Period Poverty: Surveying the Prevalence in Toledo-Area Schools.

Background: The lack of access to period products, which has been colloquially termed "period poverty," is a problem that millions of people face worldwide. Investigators have found that period poverty is a pervasive issue in the United States, despite its status as a high resource country. The purpose of this study was to determine the prevalence of period poverty in school-aged adolescents in Toledo, Ohio. Methods: This study used an observational cross-sectional design and was approved by the institutional review board. Participants completed a survey that assessed their access to period products, their level of understanding about their sexual/menstrual health, their feelings toward menstruation, and the perceived impact of periods on their lives. Results: Younger students were more likely to miss school due to lack of period products (p = 0.0084). To the question "Why don't you have pads or tampons?" 36.2% expressed financial concerns and 18.3% reported inadequate transportation. When asked whether students ever had to miss school due to their cycle, 9.4% identified a lack of products as their reason. Participants also reported high rates of absence from sports, work, spending time with family/friends, and theater/music practice due to their menstrual period. Discussion: As people across the globe experience period poverty, our study demonstrates evidence of this phenomenon among Toledo adolescents. Owing to the lack of access to menstrual hygiene products, students report repurposing miscellaneous items in place of pads or tampons, missing school or work, and associating negative connotations with their cycles.

A narrative review of the pharmaceutical management of osteoporosis.

Background and Objective: Osteoporosis is a skeletal disorder classified by the loss of bone density in older adults leading to compromised bone strength and an increased risk of fracture. It can be divided into categories based on its etiology: senile, post-menopausal, and secondary osteoporosis. Specific prevention measures and treatments exist for targeting bone loss. Here we review and summarize the literature regarding the presentation of osteoporosis and discuss pharmaceutical therapies. Methods: PubMed and Google Scholar were searched for articles published in English between 1980 and 2021. Search terms combined "senile osteoporosis", "osteoporosis treatment", "osteoporosis", "bisphosphonates", "denosumab", types of hormone therapy, and other relevant keywords used in various combinations. Key Content and Findings: Osteoporosis affects millions but often goes undiagnosed until a pathologic fracture. Dual-energy X-ray absorptiometry (DEXA) scans evaluate bone mineral density (BMD) and are a diagnostic tool for osteoporosis. Adults over the age of 65, post-menopausal women, and those with risk factors such as previous fractures are recommended to receive DEXA scans every one to two years. Bisphosphonates, denosumab, and hormonal therapies are among the most common pharmacologic treatments for osteoporosis. Conclusions: Daily, orally administered bisphosphonates are the first-line therapy for osteoporosis given their efficacy in decreasing fracture risk and favorable safety profile. Denosumab is an alternative that is administered subcutaneously every six months and may be given as initial therapy to select patients. Hormonal therapies are used if patients cannot tolerate bisphosphonates or denosumab or are refractory to these medications. Preventative measures for osteoporosis include tailored exercise and sufficient intake of calcium and vitamin D via diet or supplementation.

Spondylodiscitis secondary to Mycobacterium chelonae: a case report.

Background: Spondylodiscitis secondary to Mycobacterium chelonae (M. chelonae) is a rare primary infection of the spine, with a few case reports highlighted. Treatment of this infection is not well established but here we discuss a case where a patient recovered well following early aggressive surgical intervention and antibiotic treatment. Case Description: A 32-year-old male presented with a 3-month history of worsening low back pain, Horner's syndrome, dysphagia, lower extremity weakness, and a 5-day history of bowel and bladder incontinence. The patient had an extensive orthopedic history but no recent trauma or history of spinal surgery. He had no known prior medical conditions that would suggest immunocompromise. Magnetic resonance imaging (MRI) scan showed lumbar spondylodiscitis, and blood cultures did not show any growth. The patient underwent L4-S1 decompression and fusion with iliac crest bone grafting, and intraoperative biopsy. Intraoperative tissue cultures grew M. chelonae. Repeat computerized tomography (CT)-guided biopsy confirmed the pathogen. The patient was initially treated with vancomycin and piperacillin-tazobactam. Numerous alterations in antibiotic regimen occurred secondary to medication adverse effects and noncompliance, and he was ultimately treated with azithromycin and tigecycline. Interval follow-up demonstrated gradual improvement of bilateral lower extremity strength and return of bowel and bladder function. Follow-up at 16 months post-operatively demonstrated significant improvement in pain and neurological symptoms, with no signs of infection recurrence. Conclusions: This case demonstrates the importance of aggressive surgical management of M. chelonae spondylodiscitis. Early aggressive surgical management in combination with antibiotics may improve clinical outcomes for these patients.