| 1. |
- Piltonen, Terhi T, et al.
(author)
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Utility of Serum Anti-Müllerian Hormone Measurement as Part of Polycystic Ovary Syndrome Diagnosis.
- 2024
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In: Seminars in reproductive medicine. - 1526-4564. ; 42:1, s. 49-59
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Research review (peer-reviewed)abstract
- The 2023 international evidence-based guideline update for the assessment and management of polycystic ovary syndrome (PCOS) recommends using the Rotterdam criteria for the diagnosis of PCOS. The updated guideline has evidence-based recommendation for the diagnosis, and it now also includes serum anti-Müllerian hormone (AMH) measurement as an alternative tool for gynecological ultrasound to diagnose polycystic ovary morphology (PCOM). The aim of this new recommendation was to facilitate PCOS diagnostic workup in primary care and other disciplines, as currently most diagnosing is done in gynecology and infertility clinics. Here, we review factors affecting AMH levels as well as the utility of AMH in PCOS diagnosis. We identified relevant studies that report different cut-offs for AMH to diagnose PCOM as part of PCOS diagnosis. There are, however, some limitations when using AMH that should be acknowledged. These include physiological aspects like age, ethnicity, and obesity and iatrogenic causes like hormonal medication and ovarian surgery. Also reference ranges are different depending on AMH assay used. As a summary, we conclude that AMH is a usable tool in PCOM diagnostics, but it does not have a single cut-off. Therefore, further studies are needed to establish age and assay-based reference ranges.
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| 2. |
- Johansson, Åsa, et al.
(author)
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Precision medicine in complex diseases - : Molecular subgrouping for improved prediction and treatment stratification
- 2023
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In: Journal of Internal Medicine. - : John Wiley & Sons. - 1365-2796 .- 0954-6820. ; 294:4, s. 378-396
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Research review (peer-reviewed)abstract
- Complex diseases are caused by a combination of genetic, lifestyle, and environmental factors and comprise common noncommunicable diseases, including allergies, cardiovascular disease, and psychiatric and metabolic disorders. More than 25% of Europeans suffer from a complex disease, and together these diseases account for 70% of all deaths. The use of genomic, molecular, or imaging data to develop accurate diagnostic tools for treatment recommendations and preventive strategies, and for disease prognosis and prediction, is an important step toward precision medicine. However, for complex diseases, precision medicine is associated with several challenges. There is a significant heterogeneity between patients of a specific disease-both with regards to symptoms and underlying causal mechanisms-and the number of underlying genetic and nongenetic risk factors is often high. Here, we summarize precision medicine approaches for complex diseases and highlight the current breakthroughs as well as the challenges. We conclude that genomic-based precision medicine has been used mainly for patients with highly penetrant monogenic disease forms, such as cardiomyopathies. However, for most complex diseases-including psychiatric disorders and allergies-available polygenic risk scores are more probabilistic than deterministic and have not yet been validated for clinical utility. However, subclassifying patients of a specific disease into discrete homogenous subtypes based on molecular or phenotypic data is a promising strategy for improving diagnosis, prediction, treatment, prevention, and prognosis. The availability of high-throughput molecular technologies, together with large collections of health data and novel data-driven approaches, offers promise toward improved individual health through precision medicine.
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| 3. |
- Franzén, Karin M, 1958-, et al.
(author)
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Surgery for urinary incontinence in women 65 years and older : a systematic review
- 2015
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In: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 26:8, s. 1095-1102
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Research review (peer-reviewed)abstract
- Introduction and hypothesis: Urinary incontinence (UI) is common among the elderly, but the literature is sparse on the surgical treatment of UI among the elderly. This systematic review aims to assess the effectiveness of surgical interventions as treatment for urinary incontinence in the elderly population ≥65 years of age.Methods: Randomized controlled trials (RCT) and prospective nonrandomized studies (NRS) were included. The databases PubMed (NLM), EMBASE (Elsevier), Cochrane Library (Wiley), and Cinahl (EBSCO) were searched for the period 1966 up to October 2013. The population had to be ≥65 years of age and had to have undergone urethral sling procedures, periurethral injection of bulking agents, artificial urinary sphincter surgery, bladder injection treatment with onabotulinumtoxin A or sacral neuromodulation treatment. Eligible outcomes were episodes of incontinence/urine leakage, adverse events, and quality of life.The studies included had to be at a moderate or low risk of bias. Mean difference (MD) or standard mean difference (SMD)as well as risk difference (RD) and the 95 % CI were calculated.Results: Five studies-all on the suburethral sling procedure in women- that fulfilled the inclusion criteria were identified. The proportion of patients reporting persistent SUI after surgery ranged from 5.2 to 17.6 %. One study evaluating quality of life (QoL) showed a significant improvement after surgery. The complication rates varied between 1 and 26 %, mainly bladder perforation, bladder emptying disturbances, and de novo urge.Conclusion: The suburethral sling procedure improves continence as well as QoL among elderly women with SUI; however, evidence is limited.
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| 4. |
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| 5. |
- Ahlborg, Gunnar, 1948, et al.
(author)
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Reproductive effects of chemical exposures in health professions
- 1995
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In: Journal of Occupational and Environmental Medicine. - 1076-2752. ; 37:8, s. 957-61
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Research review (peer-reviewed)abstract
- Numerous chemical substances are handled by persons working in the health care sector. At exposure levels that may occur in the occupational setting, some of these substances are potentially harmful to the reproductive processes. Among the potentially harmful substances are anesthetic gases, antineoplastic agents, and sterilants. The epidemiological evidence of increased risks for adverse reproductive effects (eg, subfertility, spontaneous abortions, congenital defects) from such exposure is not unequivocal. However, due to the toxic potential, exposures should be kept at a minimum, and this may be especially important for workers who are pregnant or are planning to achieve pregnancy.
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| 6. |
- Ragnarsdottir, Bryndis, et al.
(author)
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TLR- and CXCR1-dependent innate immunity: insights into the genetics of urinary tract infections.
- 2008
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In: European Journal of Clinical Investigation. - : Wiley. - 0014-2972 .- 1365-2362. ; 38 Suppl 2, s. 12-20
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Research review (peer-reviewed)abstract
- The susceptibility to urinary tract infection (UTI) is controlled by the innate immune response and Toll like receptors (TLRs) are the sentinels of this response. If productive, TLR4 signalling may initiate the symptomatic disease process. In the absence of TLR4 signalling the infected host instead develops an asymptomatic carrier state. The activation of mucosal TLR4 is also influenced by the properties of the infecting strain, and pathogens use their virulence factors to trigger 'pathogen-specific' TLR4 responses in the urinary tract but do not respond to the asymptomatic carrier strains in patients with asymptomatic bacteriuria (ABU). The TLR4 dependence has been demonstrated in mice and the relevance of low TLR4 function for protection for human disease was recently confirmed in children with asymptomatic bacteriuria, who expressed less TLR4 than age matched controls. Functional chemokines and functional chemokine receptors are crucial for neutrophil recruitment, and for the neutrophil dependent bacterial clearance. Interleukin (IL)-8 receptor deficient mice develop acute septic infections and chronic tissue damage, due to aberrant neutrophil function. This mechanism is relevant for human UTI as pyelonephritis prone children express low levels of the human CXCL8 (Il-8) receptor, CXC chemokine receptor 1 (CXCR1) and often have heterozygous CXCR1 polymorphisms. This review illustrates how intimately the innate response and the susceptibility to UTI are linked and sophisticated recognition mechanisms that rely on microbial virulence and on host TLR4 and CXCR1 signalling.
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| 7. |
- Adolfsson, Margareta, 1950-, et al.
(author)
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Pain management for children with cerebral palsy in school settings in two cultures: action and reaction approaches
- 2018
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In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 40:18, s. 2152-2162
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Research review (peer-reviewed)abstract
- © 2017 Informa UK Limited, trading as Taylor & Francis Group Background: Children with cerebral palsy (CP) face particular challenges, e.g. daily pain that threaten their participation in school activities. This study focuses on how teachers, personal assistants, and clinicians in two countries with different cultural prerequisites, Sweden and South Africa, manage the pain of children in school settings. Method: Participants’ statements collected in focus groups were analysed using a directed qualitative content analysis framed by a Frequency of attendance-Intensity of involvement model, which was modified into a Knowing-Doing model. Results: Findings indicated that pain management focused more on children’s attendance in the classroom than on their involvement, and a difference between countries in terms of action-versus-reaction approaches. Swedish participants reported action strategies to prevent pain whereas South African participants primarily discussed interventions when observing a child in pain. Conclusion: Differences might be due to school- and healthcare systems. To provide effective support when children with CP are in pain in school settings, an action-and-reaction approach would be optimal and the use of alternative and augmentative communication strategies would help to communicate children’s pain. As prevention of pain is desired, structured surveillance and treatment programs are recommended along with trustful collaboration with parents and access to “hands-on” pain management when needed.Implications for rehabilitation•When providing support, hands-on interventions should be supplemented by structured preventive programs and routines for parent collaboration (action-and-reaction approach).•When regulating support, Sweden and South Africa can learn from each other;○In Sweden, the implementation of a prevention program has been successful.○In South Africa, the possibilities giving support directly when pain in children is observed have been beneficial.
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| 8. |
- Ebrahimi, Sheida, et al.
(author)
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Application of PET/MRI in Gynecologic Malignancies
- 2024
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In: Cancers. - : MDPI. - 2072-6694. ; 16:8
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Research review (peer-reviewed)abstract
- Simple Summary This article reviews the value of Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) in evaluating female pelvic cancers. It also provides a comparative analysis of PET/MRI with other imaging modalities in the context of female pelvic malignancies and outlines their respective strengths and limitations. The aim of this narrative review is to introduce to clinicians up and coming technology and how it may be valuable to their assessment of female pelvic cancers.Abstract The diagnosis, treatment, and management of gynecologic malignancies benefit from both positron emission tomography/computed tomography (PET/CT) and MRI. PET/CT provides important information on the local extent of disease as well as diffuse metastatic involvement. MRI offers soft tissue delineation and loco-regional disease involvement. The combination of these two technologies is key in diagnosis, treatment planning, and evaluating treatment response in gynecological malignancies. This review aims to assess the performance of PET/MRI in gynecologic cancer patients and outlines the technical challenges and clinical advantages of PET/MR systems when specifically applied to gynecologic malignancies.
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| 9. |
- Tamadon, Amin, et al.
(author)
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How to choose the suitable animal model of polycystic ovary syndrome?
- 2018
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In: Traditional Medicine and Modern Medicine. - 2575-9000 .- 2575-9019. ; 1:2, s. 95-113
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Research review (peer-reviewed)abstract
- Polycystic ovary syndrome (PCOS) is a gynecological metabolic and endocrine disorder with uncertain etiology. To understand the etiology of PCOS or the evaluation of various therapeutic agents, different animal models have been introduced. Considering this fact that is difficult to develop an animal model that mimics all aspects of this syndrome, but, similarity of biological, anatomical, and/or biochemical features of animal model to the human PCOS phenotypes can increase its application. This review paper evaluates the recently researched animal models and introduced the best models for different research purposes in PCOS studies. During January 2013 to January 2017, 162 studies were identified which applied various kinds of animal models of PCOS including rodent, primate, ruminant and fish. Between these models, prenatal and pre-pubertal androgen rat models and then prenatal androgen mouse model have been studied in detail than others. The comparison of main features of these models with women PCOS demonstrates higher similarity of these three models to human conditions. Thereafter, letrozole models can be recommended for the investigation of various aspects of PCOS. Interestingly, similarity of PCOS features of post-pubertal insulin and human chorionic gonadotropin rat models with women PCOS were considerable which can make it as a good choice for future investigations.
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| 10. |
- Jordal, Malin, 1973-, et al.
(author)
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Surgical Healthcare Interventions after Female Genital Mutilation/Cutting : A Review of the Evidence
- 2022
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In: CLINICAL AND EXPERIMENTAL OBSTETRICS & GYNECOLOGY. - : IMR Press. - 0390-6663 .- 2709-0094. ; 49:6
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Research review (peer-reviewed)abstract
- Background: Female genital mutilation/cutting (FGM/C) is a global public health problem associated with an increased risk of physical, sexual, and mental health consequences. Surgical healthcare intervention may alleviate negative health consequences related to FGM/C. In this review, we aim to offer an overview of documented effects of surgical healthcare interventions after FGM/C, from the perspectives of both healthcare providers (HCPs) performing such interventions and the women receiving them.Methods: We searched four databases (PUBMED/MEDLINE, CINAHL, PsychInfo, Cochrane Library) for peer-reviewed articles published between 2000 and 2021, and retrieved a total of 1978 citations (1203 + 775). After scrutinizing the citations with the inclusion criteria (1) observable outcomes of surgical healthcare interventions after FGM/C, (2) HCPs' perceptions of FGM/C-related surgical healthcare and experiences of providing surgical care for FGM/C-affected women, and (3) FGM/C-affected women's perceptions and experiences of the effects of FGM/C-related surgical healthcare, we selected 38 articles to include in this review.Results: HCPs and FGM/C-affected women differed in their views on surgical interventions. While providers seemed to suggest premarital defibulation regardless of a woman's age and marital status, affected women voiced social and marital concerns related to defibulation, which sometimes overrode the physical consequences. On the other hand, some providers were reluctant to perform intrapartum defibulation due to uncertainty or misinformation about infibulated women's wishes, while women often expected and desired defibulation prenatally. And while gynecologists demonstrated skepticism towards clitoral reconstruction, most women who had undergone the procedure were satisfied, particularly regarding the psychosocial and sexual aspects.Conclusions: Providers and recipients of surgical interventions after FGM/C seem to display contrasting views on surgical intervention after FGM/C, which may have implications for healthcare recommendations as well as satisfaction. This apparent ambiguity between providers' and recipients' perceptions of surgical interventions needs further investigation.
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