Apparent autistic traits in transgender people: a prospective study of the impact of gender-affirming hormonal treatment.

PURPOSE: We evaluated differences in Autism Spectrum Quotient (AQ) scores between a sample of hormone-naïve transgender and cisgender people and the impact of gender-affirming hormonal treatment (GAHT) on AQ scores across time. Furthermore, we assessed alexithymia and social anxiety as possible mediators of changes in AQ scores. METHODS: A cross-sectional comparison between cisgender and transgender people before GAHT and a prospective study on the effects of GAHT over time were performed. Transgender and cisgender people completed several psychometric tests. A total sample of 789 persons (n = 229 cismen; n = 172 ciswomen; n = 206 transmen; n = 182 transwomen) referring to the Florence and Rome Gender Clinics between 2018 and 2020 was enrolled. Of these, 62 participants referring to the Florence Gender Clinic were evaluated in a prospective study at baseline and 12 months after GAHT. RESULTS: Groups showed significant differences in terms of autistic traits: ciswomen showed lower scores of AQ, while cismen reported higher scores of AQ than all other groups. Transgender individuals showed significant higher levels of Gender Dysphoria (GD), body uneasiness, alexithymia and social anxiety, compared to cisgender ones. No significant differences in general psychopathology were found between groups. Across time, transmen and transwomen showed a significant reduction in AQ scores. The decrease in alexithymia and social anxiety after GAHT did not predict the change in AQ scores. CONCLUSIONS: The autistic traits in our sample may represent an epiphenomenon of GD rather than being part of an Autism Spectrum Disorder (ASD) condition, since they significantly decreased after 12 months of GAHT.

SIGIS-SIAMS-SIE position statement of gender affirming hormonal treatment in transgender and non-binary people.

PURPOSE: Gender Incongruence (GI) is a marked and persistent incongruence between an individual's experienced and the assigned gender at birth. In the recent years, there has been a considerable evolution and change in attitude as regards to gender nonconforming people. METHODS: According to the Italian Society of Gender, Identity and Health (SIGIS), the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE) rules, a team of experts on the topic has been nominated by a SIGIS-SIAMS-SIE Guideline Board on the basis of their recognized clinical and research expertise in the field, and coordinated by a senior author, has prepared this Position statement. Later on, the present manuscript has been submitted to the Journal of Endocrinological Investigation for the normal process of international peer reviewing after a first internal revision process made by the SIGIS-SIAMS-SIE Guideline Board. RESULTS: In the present document by the SIGIS-SIAMS-SIE group, we propose experts opinions concerning the psychological functioning, gender affirming hormonal treatment, safety concerns, emerging issues in transgender healthcare (sexual health, fertility issues, elderly trans people), and an Italian law overview aimed to improve gender non-conforming people care. CONCLUSION: In this Position statement, we propose experts opinions concerning the psychological functioning of transgender people, the gender-affirming hormonal treatment (full/partial masculinization in assigned female at birth trans people, full/partial feminization and de-masculinization in assigned male at birth trans people), the emerging issues in transgender health care aimed to improve patient care. We have also included an overview of Italian law about gender affirming surgery and registry rectification.

Transition memories: experiences of trans adult women with hormone therapy and their beliefs on the usage of hormone blockers to suppress puberty.

PURPOSE: In recent years, an increasing number of specialized gender clinics have been prescribing gonadotropin-releasing hormone (GnRH) analogs to adolescents diagnosed with gender dysphoria (GD) to suppress puberty. This paper presents qualitative research on the hormone therapy (HT) experiences of older trans-people and their views on puberty suppression. The main aim of this research was to explore the psychological aspects of hormonal treatments for gender non-conforming adults, including the controversial use of puberty suppression treatments. METHODS: Using a semi-structured interview format, ten adult trans-women were interviewed (mean age: 37.4) to explore their personal histories regarding GD onset and development, their HT experiences, and their views on the use of GnRH analogs to suppress puberty in trans-children and adolescents. RESULTS: the interview transcripts were analyzed using the consensual qualitative research method from which several themes emerged: the onset of GD, childhood experiences, experiences with puberty and HT, views on the puberty suspension procedure, and the effects of this suspension on gender identity and sexuality. CONCLUSIONS: The interviews showed that overall, the participants valued the new treatment protocol due to the opportunity to prevent the severe body dysphoria and social phobia trans-people experience with puberty. It seems that the risk of social isolation and psychological suffering is increased by the general lack of acceptance and stigma toward trans-identities in the Italian society. However, during gender transitions, they highlight the need to focus more on internal and psychological aspects, rather than over-emphasize physical appearance. This study gives a voice to an under-represented group regarding the use of GnRH analogs to suppress puberty in trans-individuals, and collected firsthand insights on this controversial treatment and its recommendations in professional international guidelines.

In vitro toxicity towards kiwifruit pollen of the antimicrobial peptides magainins 1 and 2.

In vitro toxicity of the antimicrobial peptides (AMPs) magainin 1 and 2 to a higher plant organism, i.e., the bicellular male gametophyte of Actinidia Deliciosa (kiwifruit), is investigated. Heavy damage to the plasma membrane, the primary cellular target of the peptides, was rapidly induced: in as few as 15 min, from 70 to nearly 100 % of pollen grains were rendered unviable by 20 microM magainin 1 or 2, respectively. Therefore, kiwifruit pollen sensitivity to natural magainins seemed to be higher if compared to the sensitivity of other pollen species towards magainin 2 amide or synthetic magainin analogues. Strong dose-dependent inhibitory effects on kiwifruit pollen performance were registered: as for magainin 1, the EC (50) at 120 min varied from 14.0 (germination) to 15.8 microM (tube elongation). The inhibitory effect was much greater when administering magainin 1 to elongating tubes rather than to ungerminated pollen grains. The two peptides differentially affected kiwifruit pollen, in line with the previously documented greater activity of magainin 2 in other cell systems. Furthermore, 20 microM magainin 1-treated pollen grains took on a shrivelled shape within 30 min of incubation, an increasingly widespread effect with higher peptide concentration. At the ultrastructural level, both protoplast shrinkage and striking organelle alterations were evident, including chromatin condensation, swelling and loss of mitochondrial cristae, dilation of rough endoplasmic reticulum cisternae, and vacuolization of cytoplasm. To our knowledge, similar alterations in animal or plant cells treated with AMPs have not been described yet.

Enfermedad inflamatoria intestinal crónica en pediatría: manifestaciones sistémicas y extradigestivas / Chronic inflamatory intestinal disease in children: Systemic and extradigestive manifestations

Se denomina Enfermedad Inflamatoria Intestinal Crónica (EIIC) a la colitis ulcerosa (CU) a la enfermedad de Crohn y a un tercer grupo, la colitis indeterminada (CI). Los avances de los métodos diagnósticos: técnicas de laboratorio, estudios radiológicos, endoscopía y anatomía patológica, permiten reconocer y precisar el diagnóstico de EIIC, en sus tres formas. Las manifestaciones sistémicas y extradigestivas son frecuentes, pudiendo preceder a los síntomas gastrointestinales, coincidir con ellos o presentarse después de larga evolución. El objetivo de este estudio fue evaluar las manifestaciones sistémicas y extradigestivas de esta enfermedad para alertar a los pediatras y facilitar su diagnóstico. Se analizaron 146 historias clínicas de niños co EIIC atendidos en el consultorio interdisciplinario del Hospital Juan P Garrahan entre marzo de 1990 y marzo de 2002. Se analizaron las siguientes variables al momento del diagnóstico: sexo, edad, tipo de enfermedad inflamatoria intestinal ; manifestaciones sistémicas: desnutrición, hipoalbuminemia, anemia, eritrocedimentación acelerada ; manifestaciones extradigestivas: articulares, hepatobiliares, mucocutáneas, renales y pulmonares. Resultados: 115 pacientes correspondieron a CU (78.7 por ciento), 16 a EC (11 por ciento) y 15 a CI (10.3 por ciento). La edad media al diagnóstico fue de 12 años (rango 0.5-16 años). Mujeres 52.7 por ciento y varones 47.3 por ciento. El 63.7 por ciento de los pacientes presentaron manifestaciones sistémicas y/o extradigestivas.El compromiso nutricional se presentó en el 32.1 por ciento, siendo más frecuente en la EC. Las manifestaciones extradigestivas se hallaron en el 70/146 pacientes. Su distribución fue: 22.6 por cientoarticular, 15 por ciento hepatobiliar, 8.2 por ciento mucocutánea, 1.4 por ciento renal y 0.7 por ciento pulmonar. Las manifestaciones sistémicas y extradigestivas precedieron al diagnóstico de EIIC en el 25.8 por ciento de los pacientes, coincidieron con el 50 por ciento y aparecieron en el transcurso de la evolución en el 24.2 por ciento Conclusión: La EIIC requiere un alto índice de sospecha, el pediatra debe estar atento a los síntomas y signos clínicos y las alteraciones del laboratorio para realizar la consulta o la derivación oportuna a centros pediátricos de mayor complejidad

Enfermedad inflamatoria intestinal crónica en pediatría: manifestaciones sistémicas y extradigestivas / Chronic inflamatory intestinal disease in children: Systemic and extradigestive manifestations

Se denomina Enfermedad Inflamatoria Intestinal Crónica (EIIC) a la colitis ulcerosa (CU) a la enfermedad de Crohn y a un tercer grupo, la colitis indeterminada (CI). Los avances de los métodos diagnósticos: técnicas de laboratorio, estudios radiológicos, endoscopía y anatomía patológica, permiten reconocer y precisar el diagnóstico de EIIC, en sus tres formas. Las manifestaciones sistémicas y extradigestivas son frecuentes, pudiendo preceder a los síntomas gastrointestinales, coincidir con ellos o presentarse después de larga evolución. El objetivo de este estudio fue evaluar las manifestaciones sistémicas y extradigestivas de esta enfermedad para alertar a los pediatras y facilitar su diagnóstico. Se analizaron 146 historias clínicas de niños co EIIC atendidos en el consultorio interdisciplinario del Hospital Juan P Garrahan entre marzo de 1990 y marzo de 2002. Se analizaron las siguientes variables al momento del diagnóstico: sexo, edad, tipo de enfermedad inflamatoria intestinal ; manifestaciones sistémicas: desnutrición, hipoalbuminemia, anemia, eritrocedimentación acelerada ; manifestaciones extradigestivas: articulares, hepatobiliares, mucocutáneas, renales y pulmonares. Resultados: 115 pacientes correspondieron a CU (78.7 por ciento), 16 a EC (11 por ciento) y 15 a CI (10.3 por ciento). La edad media al diagnóstico fue de 12 años (rango 0.5-16 años). Mujeres 52.7 por ciento y varones 47.3 por ciento. El 63.7 por ciento de los pacientes presentaron manifestaciones sistémicas y/o extradigestivas.El compromiso nutricional se presentó en el 32.1 por ciento, siendo más frecuente en la EC. Las manifestaciones extradigestivas se hallaron en el 70/146 pacientes. Su distribución fue: 22.6 por cientoarticular, 15 por ciento hepatobiliar, 8.2 por ciento mucocutánea, 1.4 por ciento renal y 0.7 por ciento pulmonar. Las manifestaciones sistémicas y extradigestivas precedieron al diagnóstico de EIIC en el 25.8 por ciento de los pacientes, coincidieron con el 50 por ciento y aparecieron en el transcurso de la evolución en el 24.2 por ciento Conclusión: La EIIC requiere un alto índice de sospecha, el pediatra debe estar atento a los síntomas y signos clínicos y las alteraciones del laboratorio para realizar la consulta o la derivación oportuna a centros pediátricos de mayor complejidad

Fallo hepático fulminante por hepatitis a: evolución y costos / Fulminant liver failure caused by hepatitis A: outcome and cost

La hepatitis A (HA) es una de las enfermedades inmunoprevenibles más frecuente, constituye actualmente en nuestro país un grave problema de la Salud Pública, por su alta incidencia 40/100.000 habitantes según informe del SINAVE 2002. La complicación más severa es el fallo Hepático fulminante (FHF), emergencia médica que se presenta en el 1/1000 de los pacientes sintomáticos infectados por virus de hepatitis A (VHA). Las tasas de morbimortalidad del FHF continúan siendo altas, lo que genera importantes costos. Nuestro objetivo fue analizar características, evolución y costos de la población internada por FHF secundario a VHA con indicación de trasplante hepático (TXH) en el Hospital de Pediatría Juan P. Garrahan, en el período comprendido entre noviembre de 1992 a junio de 2003. Se analizó: Lugar de procedencia, edad, días de internación en cuidados intermedios (CIM) y/o intensivos (UCI) y evolución. Los costos se obtuvieron del Departamento de Costos del hospital. Para evaluar el tiempo perdido por muerte prematura, utilizamos el cálculo de los años de vida potencial perdidos. Durante el período de estudio se realizaron 308 trasplantes hepáticos. Fueron asistidos por Falla Hepática Fulminante 145 pacientes (p) de ellos el 58 por ciento (p:84) fueron Hepatitis por Virus de Hepatitis A. La edad media de los niños fue de 4.6 años (1a-11a). Los datos de la evolución fueron: el 20 por ciento (n:17) fallecieron en lista de espera de emergencia, el 11 por ciento (n:9). la función hepática se recuperó antes que el injerto apareciera, el 69% (n:58) fueron trasplantados. El TXH se realizó con donante cadavérico en el 90% (n:52) de los casos, se utilizó donante vivo relacionado en el 10 por ciento (n:6). Requirieron retrasplante el (19 por ciento) (n: 11). La mortalidad del FHF por VHA fue del 38 por ciento (n:32). La mortalidad por trasplante hepático fue del 26 por ciento (n:15). Los años perdidos por muerte prematura fueron 2.275 años.

Internal working models of attachment during late childhood and early adolescence: an exploration of stability and change.

This article addresses the question of how the transition from late childhood to early adolescence influences the organization of attachment. The applicability of a measure for attachment representations in early adolescence, the Attachment Interview for Childhood and Adolescence (AICA), was explored. The AICA is based on the Adult Attachment Interview, which was adapted in minor ways to the early adolescent age-group. It was hypothesized that attachment shows considerable stability from late childhood to early adolescence, although some changes might become manifest especially because distancing mechanisms toward the parents may be activated in this period. Also, stability may be different for the various secure and insecure attachment classifications. Lastly, because gender differences become larger during the transition from childhood to adolescence, attachment differences between boys and girls were explored. The same 31 Italian participants (14 girls, 17 boys) completed the AICA at 10 years and at 14 years of age. The AICA attachment classification distributions did not differ from Adult Attachment Interview (AAI) distributions in comparable but older adolescent or young adult samples. The stability of attachment security was considerable: 74% (k = .48). The stability of the dismissing and secure categories was somewhat higher than the stability of the (small) preoccupied and unresolved categories. The participants tended to show more dismissing strategies across the four years, and to report more rejection from their parents. It was suggested that the activation of dismissing defense mechanisms might be necessary to keep parental figures at some distance in order to achieve a more definite personal identity. Finally, no significant gender differences in attachment emerged during the transition from late childhood to early adolescence.