195, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34917035

RESUMEN

Objective: In autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) defects in the autoimmune regulator gene lead to impaired immunotolerance. We explored the effects of immunodeficiency and endocrinopathies on gynecologic health in patients with APECED. Design: Cross-sectional cohort study combined with longitudinal follow-up data. Methods: We carried out a gynecologic evaluation, pelvic ultrasound, and laboratory and microbiologic assessment in 19 women with APECED. Retrospective data were collected from previous study visits and hospital records. Results: The study subjects' median age was 42.6 years (range, 16.7-65.5). Sixteen patients (84%) had premature ovarian insufficiency, diagnosed at the median age of 16.5 years; 75% of them used currently either combined contraception or hormonal replacement therapy. In 76% of women, the morphology and size of the uterus were determined normal for age, menopausal status, and current hormonal therapy. Fifteen patients (79%) had primary adrenal insufficiency; three of them used dehydroepiandrosterone substitution. All androgen concentrations were under the detection limit in 11 patients (58%). Genital infections were detected in nine patients (47%); most of them were asymptomatic. Gynecologic C. albicans infection was detected in four patients (21%); one of the strains was resistant to azoles. Five patients (26%) had human papillomavirus infection, three of which were high-risk subtypes. Cervical cell atypia was detected in one patient. No correlation between genital infections and anti-cytokine autoantibodies was found. Conclusions: Ovarian and adrenal insufficiencies manifested with very low androgen levels in over half of the patients. Asymptomatic genital infections, but not cervical cell atypia, were common in female patients with APECED.


Asunto(s)
Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/epidemiología , Poliendocrinopatías Autoinmunes/diagnóstico , Poliendocrinopatías Autoinmunes/epidemiología , Adolescente , Adulto , Anciano , Autoanticuerpos/sangre , Estudios de Cohortes , Estudios Transversales , Enfermedades del Sistema Endocrino/sangre , Enfermedades del Sistema Endocrino/diagnóstico , Enfermedades del Sistema Endocrino/epidemiología , Femenino , Finlandia/epidemiología , Estudios de Seguimiento , Enfermedades de los Genitales Femeninos/sangre , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Poliendocrinopatías Autoinmunes/sangre , Estudios Retrospectivos
14.
Eur J Dermatol ; 31(4): 493-498, 2021 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-34642139

RESUMEN

Psoriasis is an immune-mediated inflammatory disease and its relationship with infection has been extensively investigated. Concern for the increased prevalence of human papilloma virus (HPV) infection in patients undergoing systemic immunomodulatory or immunosuppressive therapies for psoriasis has been gradually growing among clinicians. To evaluate the prevalence of HPV in a cohort of patients with psoriasis treated with currently available systemic, conventional and biotechnological drugs. A multi-centric prospective study was conducted in the main dermatological clinical centres of central and southern Italy. Data from 588 patients (366 males and 222 females) with moderate-to-severe psoriasis, aged ≥18 years and treated with conventional and biological drugs, were collected based on a documented history of HPV infection, a positive Papanicolaou test (Pap-test) when available, and clinical evidence of genital warts reported during consultation. Overall, 18 of 588 patients (3.6% [95% CI: 1.8-4.5]) were positive for HPV or had a history of cervical cancer. Considering anamnestic and demographic data, such as gender, age, smoking, weight and body mass index, no statistically significant differences between HPV+ and HPV- patients were found. Moreover, the eradication of HPV infection was successfully achieved using conventional treatments. The prevalence of HPV infection in patients with moderate-to-severe psoriasis, undergoing systemic treatment with immunosuppressive agents or biologics, appears to be the same as that in the general Italian population, indicating that the level of infection among such patients is acceptable.


Asunto(s)
Factores Biológicos/efectos adversos , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Masculinos/epidemiología , Inmunosupresores/efectos adversos , Infecciones por Papillomavirus/epidemiología , Psoriasis/tratamiento farmacológico , Adulto , Factores Biológicos/uso terapéutico , Femenino , Enfermedades de los Genitales Femeninos/virología , Enfermedades de los Genitales Masculinos/virología , Humanos , Huésped Inmunocomprometido , Inmunosupresores/uso terapéutico , Italia/epidemiología , Masculino , Persona de Mediana Edad , Gravedad del Paciente , Prevalencia , Estudios Prospectivos , Psoriasis/inmunología , Factores de Riesgo
15.
Vet Microbiol ; 261: 109213, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34481272

RESUMEN

Bovine genital leptospirosis (BGL) is characterized by silent chronic reproductive disorders, most related to early embryonic death leading to estrus repetition, subfertility and abortions. However, most studies were conducted in slaughterhouses, which lacks reproductive and sanitary history of the studied animals. This study aimed to evaluate the occurrence of Leptospira sp. infection in live cows with history of low reproductive efficiency. Blood, urine, cervico-vaginal mucus and uterine fragment were collected from nine cows of the same herd presenting reproductive failure (abortions, estrus repetition and chronic infertility). Serology (MAT) and molecular analysis (PCR and nucleotide sequencing) were performed. Serology showed three (33.3%) seroreactive cows, two to Sejroe and one to Icterohaemorrhagiae serogroups. Six cows (66.7%) presented leptospiral DNA on genital samples, while all urine samples were negative. L. interrogans was identified in five samples, very closely related to strains from Sejroe (n = 3) and Icterohaemorrhagiae (n = 2) serogroups, while L. noguchii was identified in one sample. Results from this preliminary study demonstrates the presence of leptospires on uterus and reinforces the negative impact of leptospiral infection on reproductive tract, highlighting its association with reproductive failures on live animals.


Asunto(s)
Enfermedades de los Bovinos/epidemiología , Enfermedades de los Genitales Femeninos/veterinaria , Infertilidad/veterinaria , Leptospirosis/veterinaria , Animales , Bovinos , Enfermedades de los Bovinos/microbiología , Femenino , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Femeninos/microbiología , Infertilidad/complicaciones , Leptospira/genética , Leptospira/aislamiento & purificación , Leptospirosis/complicaciones , Leptospirosis/epidemiología , Útero/microbiología
16.
Front Endocrinol (Lausanne) ; 12: 696879, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34367069

RESUMEN

Background and Aim: Anogenital distance (AGD) can serve as a life-long indicator of androgen action in gestational weeks 8-14. AGD has been used as an important tool to investigate the exposure to endocrine-disrupting compounds in newborns and in individuals with male reproductive disorder. Endometriosis and polycystic ovary syndrome (PCOS) are two common gynecological disorders and both are related to prenatal androgen levels. Therefore, we performed a systematic review to evaluate the relationships of AGD with these gynecological disorders. Methods: PubMed, Web of Science, and Embase were searched for published studies up to January 25, 2021. No language restriction was implemented. Results: Ten studies were included in this review. Five focused on women with endometriosis, and six investigated women with PCOS. According to these studies, PCOS patients had longer AGD than controls, while endometriosis patients had shorter AGD than controls. In conclusion, this study provides a detailed and accurate review of the associations of AGD with endometriosis and PCOS. Conclusion: The current findings indicate the longer AGD was related to PCOS and shorter AGD was related to endometriosis. However, further well-designed studies are needed to corroborate the current findings.


Asunto(s)
Canal Anal/anatomía & histología , Enfermedades de los Genitales Femeninos/etiología , Genitales Femeninos/anatomía & histología , Canal Anal/patología , Pesos y Medidas Corporales , Endometriosis/epidemiología , Endometriosis/etiología , Femenino , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Femeninos/patología , Genitales Femeninos/patología , Humanos , Recién Nacido , Masculino , Enfermedades Peritoneales/epidemiología , Enfermedades Peritoneales/etiología , Síndrome del Ovario Poliquístico/epidemiología , Síndrome del Ovario Poliquístico/etiología , Embarazo , Factores de Riesgo
17.
PLoS One ; 16(6): e0252521, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34086759

RESUMEN

BACKGROUND: Gynaecological morbidities are more common than reproductive and contraceptive morbidities and constitute a substantial proportion of disease burden in women. This study aimed to examine the prevalence and factors associated with gynaecological morbidities and the treatment-seeking behaviour among adolescent girls residing in Bihar and Uttar Pradesh, India. METHODOLOGY: The study utilized data from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey with a sample size of 14,625 adolescents girls aged 10-19 years. We defined gynaecological morbidity in dichotomous form, created from five questions on different morbidities. Further, the treatment-seeking behaviour was assessed for reported gynaecological morbidities three months prior to the survey. Univariate and bivariate analysis was used to perform analysis to carve out the preliminary results. Additionally, the study employed the heckprobit selection model, a two-equation model, to identify the determinants of outcome variables. RESULTS: Overall, about one-fourth (23.6%) of the adolescent girls reported suffering from gynaecological morbidities, and only one-third of them went for treatment. Non-Scheduled Caste/Scheduled Tribe (Non-SC/ST) adolescents were significantly less likely to have gynaecological morbidities (ß: -0.12; CI: -0.18, -0.06) compared to SC/ST counterparts; however, they were more likely to go for the treatment (ß: 0.09; CI: 0.00, 0.19). The adolescents who had 8-9 (ß: 0.17; CI: 0.05, 0.29) or ten and above years of education (ß: 0.21; CI: 0.09, 0.34) had a higher likelihood of going for the treatment than adolescents with no education. Moreover, adolescents who belonged to rural areas were less likely to go for the treatment of gynaecological morbidities (ß: -0.09; CI: -0.17, -0.01) than urban counterparts. CONCLUSION: Multi-pronged interventions are the need of the hour to raise awareness about the healthcare-seeking behaviour for gynaecological morbidities, especially in rural areas. Adolescent girls shall be prioritized as they may lack the knowledge for gynaecological morbidities, and such morbidities may go unnoticed for years. Mobile clinics may be used to disseminate appropriate knowledge among adolescents and screen asymptomatic adolescents for any possible gynaecological morbidity.


Asunto(s)
Enfermedades de los Genitales Femeninos/epidemiología , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Niño , Femenino , Enfermedades de los Genitales Femeninos/psicología , Humanos , India , Morbilidad , Factores Socioeconómicos
18.
Biomed Res Int ; 2021: 6675579, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34055999

RESUMEN

BACKGROUND: Each year, not less than three million women are circumcised, and more hundred million females have already been circumcised. In many African societies, the practice of female genital mutilation (FGM) is a serious cultural practice. Aim: This current study is aimed at identifying the socioeconomic predictors of female genital mutilation in Ghana. METHODS: The design adopted for this study was a descriptive cross-sectional survey relying on data from the Ghana Multiple Indicator Cluster Survey (MICS) 2017/18. SPSS software was used for data analysis. Chi-square and binary logistic regression were used for associations. RESULTS: Overall FGM prevalence, this study recorded was 11.7%. The region with the highest (50.5%) prevalence was the Upper West Region. Area of residence predicted rural (AOR = 2.30, 95%C.I. = 1.75-3.00) Upper West/western Region (AOR = 1.84, 95%C.I. = 1.23-2.75). In terms of ethnicity, the tribes that predicted FGM when compared with the Akan tribe were Guan (AOR = 8.91, 95%C.I. = 3.53-22.51), Gruma (AOR = 6.45, 95%C.I. = 2.91-14.31), Mole-Dagbani (AOR = 38.10, 95%C.I. = 21.20-68.49), Grusi (AOR = 45.30, 95%C.I. = 24.47 - 83.49), Mande (AOR = 68.58, 95%C.I. = 30.85 - 152.42), and other tribes (AOR = 29.33, 95%C.I. = 16.11-53.39). Women in the richest/poorest wealth index quintile (AOR = 1.80, 95%C.I. = 1.19-2.72). CONCLUSION: The study prevalence of FGM is still high in the northern part of Ghana, and the predicted factors were residence region, ethnicity, educational level, and economic status.


Asunto(s)
Enfermedades de los Genitales Femeninos/epidemiología , Factores Socioeconómicos , Adolescente , Adulto , Estudios Transversales , Escolaridad , Femenino , Ghana/epidemiología , Humanos , Modelos Logísticos , Persona de Mediana Edad , Prevalencia , Población Rural , Encuestas y Cuestionarios , Adulto Joven
19.
CMAJ ; 193(21): E753-E760, 2021 05 25.
Artículo en Inglés | MEDLINE | ID: mdl-34035055

RESUMEN

BACKGROUND: Reduced use of the emergency department during the COVID-19 pandemic may result in increased disease acuity when patients do seek health care services. We sought to evaluate emergency department visits for common abdominal and gynecologic conditions before and at the beginning of the pandemic to determine whether changes in emergency department attendance had serious consequences for patients. METHODS: We conducted a population-based analysis using administrative data to evaluate the weekly rate of emergency department visits pre-COVID-19 (Jan. 1-Mar. 10, 2020) and during the beginning of the COVID-19 pandemic (Mar. 11-June 30, 2020), compared with a historical control period (Jan. 1-July 1, 2019). All residents of Ontario, Canada, presenting to the emergency department with appendicitis, cholecystitis, ectopic pregnancy or miscarriage were included. We evaluated weekly incidence rate ratios (IRRs) of emergency department visits, management strategies and clinical outcomes. RESULTS: Across all study periods, 39 691 emergency department visits met inclusion criteria (40.2 % appendicitis, 32.1% miscarriage, 21.3% cholecystitis, 6.4% ectopic pregnancy). Baseline characteristics of patients presenting to the emergency department did not vary across study periods. After an initial reduction in emergency department visits, presentations for cholecystitis and ectopic pregnancy quickly returned to expected levels. However, presentations for appendicitis and miscarriage showed sustained reductions (IRR 0.61-0.80), with 1087 and 984 fewer visits, respectively, after the start of the pandemic, relative to 2019. Management strategies, complications and mortality rates were similar across study periods for all conditions. INTERPRETATION: Although our study showed evidence of emergency department avoidance in Ontario during the first wave of the COVID-19 pandemic, no adverse consequences were evident. Emergency care and outcomes for patients were similar before and during the pandemic.


Asunto(s)
Apendicitis , COVID-19 , Colecistitis , Servicio de Urgencia en Hospital/tendencias , Utilización de Instalaciones y Servicios/tendencias , Enfermedades de los Genitales Femeninos , Aceptación de la Atención de Salud/estadística & datos numéricos , Aborto Espontáneo/diagnóstico , Aborto Espontáneo/epidemiología , Aborto Espontáneo/terapia , Adulto , Anciano , Apendicitis/diagnóstico , Apendicitis/epidemiología , Apendicitis/terapia , COVID-19/epidemiología , COVID-19/psicología , Colecistitis/diagnóstico , Colecistitis/epidemiología , Colecistitis/terapia , Estudios Transversales , Femenino , Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Femeninos/terapia , Humanos , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Pandemias , Embarazo , Embarazo Ectópico/diagnóstico , Embarazo Ectópico/epidemiología , Embarazo Ectópico/terapia , Índice de Severidad de la Enfermedad
20.
Acta Obstet Gynecol Scand ; 100(9): 1722-1729, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33797081

RESUMEN

INTRODUCTION: Hysterectomy has been one of the most common surgical procedures in women in Finland. We studied the population-based trends of hysterectomy and its indications from 1986 to 2017. MATERIAL AND METHODS: A retrospective population-based cohort was created from the Care Register for Health Care by identifying women who had a hysterectomy from 1986 to 2017 and calculating the number of women from the Digital and Population Data Services Agency. We estimated the number and incidence of hysterectomy by period and age as well as by indication. We considered the primary diagnosis at the time of surgery as the indication of hysterectomy. RESULTS: The number of hysterectomies increased from 7492 procedures in 1986 to 12 404 procedures in 1998, and reduced substantially after that to 5971 procedures in 2017, the turning point being in 1999. The incidence rate of hysterectomy has decreased on average by 2.5% annually from 432.6 per 100 000 women in 1998-2001 to 224.5 per 100 000 women in 2014-2017. The median age at the time of hysterectomy has increased from 51 years in 1998-2001 to 55 years in 2014-2017. The cumulative burden of hysterectomy by age of 60 years has nearly halved from the first 4-year period (23%) to the last (12%). After 2010, the most common indication has been genital prolapse and incontinence, whereas earlier it was uterine fibroids. CONCLUSIONS: The number and incidence of hysterectomies have fluctuated during the observation period 1986-2017 and decreased considerably during the past 17 years in Finland. This is probably a result of the availability of hormonal and other conservative treatment options for bleeding disorders and uterine fibroids. As hysterectomy practically removes the risk for endometrial cancer, the change in hysterectomy incidence over time emphasizes the importance of correcting endometrial cancer incidence according to hysterectomy incidence.


Asunto(s)
Histerectomía/tendencias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Finlandia/epidemiología , Enfermedades de los Genitales Femeninos/epidemiología , Enfermedades de los Genitales Femeninos/cirugía , Humanos , Incidencia , Leiomioma/epidemiología , Leiomioma/cirugía , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Neoplasias Uterinas/epidemiología , Neoplasias Uterinas/cirugía , Adulto Joven
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