Systematic Review: Puberty suppression with GnRH analogues in adolescents with gender incongruity.

CONTEXT: Gender incongruence is defined as disharmony between assigned gender and gender identity. Several interventions are liable in this case including genital affirming surgery among other surgical interventions such as harmonization, and also the use of gonadotropin-releasing hormone agonists (GnRHa) for gonadal shielding. This aids in preventing the development of secondary sexual characteristics related to the genetic sex. OBJECTIVE: Systematically review the treatment of gender incongruity with GnRHa analogues. DATA SOURCES: The data source of this research is from Pubmed-Medline and Embase. STUDY SELECTION: Articles published between 2009 and 2019 which studied transgender adolescents treated with GnRHa were carefully selected. DATA EXTRACTION: Were extracted: design, sample size, study context, targeted subjects of intervention, outcome measures, and results. RESULTS: Eleven studies were included. The use of GnRHa seems to be well tolerated by the studied population. When started in pubertal transition, it was associated with a more distinct resemblance to body shape than to the affirmed sex. In addition to preventing the irreversible phenotypic changes that occur in cross-hormonal therapy, the use of GnRHa can equally contribute to the mental health of these adolescents. LIMITATION: There are few consistent studies on the use of GnRHa for gender incongruence. CONCLUSION: As the population of transgender children and adolescents grows, they acquire knowledge and greater access to the various forms and stages of treatment for sex reassignment. The medical community needs to be adequately prepared to better serve this population and offer the safest resources available.

Effect of a Pheromone on Stress-Associated Reactivation of Feline Herpesvirus-1 in Experimentally Inoculated Kittens.

BACKGROUND: Stress contributes to reactivation of feline herpesvirus-1 (FHV-1). The usage of pheromones to decrease stress in FHV-1 experimentally inoculated kittens has not previously been investigated. HYPOTHESIS/OBJECTIVES: To determine whether a feline pheromone would lessen stress, resulting in decreased recurrence of FHV-1-associated illness in kittens. ANIMALS: Twelve 5-month-old, purpose-bred kittens. METHODS: Randomized, double-blind, placebo-controlled clinical trial. Kittens previously infected with the same dose of FHV-1 were randomized into 2 separate but identical group rooms. After a 2-week equilibration period, a diffuser containing either the pheromone or placebo was placed in each of the rooms, and the kittens acclimated for an additional 2 weeks. Every 2 weeks thereafter, for the 8-week study period, housing was alternated between kennel- and group housing. Blinded observers applied a standardized clinical and behavioral scoring rubric daily. After each 2-week period, serum cortisol concentrations and quantitative PCR for FHV-1 and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) ratios were evaluated. Clinical, behavioral, and laboratory test results were compared between groups within individual and combined study periods. RESULTS: Sneezing occurred more frequently in the placebo group during individual (P = 0.006) and combined study periods (P = 0.001). Sleep at the end of observation periods occurred more frequently in the pheromone group during individual (P = 0.006) and combined study periods (P < 0.001). CONCLUSIONS AND CLINICAL IMPORTANCE: The findings suggest that the pheromone decreased stress, and the decrease in stress response may have resulted in decreased sneezing associated with FHV-1.

Spatial variability of trace metals and inorganic nutrients in surface waters of Todos Santos Bay, México in the summer of 2005 during a red tide algal bloom.

Dissolved and particulate metals (Ag, Cd, Co, Cu, Ni, and Zn) and nutrients (PO(4), NO(3), and H(4)SiO(4)) were measured in Todos Santos Bay (TSB) in August 2005. Two sources producing local gradients were identified: one from a dredge discharge area (DDA) and another south of the port and a creek. The average concentrations of dissolved Cd and Zn (1.3 and 15.6 nM, respectively) were higher by one order of magnitude than the surrounding Pacific waters, even during upwelling, and it is attributed to the presence of a widespread and long-lasting red tide coupled with some degree of local pollution. A clear spatial gradient (10 to 6 pM), from coast to offshore, of dissolved Ag was evident, indicating the influence of anthropogenic inputs. The particulate fraction of all metals, except Cu, showed a factor of ~3 decrease in concentrations from the DDA to the interior of the bay. The metal distributions were related to the bay's circulation by means of a numerical model that shows a basically surface-wind-driven offshore current with subsurface compensation currents toward the coast. Additionally, the model shows strong vertical currents over the DDA. Principal component analysis revealed three possible processes that could be influencing the metal concentrations within TSB: anthropogenic inputs (Cd, Ag, and Co), biological proceses (NO(3), Zn, and Cu), and upwelling and mixing (PO(4), H(4)SiO(4), Cd, and Ni). The most striking finding of this study was the extremely high Cd concentrations, which have been only reported in highly contaminated areas. As there was a strong red tide, it is hypothesized that the dinoflagellates are assimilating the Cd, which is rapidly remineralized and being concentrated on the stratified surface layers.

Use of the Beck Anxiety and Depression Inventories for Primary Care with Medical Outpatients.

The effectiveness of the Beck Anxiety (BAI-PC) and Depression (BDI-PC) Inventories for Primary Care for discriminating 56 primary care patients with and without revised, third edition Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) diagnosed anxiety and mood disorders was studied. The Anxiety and Mood modules from the Primary Care Evaluation of Mental Disorders (PRIME-MD) were used to establish diagnoses. The coefficient alphas for the BAI-PC and BDI-PC were, respectively, .90 and .88. A BAI-PC cutoff score of 5 and above yielded the highest clinical efficiency (82%) with 85% sensitivity and 81% specificity for identifying patients with and without panic, generalized anxiety, or both disorders, whereas a BDI-PC cutoff score of 6 and above afforded the highest clinical efficiency (92%) with 83% sensitivity and 95% specificity for detecting patients with and without major depressive disorders. The use of these instruments to screen primary care patients before conducting extensive diagnostic evaluations with them was discussed.

Performance of HTLV-1 screening assays in Brazil.

In recent years a variety of studies have been carried out to compare the accuracy (generally expressed in terms of sensitivity and specificity) of commercially available anti-HTLV tests. None of these studies were performed in Brazil or in any other South American country. During the characterization of our Brazilian reference panel we evaluated the sensitivities and specificities of the Abbott HTLV EIA (100%; 89.7%) and the Biochrom HTLV-1/-2 ELISA (100%; 42.4%). Our conclusion was that both assays may be problematic in terms of correctly identifying HTLV-negative sera. We therefore adjusted the cut-off values using receiver operating characteristics (ROC). ROC analysis, which involves calculating sensitivity and specificity for several cut-off values, can be used to ascertain the co-variation in the specificity and sensitivity of any assay giving quantitative results. The optimum cut-off value for the assay in a given study population is the point that gives highest possible sensitivity in conjunction with a small false-positive fraction. Using the HTLV-1/-2 Western blot as the "gold standard", we were able to improve the specificity of the Biochrom HTLV-1/-2 assay to 95% without affecting its sensitivity of 100%. However, it seems that when using the Biochrom HTLV-1/-2 ELISA, there may be problems in separating positive and negative sera. In the case of the Abbott HTLV EIA, our ROC analysis revealed that the cut-off value suggested by the manufacturer was nearly identical to the optimum cut-off value. Adjustment will affect neither sensitivity nor specificity. However, a slight adjustment of the cut-off value result in a clearer separation of the positive and negative populations. Furthermore, we assume that this adjustment will help to avoid false-positive results when larger serum panels are investigated. Further investigations will show whether or not this problem is linked to the geographical regions where the test is performed (e.g. polyclonal stimulation due to parasitic infections in tropical countries).

Microbiology of the lower genital tract in postmenarchal adolescent girls: differences by sexual activity, contraception, and presence of nonspecific vaginitis.

The prevalence of selected microorganisms in the lower genital tract in postmenarchal adolescent girls was assessed, including vaginal Gardnerella vaginalis, group B streptococcus, lactobacillus, Mycoplasma species, Ureaplasma urealyticum, Staphylococcus aureus, and yeast, and endocervical Mycoplasma species, U. urealyticum, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Specific attention was focused on important sexually transmitted disease organisms, and differences in isolations by age, sexual activity, ethnicity, contraception, and the diagnosis of nonspecific vaginitis were measured. Sexually active subjects had a mean of 6.05 organisms (SD = 3.16), compared with 3.12 organisms (SD = 3.92) in non-sexually active subjects (P = 0.001). Sexually active subjects had significantly more vaginal G. vaginalis, lactobacilli, Mycoplasma species, and U. urealyticum, as well as endocervical Mycoplasma species and U. urealyticum, compared with non-sexually active subjects; C. trachomatis, N. gonorrhoea, and T. vaginalis were isolated exclusively from the sexually active group. Significant differences in isolation rates by ethnicity were found in vaginal Mycoplasma species and U. urealyticum, and endocervical Mycoplasma species, U. urealyticum, C. trachomatis, N. gonorrhoeae, and T. vaginalis. In general, organisms were isolated from blacks most frequently; N. gonorrhoea was isolated from blacks exclusively. Differences were found in microbiologic isolations by the presence or absence of nonspecific vaginitis. Vaginal G. vaginalis and Mycoplasma species and endocervical Mycoplasma species and U. urealyticum were found significantly more often in isolates from the group with nonspecific vaginitis. It is important to define the microbial flora of the lower genital tract in adolescent girls in order to understand its role in the pathogenesis of acute salpingitis.

Chlamydia trachomatis: important relationships to race, contraception, lower genital tract infection, and Papanicolaou smear.

Chlamydia trachomatis is a common cause of sexually transmitted disease in adolescent girls. Of 366 adolescent patients screened, 15.3% were found to have chlamydial endocervical infections, with an infection rate of 23.3% in blacks, 14.3% in Hispanics, and 10.3% in whites (P = 0.01, excess for blacks). Of Chlamydia-positive patients, 63.6% had a diagnosis of lower genital tract infection, compared with 35.4% of Chlamydia-negative patients (P = 0.004). Oral contraceptive users had a higher prevalence of infection (23.8%) compared with those using a barrier method (16.2%) or with nonusers (9.3%) (P = 0.004). Inflammatory changes on Papanicolaou smears were associated with chlamydial infection (P = 0.0001). Other variables identified as risk factors for chlamydial infection included both a younger age at first intercourse (P = 0.02) and more years of sexual activity (P = 0.02). Chronologic, menarchal, and gynecologic age, biologic age of the cervix, the number of sexual partners in the last month and during a lifetime, and parity were not found to be associated with recovery of Chlamydia.

PIP: Chlamydia trachomatis is a common cause of sexually transmitted disease in adolescent girls. Of 366 adolescent patients screened, 15.3% were found to have chlamydial endocervical infections, with an infection rate of 23.3% in blacks, 14.3% in Hispanics, and 10.3% in whites (P=0.01, excess for blacks). Of Chlamydia-positive patients, 63.6% had a diagnosis of lower genital tract infection, compared with 35.4% of Chlamydia-negative patients (P=0.004). Oral contraceptive users had a higher prevalence of infection (23.8%) compared with those using a barrier method (16.2%) or with nonusers (9.3%) (P=0.004). Inflammatory changes on Papanicolaou smears were associated with chlamydial infection (P=0.0001). Other variables identified as risk factors for chlamydial infection included both a younger age at 1st intercourse (P=0.02) and more years of sexual activity (P=0.02). Chronologic, menarchal, and gynecologic age, biologic age of the cervix, number of sexual prtners in the last month, and during a lifetime, and parity were not found to be associated with recovery of Chlamydia.

Bacteriological and serological studies of fast growing mycobacteria identified as Mycobacterium friedmannii

Three recently isolated strains of a fast gowing non-pigmented mycobacterium, two of which were from a series of injection abscesses and one which was recovered from a water tank, have been compared bacteriologically and serologically in gel-diffusion tests with a number of mycobacterial type strains. The three strains and type strains of M. abscessus, M. runyonii, M. borstelense and M. friedmannii were of one species. This species deiffered in several respects from M. ranae (fortuitum), M. smegmatis and M. thamnopheos. In view of the chronological priority of M. friedmannii over the other names, we recommend that this name be adopted as the correct desigantion for this species. The origin of the type strains of M. friedmannii is discussed and reasons are given for its acceptance as representative of Friedmann´s original strains.