The global burden of gynecological diseases from 1990 to 2019.

INTRODUCTION: Gynecological diseases ranked second among new cases of noncommunicable diseases in women of reproductive age in 1990 and 2019 globally. The aim of this study was to estimate the disease burden of gynecological diseases and describe their trends in women of all ages from 1990 to 2019. METHODS: Using data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we examined the incidence, disability-adjusted life years (DALYs) and deaths from gynecological diseases by age in 204 countries and territories worldwide from 1990 to 2019. Analyses were conducted in 2022. RESULTS: Globally, the age-standardized incidence rate (ASIR) and age-standardized DALY rate (ASDR) of gynecological diseases decreased by -0.176 % and -0.245 %, respectively from 1990 to 2019. Low socioeconomic development index (SDI) countries had the highest ASIR and ASDR in 2019. The age-specific incidence rate of gynecological diseases in women aged 15-29 years increased from 1990 to 2019, and the 20-24-year age group increased the greatest by 0.21%. Polycystic ovary syndrome and other types of benign disorders contributed to the major increase. CONCLUSIONS: Although the disease burden of gynecological diseases decreased slightly between 1990 and 2019 globally, it remained highest in low SDI countries. The disease burden in 20-24-year age group exhibited the fastest growth, with polycystic ovary syndrome and other types of benign disorders playing a significant role. Urgent and effective measures should be taken to target different age groups, types of gynecological disease and regions with high disease burdens.

Relationship between syncopal symptoms and head-up tilt test modes.

OBJECTIVE: Head-up tilt test (HUTT) is an important tool in the diagnosis of pediatric vasovagal syncope. This research will explore the relationship between syncopal symptoms and HUTT modes in pediatric vasovagal syncope. METHODS: A retrospective analysis was performed on the clinical data of 2513 children aged 3-18 years, who were diagnosed with vasovagal syncope, from Jan. 2001 to Dec. 2021 due to unexplained syncope or pre-syncope. The average age was 11.76 ± 2.83 years, including 1124 males and 1389 females. The patients were divided into the basic head-up tilt test (BHUT) group (596 patients) and the sublingual nitroglycerine head-up tilt test (SNHUT) group (1917 patients) according to the mode of positive HUTT at the time of confirmed pediatric vasovagal syncope. RESULTS: (1) Baseline characteristics: Age, height, weight, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and composition ratio of syncope at baseline status were higher in the BHUT group than in the SNHUT group (all P < 0.05). (2) Univariate analysis: Age, height, weight, HR, SBP, DBP, and syncope were potential risk factors for BHUT positive (all P < 0.05). (3) Multivariate analysis: syncope was an independent risk factor for BHUT positive, with a probability increase of 121% compared to pre-syncope (P<0.001). CONCLUSION: The probability of BHUT positivity was significantly higher than SNHUT in pediatric vasovagal syncope with previous syncopal episodes.

[Diagnosis of vasovagal syncope in children with postural orthostatic tachycardia syndrome].

OBJECTIVE: To study the diagnosis of vasovagal syncope (VVS) in children with postural orthostatic tachycardia syndrome (POTS). METHODS: The clinical data of 57 children with POTS diagnosed by the head-up tilt test between January 2007 and December 2010 were studied retrospectively. Of the 57 children, there were 29 boys and 28 girls who were aged from 5 to 16 years (12.2±1.9 years). RESULTS: Twenty-four (42%) out of 57 children were diagnosed with VVS by prolonging the duration of the head-up tilt test (for the children with orthostatic tolerance): cardioinhibitory (20 cases), mixed (3 cases) and vasoinhibitory (1 case). The POTS children with VVS were older than those without (13.0±1.4 years vs 11.5±2.1 years; P<0.05). There were no significant differences in gender and clinical symptoms between the POTS children with and without VVS. CONCLUSIONS: Some children with POTS may have coexisting VVS, suggesting that it is important to avoid misdiagnosis of VVS by prolonging the duration of head-up tilt test in POTS children with orthostatic tolerance. There are no obvious differences in gender and clinical symptoms between the POTS children with and without VVS.

[Differences between age and gender in patients with micturition syncope].

OBJECTIVE: To study the difference between age and gender in patients with micturition syncope (MS). METHODS: A total of 56 patients with MS were diagnosed from 1 542(3-72 years old) cases with unexplained syncope or symptoms of presyncope during micturition in our hospital. The age, onset age, positive rate of head up tilt table test (HUTT) and their correlation with age and gender were analyzed. RESULTS: The average age of patients with MS was older than that of patients with nonmicturition syncope (NMS)[5-67(35.5)years old vs. 3-72(12)years old,Z=-7.587,P<0.01]. Among the patients with MS, adults (>18 years old) were more than children (≤ 18 years old) (9.4% vs. 1.0%,χ2=65.689,P<0.01). There was gender difference in the onset rate of MS (male 5.0% vs. female 2.5%,χ 2=6.858,P<0.01). There was no difference in the positive rate of HUTT between the MS and NMS groups, and between the males and females with MS. There was no difference in age and onset age between the HUTT positive and negative group, and between the males and females. CONCLUSION: MS occurs more often in adults and males. Bezold Jazisch reflex may play a role in the mechanism of MS.