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2.
Ann Intern Med ; 175(5): JC56, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35500264

RESUMEN

SOURCE CITATION: Rubino DM, Greenway FL, Khalid U, et al. Effect of weekly subcutaneous semaglutide vs daily liraglutide on body weight in adults with overweight or obesity without diabetes: the STEP 8 randomized clinical trial. JAMA. 2022;327:138-50. 35015037.


Asunto(s)
Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Adulto , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Método Doble Ciego , Péptidos Similares al Glucagón , Humanos , Hipoglucemiantes/efectos adversos , Inyecciones Subcutáneas , Liraglutida/efectos adversos , Obesidad/complicaciones , Obesidad/tratamiento farmacológico , Sobrepeso/complicaciones , Aumento de Peso , Pérdida de Peso
3.
Ann Intern Med ; 175(7): JC79, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35785541

RESUMEN

SOURCE CITATION: Weinstein MM, Dunivan G, Guaderrama NM, et al. Digital therapeutic device for urinary incontinence: a randomized controlled trial. Obstet Gynecol. 2022;139:606-15. 35271539.


Asunto(s)
Diafragma Pélvico , Incontinencia Urinaria , Terapia por Ejercicio , Femenino , Humanos , Resultado del Tratamiento , Incontinencia Urinaria/terapia
4.
Am J Perinatol ; 40(2): 194-200, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-33882587

RESUMEN

OBJECTIVE: This study was aimed to evaluate the efficacy of the Edinburgh Postnatal Depression Scale (EPDS) in the immediate postpartum period, which we defined as between 3 and 24 hours postpartum for the purpose of this research. This is such that if it can predict scores obtained at the postpartum visit, it will be an opportunity to access psychiatric services for the patient that may otherwise be more difficult to access in the outpatient setting. STUDY DESIGN: Longitudinal observational study, which included an analysis of 848 consecutive participants screened with the EPDS in the hospital and at the 6-week postpartum visit. RESULTS: Receiver-operating characteristic (ROC) curve suggested >3 at delivery as a more optimal score to predict depression at the postpartum visit with sensitivity 76.5% and specificity 65.9%. The commonly accepted EPDS cut-off value of >9 was far less sensitive at 28.8% but reasonably specific at 93.2% for predicting elevated scores (>9) 6 weeks postpartum. In subgroup analysis, only a prior mental health disorder was found to be predictive of elevated scores at the postpartum visit (relative risk: 1.97, 95% confidence interval: 1.17-3.32, p = 0.01). CONCLUSION: The EPDS, originally designed to screen for postpartum depression (PPD) in the outpatient setting, does not predict the development of PPD, as determined by the EPDS (validated at the 6-week postpartum time interval) when administered during hospitalization shortly after delivery. KEY POINTS: · EPDS is a validated screening tool for PPD that is validated in the outpatient setting, but various guidelines are presently unclear on the exact timing for PPD screening.. · EPDS scores from 3 to 24 hours postpartum does not reliably predict elevated scores 6 weeks later.. · EPDS scores >3 from 3 to 24 hours postpartum may identify need to "rule out" PPD 6 weeks later..


Asunto(s)
Depresión Posparto , Femenino , Humanos , Depresión Posparto/diagnóstico , Depresión Posparto/psicología , Reproducibilidad de los Resultados , Tamizaje Masivo , Periodo Posparto , Escalas de Valoración Psiquiátrica
5.
Arch Sex Behav ; 51(7): 3647-3651, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-36044128

RESUMEN

The biopsychosocial etiology of gender dysphoria is poorly understood, but current thought suggests a complex interaction of genetic, hormonal, environmental, and differences in brain development and physiology. Twin studies have implicated a genetic role in the formation of gender identity. Congruence for gender dysphoria is more common among monozygotic twins compared to dizygotic twins. We present a case of monozygotic (identical) triplets who have each transitioned from female to male under the care of a university transgender health service. Each triplet experienced gender dysphoria from childhood and has undergone transitional endocrine care and various aspects of gender-affirming surgery. Although a pure genetic or biological component cannot be attributed as a cause of their gender dysphoria with absolute certainty since the triplets were raised together, this unusual case of gender dysphoria among a set of monozygotic triplets adds support for a heritable role in gender identity formation.


Asunto(s)
Disforia de Género , Personas Transgénero , Niño , Femenino , Disforia de Género/genética , Identidad de Género , Humanos , Masculino , Gemelos Dicigóticos/genética , Gemelos Monocigóticos/genética
6.
Ann Intern Med ; 174(8): JC93, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34339223

RESUMEN

SOURCE CITATION: Hillier TA, Pedula KL, Ogasawara KK, et al. A pragmatic, randomized clinical trial of gestational diabetes screening. N Engl J Med. 2021;384:895-904. 33704936.


Asunto(s)
Diabetes Gestacional , Diabetes Gestacional/diagnóstico , Femenino , Humanos , Tamizaje Masivo , Embarazo , Investigación
7.
Front Reprod Health ; 6: 1378644, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38486847

RESUMEN

Compounded bioidentical hormone therapy (cBHT) for menopausal symptoms maintains popularity in western countries despite the availability of hormone products in different formulations and dosages produced by pharmaceutical companies with federal oversight. Akin to many populist therapeutic trends in the history of medicine, cBHT advocates tend to capitalize on consumer fears about existing FDA-approved hormone treatments. Unsubstantiated, exaggerated, or outright false claims are commonplace in promoting cBHT. Given these elements, the basic elements of pharmaceutical messianism continue to drive the cBHT movement.

8.
Med Princ Pract ; 22(4): 313-22, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23328247

RESUMEN

The development of a screening test for cervical dysplasia has been a major force in diminishing the worldwide incidence of invasive cervical cancer. Screening intervals recommended by professional organizations have changed over the past half century. Recognition of the human papillomavirus (HPV) as the causative agent and enhanced understanding of the natural history of HPV and cervical dysplasia in different age groups have prompted the American College of Obstetricians and Gynecologists and other professional societies to defer Pap smear screening to intervals no less than 2 years apart in women 21-29, and every 3 years in women 30 and over assuming no prior history of cervical dysplasia. Screening should start no sooner than age 21. These recommendations more closely resemble those currently practiced in Europe and other parts of the developed world. Those who have undergone hysterectomy no longer need screening unless high-grade dysplasia was present. Although the value of pelvic examination is not debated in women with symptoms referable to the female genital tract, the endorsement by several professional societies of less than annual cervical cancer screening in healthy women also begs the question of whether annual pelvic examination (speculum and/or bimanual examination) benefits asymptomatic women. Some sexually transmitted infections are amenable to self-insertion of a vaginal probe or detectable by voided urine specimen. Bimanual examination is insensitive in detecting early ovarian cancer with a high false-positive rate leading to patient anxiety, excessive diagnostic testing, and unnecessary surgical procedures. Future study should focus on the frequency in which healthy asymptomatic women should undergo pelvic examination.


Asunto(s)
Examen Ginecologíco , Tamizaje Masivo , Neoplasias del Cuello Uterino/diagnóstico , Detección Precoz del Cáncer , Femenino , Humanos , Histerectomía , Menopausia , Infecciones por Papillomavirus/diagnóstico , Vacunas contra Papillomavirus , Guías de Práctica Clínica como Asunto , Displasia del Cuello del Útero/virología , Neoplasias del Cuello Uterino/virología , Frotis Vaginal
9.
BMJ Case Rep ; 16(11)2023 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-37945276

RESUMEN

A postpartum patient presented 1 week following uncomplicated pregnancy and elective repeat caesarean section with acute hypertension, severe anaemia and acute kidney injury. Her workup demonstrated microangiopathic anaemia, thrombocytopenia and liver enzyme elevations. Differential diagnoses included postpartum haemolysis-elevated liver enzyme-low platelet (HELLP) syndrome, haemolytic uraemic syndrome (HUS), and thrombotic thrombocytopenic purpura (TTP). She was treated initially with systemic corticosteroids, haemodialysis and plasmapheresis for presumed TTP while awaiting the results of ADAMSTS13 assay performed at an outside laboratory. When reported back as normal, the diagnosis of atypical HUS was established. Eculizumab was administered with rapid improvement of her condition.


Asunto(s)
Anemia Hemolítica , Síndrome Hemolítico Urémico Atípico , Púrpura Trombocitopénica Trombótica , Trombocitopenia , Femenino , Humanos , Embarazo , Anemia Hemolítica/complicaciones , Síndrome Hemolítico Urémico Atípico/complicaciones , Síndrome Hemolítico Urémico Atípico/diagnóstico , Síndrome Hemolítico Urémico Atípico/terapia , Cesárea/efectos adversos , Periodo Posparto , Púrpura Trombocitopénica Trombótica/terapia , Trombocitopenia/complicaciones , Adulto
10.
Case Rep Womens Health ; 37: e00478, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36636108

RESUMEN

A 60-year-old woman was referred for progressive and severe vulvovaginal pain characterized by erosions and Wickham's stria for the past 7 months. Her condition had not responded to oral fluconazole, topical estrogen cream, and topical clobetasol cream. Vulvar and vaginal biopsies were obtained under general anesthesia to verify the diagnosis of erosive lichen planus given the failed response to ultrapotent topical steroids. Tacrolimus cream was added but not tolerated. Oral and cutaneous lesions of lichen planus also developed. In the absence of evidence-based guidelines, three different systemic treatments were administered sequentially (hydroxychloroquine, mycophenolate, and finally cyclosporin) before a satisfactory, well-tolerated, and sustained clinical response was obtained. Topical betamethasone ointment in a taper was continued to assist in sustaining a vulvovaginal response after cyclosporin was discontinued.

12.
Case Rep Womens Health ; 34: e00398, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35242597

RESUMEN

BACKGROUND: Septic abortion with multisystem involvement is associated with significant morbidity and mortality. Access to care and legalization of abortion have greatly diminished the incidence of serious sequelae worldwide. Two complications, infective endocarditis and septic arthritis, are rarely encountered in contemporary practice. CASE: A 30-year-old woman developed infective endocarditis, septic arthritis, and reactive arthritis concurrently one week after undergoing dilation and curettage for an incomplete abortion with perioperative administration of doxycycline. She required systemic antibiotics, drainage and debridement of her right ankle, and a robotic-assisted mitral valve replacement due to septic vegetation. CONCLUSION: Septic abortion with life-threatening systemic complications is rarely encountered in modern practice. Prompt surgical uterine evacuation and broad-spectrum antibiotics are indicated to prevent systemic complications. Multispecialty consultation is usually required when endocarditis, arthritis, and other systemic complications are encountered.

13.
J Pediatr Adolesc Gynecol ; 35(6): 710-714, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35820603

RESUMEN

BACKGROUND: Diaper (irritative) dermatitis is commonly encountered in pediatric practice. In severe cases, unusual lesions could mimic other vulvar dermatoses or sexually transmitted infections. CASE: A 4-year-old female refugee with urinary and fecal incontinence was referred for medicolegal evaluation (concern for childhood sexual abuse) due to presence of diffuse vulvar, perineal, and perianal lesions. Evaluation and histology were consistent with pseudoverrucous papules and nodules. Resolution occurred following frequent diaper changes and application of a protective ointment. DISCUSSION: Pseudoverrucous papules and nodules are a rare complication of irritative diaper dermatitis with variable appearance. Urinary or fecal incontinence are primary risk factors that should raise suspicion among clinicians when atypical genital or buttocks lesions appear. Biopsy is not always necessary but could be warranted when the diagnosis is uncertain or if childhood sexual abuse is suspected.


Asunto(s)
Dermatitis del Pañal , Incontinencia Fecal , Femenino , Humanos , Niño , Preescolar , Incontinencia Fecal/complicaciones , Dermatitis del Pañal/diagnóstico , Dermatitis del Pañal/etiología
14.
Acta Obstet Gynecol Scand ; 90(5): 452-8, 2011 May.
Artículo en Inglés | MEDLINE | ID: mdl-21306320

RESUMEN

OBJECTIVE: Hypomagnesemia is associated with diabetes mellitus type 2 and other components of the metabolic syndrome in older patients. Whether serum magnesium concentrations correlate with insulin resistance, obesity, hypertension, dyslipidemia, or other components of metabolic syndrome in younger women with polycystic ovary syndrome (PCOS) is currently unknown. DESIGN: Cross-sectional analysis. SETTING: Academic medical center. POPULATION: 100 consecutive women with PCOS by the Rotterdam criteria and 20 age- and BMI-matched normal women. METHODS: Statistical analysis of the relationship between magnesium levels and a variety of physical, endocrine, and metabolic variables. The STROBE guidelines for a cross-sectional analysis were followed. MAIN OUTCOME MEASUREMENTS: Serum magnesium levels, insulin sensitivity indices, and glucose assessments. BMI, waist circumference, blood pressure, and lipids served as secondary endpoint measurements. RESULTS: No patient demonstrated hypomagnesemia. Magnesium levels did not differ between women with and those without insulin resistance, glucose intolerance, or hypertension. Magnesium levels were similar across PCOS phenotypes and WHO-defined BMI categories. Multiple regression analysis did not suggest that serum magnesium concentrations correlated with any physical, metabolic, or endocrine variable. CONCLUSIONS: Magnesium levels do not correspond with age, BMI, waist circumference, insulin sensitivity, glycemic levels, blood pressure, or lipid levels in reproductive-age women with PCOS. Magnesium concentrations are similar across PCOS phenotypes and indistinguishable from women without PCOS.


Asunto(s)
Intolerancia a la Glucosa/sangre , Hipertensión/sangre , Resistencia a la Insulina , Magnesio/sangre , Obesidad/sangre , Síndrome del Ovario Poliquístico/sangre , Adulto , Biomarcadores/sangre , Glucemia/metabolismo , Presión Sanguínea , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Lípidos/sangre , Obesidad/complicaciones , Síndrome del Ovario Poliquístico/complicaciones , Estudios Prospectivos , Circunferencia de la Cintura
15.
Sex Med ; 9(6): 100431, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34601429

RESUMEN

INTRODUCTION: Clitoral priapism due to venous outflow obstruction is a rare event and medical emergency. Androgen-induced clitoromegaly in transgender men has not been previously identified as a risk factor. AIMS: Advance current knowledge on identification and treatment of clitoral priapism in the transgender male. METHODS: A 32 year-old presurgical transgender male underwent gender-affirming laparoscopic total hysterectomy and bilateral salpingo-oöphorectomy without incident. Seven days postop, he developed progressive and painful clitoral engorgement that was persistent. Examination and imaging were consistent with clitoral priapism. RESULTS: Clitoral priapism was treated with adrenergic drugs (imipramine and pseudoephedrine) with rapid resolution of symptoms. CONCLUSION: Clitoral priapism is a rare phenomenon usually associated with use of a psychotropic medication. Whether clitoromegaly secondary to androgen administration in transgender men is a risk factor for this rare medical emergency is unknown. Prompt recognition and treatment is paramount. Kusko RE, Singhal E, Kauffman RP. Clitoral Priapism in a Transgender Male. Sex Med 2021;9:100431.

16.
Mol Cell Endocrinol ; 525: 111181, 2021 04 05.
Artículo en Inglés | MEDLINE | ID: mdl-33529690

RESUMEN

Premenopausal breast cancer is usually estrogen receptor positive, and hence, prolonged ovarian suppression by medical or surgical means to prevent recurrence has become standard of management to improve disease-free survival. Ten-year adjuvant tamoxifen therapy is associated with 3.5% fewer recurrences compared to five years. The SOFT trial demonstrated small but statistically significant incremental improvements in long-term disease-free survival by the addition of gonadotropin-releasing hormone analog treatment (triptorelin) to an aromatase inhibitor (exemestane). Profound hypoestrogenism in the premenopausal age group may not be well tolerated due to a host of bothersome side effects (primarily vasomotor symptoms, musculoskeletal complaints, genitourinary syndrome of menopause, and mood disorders). Prolonged hypoestrogenism in younger women is associated with premature development of cardiovascular disease, bone loss, cognitive decline, and all-cause mortality. This paper explores multi-system consequences of prolonged hypoestrogenism in premenopausal women derived from studies of women with and without breast cancer. Pretreatment counseling in estrogen receptor positive breast cancer should emphasize the benefit of prolonged estrogen suppression on breast cancer recurrence and established risks of lifelong hypoestrogenism on quality of life and all-cause mortality. Future genomic research may help identify the best candidates for extended ovarian suppression to avoid treating many women when only a minority benefit.


Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Estrógenos/metabolismo , Recurrencia Local de Neoplasia/patología , Ovario/patología , Femenino , Humanos , Modelos Biológicos , Factores de Riesgo
17.
Gynecol Endocrinol ; 26(1): 39-46, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20001571

RESUMEN

OBJECTIVE: To characterise the metabolic profile of women with polycystic ovary syndrome (PCOS) and non-alcoholic fatty liver disease (NAFLD) and to determine whether circulating androgens differ in PCOS women with NAFLD compared to PCOS subjects without NAFLD. METHODS: Retrospective study of 21 women with PCOS, elevated liver enzymes and ultrasound evidence of hepatic steatosis matched with 32 PCOS women with normal liver enzymes. Extensive demographic, endocrine and metabolic data were compared. Pearson's correlation coefficients were calculated to assess for potential relationships between the free androgen index (FAI) and other dependent variables. RESULTS: PCOS subjects with NAFLD demonstrate greater insulin resistance but have similar circulating androgen levels. CONCLUSION: In this pilot study, insulin resistance was the most prominent feature characterising NAFLD complicating PCOS. Total testosterone, FAI, DHEAS and 17-hydroxyprogesterone levels were similar between patients with PCOS and without NAFLD.


Asunto(s)
Hígado Graso/metabolismo , Hiperandrogenismo/metabolismo , Síndrome del Ovario Poliquístico/metabolismo , 17-alfa-Hidroxiprogesterona/sangre , Sulfato de Deshidroepiandrosterona/sangre , Hígado Graso/sangre , Hígado Graso/complicaciones , Femenino , Humanos , Hiperandrogenismo/sangre , Hiperandrogenismo/complicaciones , Insulina/sangre , Resistencia a la Insulina/fisiología , Proyectos Piloto , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/complicaciones , Prolactina/sangre , Estudios Retrospectivos , Globulina de Unión a Hormona Sexual/metabolismo , Estadísticas no Paramétricas , Testosterona/sangre , Tirotropina/sangre
18.
BMJ Case Rep ; 13(2)2020 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-32041752

RESUMEN

A 21-year-old first trimester primagravida woman with hyperemesis gravidarum was noted to have incidental subcutaneous emphysema during thyroid ultrasound. Follow-up radiograph demonstrated supraclavicular subcutaneous emphysema, left apical pneumothorax and pneumomediastinum. The patient was transferred to the intensive care unit and evaluated for esophageal rupture. Because no defects were seen on swallow studies/endoscopy and the patient was stable, she was treated conservatively with antibiotics and monitored. The patient's condition improved, and she was discharged on hospital day 6. Subcutaneous emphysema secondary to hyperemesis gravidarum is a rare but potentially life-threatening condition in which the source of the mediastinal leak needs to be immediately determined. After the more serious sources of mediastinal air have been excluded, conservative management is suitable.


Asunto(s)
Hiperemesis Gravídica/diagnóstico , Enfisema Mediastínico/etiología , Neumotórax/etiología , Enfisema Subcutáneo/etiología , Adulto , Perforación del Esófago , Femenino , Humanos , Hiperemesis Gravídica/complicaciones , Embarazo , Primer Trimestre del Embarazo , Radiografía
19.
BMJ Case Rep ; 13(10)2020 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-33040036

RESUMEN

A 21-year-old G3P2011 Caucasian woman at 27 weeks' gestation presented with fetal tachyarrhythmia between 240 and 270 beats per minute. Fetal supraventricular tachycardia, abdominal ascites, pleural effusion and pericardial effusion indicated hydrops fetalis. Management with digoxin and flecainide converted the fetus to sinus rhythm and resolved the ascites and pleural effusion within 4 days of treatment. Flecainide was discontinued at 31 weeks' gestation due to elevated liver enzymes. Intrahepatic cholestasis was treated with ursodiol. Caesarean section was performed at 37 weeks' gestation. Neonatal echocardiogram revealed a bicuspid aortic valve with mild regurgitation and a patent foramen ovale, and the infant showed no subsequent evidence of tachyarrhythmia or hydrops after delivery. Treatment of hydrops fetalis in the antenatal period is complex, and early diagnosis and treatment can quickly resolve supraventricular tachycardia-induced hydrops fetalis.


Asunto(s)
Antiarrítmicos/uso terapéutico , Terapias Fetales/métodos , Hidropesía Fetal/tratamiento farmacológico , Taquicardia Supraventricular/tratamiento farmacológico , Cesárea , Digoxina/uso terapéutico , Ecocardiografía , Femenino , Flecainida/uso terapéutico , Humanos , Hidropesía Fetal/diagnóstico , Hidropesía Fetal/etiología , Embarazo , Taquicardia Supraventricular/complicaciones , Taquicardia Supraventricular/diagnóstico , Resultado del Tratamiento , Ultrasonografía Prenatal , Adulto Joven
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