Search Results (418)

Background: Intrauterine adhesions (IUAs) or Asherman syndrome (AS) represent pathological conditions that affect the endometrium and significantly influence female fertility through a variety of mechanisms. This study aims to identify risk factors, explore pathophysiological mechanisms, diagnostic approaches, and assess how medical background influence the development of these conditions. It also seeks to associate the severity of conditions with clinical outcomes, such as fertility, miscarriages, and menstrual cycle disorders, using American Fertility Society (AFS) scoring system. Materials and methods: This retrospective cohort study included 134 patients aged 18 to 45, who followed hysteroscopy between 2016 and 2024 at two hospitals in Iasi, focusing on those diagnosed with IUAs (102 patients) and AS (32 patients), based on hysteroscopic approach. The exclusions were based of factors like acute uterine bleeding, intrauterine device, obesity and other severe conditions. Results and discussions: Women over 35 years are more likely to develop these conditions due to prior gynaecological procedures which are often associated with fertility issues. Hysteroscopy is established as the gold standard for both diagnosis and treatment, intraoperative diagnosis representing 45.6 % of cases. Amenorrhea is a primary indicator in AS patients (OR = 26.19) and dysmenorrhea as a potential marker for IUAs (OR = 2.67). Patients with IUAs and primary infertility (82.9%) typically have an AFS score 1, corresponding to improved conception rates. Those with AS and primary infertility often present an AFS score 2 (54.5%); patients with AS and secondary infertility were linked to AFS score 3 (58.8%; p = 0.137). Although the incidence of miscarriages is comparable between the two groups, the timing differs: IUAs are predominantly associated with first trimester losses (64.9%), whereas AS is more commonly linked to second trimester miscarriages (45.5%; p = 0.001). Conclusions: The study highlights the necessity of a personalized approach in diagnosing and treating IUAs and AS, considering factors such as age, fertility index, and disease severity. The integration of hysteroscopic techniques with individualized treatment plans based on the patient’s unique medical profile is crucial for adequate management of IUAs and AS. Full article

Spontaneous coronary artery dissection (SCAD) is an uncommon but significant cause of acute coronary syndrome (ACS), predominantly affecting younger women without traditional cardiovascular risk factors. SCAD is defined as a non-atherosclerotic, non-traumatic dissection of the coronary artery, leading to the formation of an intramural haematoma or intimal tear causing obstruction to blood flow and myocardial ischaemia. Unlike traditional atherosclerotic coronary artery disease, SCAD has unique pathophysiological mechanisms. SCAD is thought to arise secondary to a bleed and/or dissection within the arterial wall, linked to hormonal influences with potential triggers of physical or emotional stress and predisposition such as an underlying connective tissue disorder. Despite being increasingly recognised, SCAD remains underdiagnosed, and knowledge regarding SCAD epidemiology is limited. In addition, the impact of SCAD extends beyond the immediate cardiac event, encompassing psychological distress, the need for rehabilitation, and long-term surveillance. This has implications not just for the patient but also their family and the healthcare system. This narrative review summarises the current knowledge of SCAD epidemiology, including the affected population, its associated risk factors, and healthcare impact. By identifying current gaps in knowledge, this review aims to encourage targeted research, public awareness, and policy initiatives to improve outcomes for individuals affected by SCAD. Full article

Endometriosis is a complex and multifaceted gynecological disorder characterized by the abnormal growth and presence of endometrial-like tissue outside the confines of the uterine cavity. It can lead to a wide range of distressing symptoms, including chronic pelvic pain, heavy and/or irregular menstrual bleeding, and significant challenges with fertility. While the association between endometriosis and infertility is well recognized, the precise mechanisms through which the disease affects oocyte and embryo quality remain controversial. Studies that utilized transcriptomic, metabolomic, and ultrastructural analyses indicated dysregulated energy metabolism, oxidative stress, mitochondrial dysfunction, and inflammatory alterations in the ovarian microenvironment. The impact of endometriosis on fertilization, embryo development, and implantation remains debated, with conflicting findings across different study designs. Some investigations reported impaired oocyte morphology, reduced fertilization rates, and poorer embryo quality, while others suggested that endometriosis does not significantly affect ART outcomes when confounding factors are controlled. Recent studies highlight the importance of distinguishing the disease severity, lesion location, and prior surgical interventions when assessing reproductive outcomes. The need for standardized methodologies in evaluating oocyte and embryo quality, alongside personalized treatment approaches, is emphasized. Further research is warranted to elucidate the precise molecular mechanisms underlying these effects and to develop targeted therapeutic strategies aimed at improving ART success in women with endometriosis. This narrative review provides a thorough examination of the previous research on the impact of endometriosis on oocyte and embryo quality, highlighting both the known mechanisms and the areas that require further investigation. This will help to guide future research and clinical management strategies to improve reproductive outcomes for women with endometriosis. Full article

Menstrual bleeding disorders (MBDs) are multifaceted issues affecting women’s health. Understanding their causes and impacts is vital for management and treatment. MBDs can affect women’s self-esteem (SE), creating a cycle of physical and emotional challenges. Women may resort to unhealthy behaviours; therefore, we raised the question of whether MBD women’s self-esteem differs in dietary behaviours, consequently leading to obesity. This cross-sectional study investigated the relationship between SE, dietary behaviours and body fat (BF) distribution in 63 19–35 y MBD women. It was conducted on two BMI and age-matched groups that differ by android fat content. Rosenberg’s SE questionnaire and Food Frequency Questionnaire were used. BF distribution was measured by dual-energy-X-ray-absorptiometry (DXA), and the android-to-gynoid fat ratio was calculated. We revealed the following determinants of higher android-to-gynoid fat distribution: medium or high self-esteem (OR: 3.4, 95%CI: 1.0; 10.8), daily milk products frequency intake (OR: 3.3, 95%CI: 1.1; 10.3). The level of self-esteem could affect dietary behaviours. Women with higher android fat distribution tend to consume dairy products more frequently but with less meat. Women with lower android fat distribution had lower SE. The issues raised in this project affect a complex area that requires further research in a larger group of participants. Full article

Inflammatory bowel disease (IBD) is a chronic and relapsing inflammatory disorder of the gastrointestinal tract with limited treatment options. This study investigates the preventive effects of fermented Kamut wheat enzyme (FKW) diet on the progression of dextran sulfate sodium (DSS)-induced colitis in mice, with a focus on gut microbiota modulation and inflammatory cytokine regulation. Female C57BL/6J mice were divided into groups and fed a diet consisting of either a FKW diet (containing 39.80% FKW) or a control diet under 1.25% and 2.50% DSS conditions. The FKW diet was formulated based on the AIN-93G standard rodent formula, with the FKW diet providing comparable amounts of total proteins, crude lipids, and dietary fibers as the control diet. The FKW diet effectively mitigated the progression of colitis, as evidenced by improvements in key indicators such as dietary intake, body weight, colon length, stool consistency, and bleeding, particularly in the 1.25% DSS group. Histopathological analysis revealed preservation of colonic architecture and reduced mucosal damage in the FKW group. The diet also resulted in a significant reduction in pro-inflammatory cytokines (TNF-α, IL-6, IL-1β, and IFN-γ) and myeloperoxidase (MPO) levels, coupled with an increase in anti-inflammatory IL-10. Gut microbiota analysis showed increased abundance of beneficial bacteria such as Muribaculaceae, Lachnospiraceae NK4A136 and Bacteroides acidifaciens and decreased pathogenic bacteria like Escherichia/Shigella and Bilophila. These findings underscore the potential of FKW as a preventive dietary intervention for mitigating the progression of colitis, emphasizing the role of gut microbiota in supporting intestinal health. These results highlight FKW’s potential to reduce the risk of colitis development, providing a foundation for future research into its preventive applications. Full article

Platelet dysfunction plays a critical role in the pathogenesis of various disorders affecting the hemostatic-coagulant system. This review aims to explore the mechanisms by which platelet dysfunctions contribute to the disruption of hemostasis, leading to an increased risk of both thrombosis and bleeding. Platelets, traditionally known for their role in clot formation, can exhibit altered functionality under pathological conditions such as cardiovascular diseases, metabolic disorders, and autoimmune diseases, impacting their interaction with coagulation factors and vascular endothelium. The review discusses the molecular and cellular mechanisms underlying platelet dysfunction, including aberrations in platelet activation, aggregation, and secretion. It also highlights the interplay between platelets and other components of the coagulation cascade, such as fibrinogen and clotting factors, in maintaining vascular integrity. Moreover, the review examines clinical implications, including how platelet dysfunction can be a contributing factor in conditions like deep vein thrombosis, stroke, and disseminated intravascular coagulation (DIC). Finally, current therapeutic approaches targeting platelet dysfunctions, including antiplatelet agents and emerging therapies, are reviewed to provide insights into potential strategies for managing fluid-coagulation system imbalances. This review underscores the importance of a comprehensive understanding of platelet dysfunction to improve diagnosis and treatment of hemostatic disorders. Full article

Background/Objectives: Zellweger spectrum disorder (ZSD), a rare genetic disease characterized by defects in peroxisome biogenesis, results in dysfunction of all organ systems, including feeding difficulties, gastrointestinal bleeding, and reduced overall growth. Despite this nutritional impact, no published studies have assessed dietary intake in ZSD. The purpose of this study was to determine nutrient intake in individuals with ZSD or a related peroxisomal disorder using two methods of dietary assessment as provided by family caregivers. Methods: Family caregivers participated in multiple 24 h dietary recall interviews and completed 3-day food records for their child with ZSD or a related single-enzyme peroxisomal disorder over a 6-month period. Results: Twenty-one subjects (eleven orally fed and ten enterally fed), ranging from 1 to 33 years of age, were included in the study. Energy and nutrient intake as reported by dietary recall vs. 3-day food record were highly correlated for all nutrients (r² = 0.998, p < 0.0001). Mean nutrient intakes for subjects generally achieved or exceeded DRI requirements, except for fiber (about 50% of DRI). Conclusions: These results show that dietary assessment is feasible in individuals with ZSD using caregiver input, regardless of feed modality, and that dietary intake is consistent across different methods of assessment. These findings may be applicable in dietary assessments for individuals with ZSD and similar genetic disorders and a methodological consideration in clinical interventions. Full article

Background/Objectives: Children with autism spectrum disorder (ASD) often face challenges in maintaining oral hygiene due to sensory sensitivities, behavioral difficulties, and limited access to specialized dental care. This study aimed to assess the oral hygiene status of children with ASD and compare it with neurotypical peers. Methods: A cross-sectional study was conducted with 74 children with ASD and 74 neurotypical children. Dental exams measured oral hygiene and caries prevalence using the DMFT/dmft, Oral Hygiene Index (OHI), and Sulcus Bleeding Index (SBI). Tooth brushing frequency and dental visits were also recorded. Statistical analysis was performed using the Mann–Whitney U test and Fisher’s exact test. Results: Children with ASD had significantly poorer oral hygiene and higher caries rates compared to controls. Boys with ASD had higher DMFT scores, indicating more caries. Additionally, ASD children brushed their teeth less often and had fewer dental visits. Preventive treatments were underutilized in this group despite a higher need. Conclusions: Children with ASD face notable oral health challenges, including poor hygiene, higher caries prevalence, and limited preventive care. These findings highlight the need for tailored interventions, improved parental education, and specialized dental care strategies for this population. Full article

Background/Objectives: Low bone mineral density (BMD) is common in hemophilia patients. Identifying high-risk patients for low BMD early is essential to prevent complications and reduce morbidity. The parathyroid hormone (PTH)/calcium (Ca) ratio is a cost-effective marker for predicting BMD, highlighting the need for routine screening and early intervention in this population. Hemophilia is a hereditary bleeding disorder caused by deficiencies in clotting factors VIII (hemophilia A) and IX (hemophilia B). Patients with hemophilia are at risk of low bone mineral density (BMD). This study aimed to evaluate the prevalence of low BMD, associated risk factors, and raise awareness regarding its significance in hemophilia patients. Methods: We retrospectively assessed bone metabolism in 62 hemophilia patients followed at our center. BMD was evaluated using dual-energy X-ray absorptiometry (DEXA). Additionally, serum levels of 25-OH-D3, alkaline phosphatase, PTH, Ca, phosphor, and creatinine were measured. The PTH/Ca, PTH/25-OH-D3, and Ca×25-OH-D3/PTH ratios were calculated. Results: The median age of the 62 patients with hemophilia included in the study (hemophilia A: 87.1%, hemophilia B: 12.9%) was 37 years (range: 21–66), and all were male. Of these patients, 67.7% (n = 42) had severe, 21% (n = 13) had moderate, and 11.3% (n = 7) had mild hemophilia. A total of 85.5% of patients were on factor prophylaxis, and 75.4% had a target joint. In laboratory analysis, the median 25-OH-D3 level was 13.4 µg/L and 75% patients had 25-OH-D3 deficiency. According to DEXA results, 62.9% had lower than normal BMD. When we divided the patients into normal and low BMD groups according to DEXA results, weight (p = 0.006), height (p = 0.024), factor levels (p = 0.004), PTH (p = 0.010), AST (p = 0.029), and PTH/Ca (p = 0.011) levels were statistically significantly different between the groups. The severity of the disease and the rate of receiving prophylaxis were higher in the group with low BMD (p = 0.015, p = 0.006, respectively). In multivariate analysis, PTH/Ca ratio and weight were found to be independent risk factors for BMD. A linear relationship was found between PTH/Ca ratio and BMD. The optimal cut-off value for PTH/Ca was 6.57, with a selectivity of 65% and specificity of 82%. When we divided the patients into groups according to the cut-off value of 6.57, we found that the probability of low BMD increased approximately 7-fold in the group with PTH/Ca > 6.57 (OR 7.045, 95% CI 1.485–33.42, p = 0.014). There was an inverse association between patient weight and low BMD (p = 0.043). Conclusions: Low BMD is a critical public health concern frequently observed in patients with hemophilia. The study highlights a high rate of low BMD and 25-OH-D3 deficiency in hemophilia patients, with the PTH/Ca ratio shown to be useful in predicting BMD. The PTH/Ca ratio is suggested as an accessible, cost-effective, and practical test for evaluating BMD in hemophilia patients. Full article

Hemophilic arthropathy (HA) is a complication of hemophilia, which is a genetic disorder characterized by a deficiency in blood clotting factors. HA is characterized by joint damage with inflammatory responses, pain, and movement limitations due to recurrent bleeding in the joints. The inflammatory reactions contribute to the activation of coagulation factors, which can exacerbate bleeding and further damage the affected joints. Therefore, the interaction between inflammation and coagulation plays a crucial role in the progression and complications of HA. Management strategies often focus both on inflammation and coagulation to alleviate symptoms and preserve joint function. Temperature can influence the inflammatory response and coagulation. The aim of this work was to understand how temperature management can positively or negatively influence the HA. We have carried out a narrative review of the available literature. This review explores the impacts of temperature on biological processes, and it discusses the possible clinical implications for the HA treatment. Our research shows that cold exposure has anti-inflammatory and analgesic effects, while heat is linked to pro-inflammatory cytokine release. Both hot and cold treatments are ill-advised for hemophilia patients. Heat stimulates neo-angiogenesis, and cold hampers coagulation, posing risks for increased bleeding in individuals with hemophilia. Full article

Background: Despite ongoing efforts to improve the pancreaticoduodenectomy technique and perioperative care, surgical site infection (SSI) remains a contributor to morbidity. Efforts to reduce SSI include the use of negative pressure wound therapy (NPWT), but studies and meta-analyses have been met with conflicting results. We aimed to provide an up-to-date large-scale cohort study to assess the impact of NPWT on SSIs. Methods: Utilizing the National Surgical Quality Improvement Program database, we included patients undergoing a pancreaticoduodenectomy between 2017 and 2021 and divided patients into the NPWT and non-NPWT cohorts. A bivariate analysis was performed to compare baseline characteristics and complication rates between the cohorts. Multivariate logistic regression analysis was performed to assess the independent effect of NPWT on 30-day serious complication, 30-day mortality, and the development of deep or superficial SSI. A priori sensitivity analyses were performed in high-risk and malignancy cohorts. Results: Of the 14,044 included patients, 1689 (12.0%) patients had a prophylactic NPWT device, while 12,355 (88.0%) did not. Patients were more likely to have NPWT if they had higher ASA scores, had diabetes, were dialysis-dependent, or had a hard pancreas, but they were less likely if they were a smoker, had steroid use, or had a bleeding disorder. Most complications occurred similarly between the two cohorts, including superficial and deep SSI, but NPWT patients had a longer length of stay (10.4 d vs. 9.5 d, p < 0.001) and higher organ space SSI (22.6% vs. 17.4%, p < 0.001). Following multivariable modeling to control for demographic differences, NPWT was not independently associated with a difference in likelihood of SSI (aOR 0.94, p = 0.691) or serious complications (aOR 0.958, p = 0.669). Furthermore, the sensitivity analyses of both high-risk and malignant subgroup also did not see an independent association of NPWT on the rate of SSI (aOR 0.98, p = 0.898 and 0.96, p = 0.788, respectively). Conclusion: NPWT is used infrequently and is not significantly associated with improved outcomes including in the high-risk or malignant subgroups based on multivariable analysis for surgical site infections nor did it improve the outcomes of 30-day serious complications in these subgroups. Considering this and other studies showing the limited benefit of NPWT in all-comers and in high-risk cohorts, it remains unclear whether NPWT offers benefits following PD. Full article

Background/Objectives: Evans’ syndrome (ES) is a rare autoimmune disorder characterized by the simultaneous or sequential onset of immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA). Given its rarity, available data concerning the clinical course and optimal management in pregnancy are limited. Methods: We present the case of a 32-year-old woman who experienced ES during her first pregnancy. She had been previously diagnosed with childhood-onset SLE at the age of 14 but had been in treatment-free remission since the age of 24. The treatment of both AIHA and ITP included intravenous immunoglobulins, cyclosporine-A, high dosage oral corticosteroids, and, in the second trimester, rituximab. The delivery was planned at 34 + 6 weeks of gestation (GW); no immunological alterations or infectious complications were detected in the newborn. The post-delivery period was uncomplicated, and the mother was discharged with a normal blood count. A narrative review of available ES cases during pregnancy is also presented. Results: A total of 16 patients with ES in pregnancy were reported, including the one we described. None of them developed major bleedings during gestation, while a case of abruptio placentae with delayed postpartum hemorrhage occurred. ITP was difficult to treat in 4/16 women after delivery; 4/16 patients also developed gestational hypertensive disorders. Perinatal outcomes include 13/17 healthy newborns and 4/17 stillbirths (2 of them were twins), of which 1 was due to fetal AIHA. Gestational age at birth was before 37 GW in 8/17. In 15/16 women, ES resolved after delivery. Conclusions: The occurrence of ES during pregnancy has been rarely reported; it constitutes a clinical challenge due to the need for multiple treatments, including conventional immunosuppressants and/or biologic drugs as steroid-sparing agents. After delivery, ES appeared to be less resistant to treatment than it was during pregnancy. Full article

Background/Objectives: Thalassemia, a hereditary blood disorder, leads to reduced hemoglobin levels, impairing oxygen transport and negatively impacting patient health. Recent research suggests a possible association between thalassemia and gastrointestinal (GI) symptoms, such as abdominal pain, diarrhea, and GI bleeding, potentially due to immune compromise and iron overload. This systematic review aims to explore the prevalence and underlying factors of GI pathologies in thalassemia patients, excluding treatment-related effects and iron overload. Methods: A comprehensive search following the PRISMA guidelines was conducted to identify the prevalence and causes of GI disorders in thalassemia patients. Studies assessing non-treatment-related GI symptoms and their links to thalassemia were analyzed. After screening 1902 studies, 13 were included to investigate gastrointestinal manifestations in thalassemia patients. Results: Evidence indicates potential associations between thalassemia and GI disorders, including malabsorption, inflammatory bowel disease, Heliobacter pylori (H. pylori) infection, and celiac disease. Findings highlight immune compromise and iron dysregulation as possible contributing factors. Conclusions: This review highlights the importance of further research into the GI manifestations of thalassemia to enable early detection and improve patient health outcomes and quality of life. Addressing this gap may provide insights into better clinical management strategies for thalassemia patients. Full article

Background: Acquired hemophilia A (AHA) is a rare, life-threatening autoimmune disorder characterized by inhibitory autoantibodies against factor VIII (FVIII), resulting in spontaneous or trauma-related bleeding. This study reviews a single-center cohort to evaluate patient characteristics, treatments, and outcomes. Methods: We retrospectively reviewed the records of 22 adult patients diagnosed with AHA between 2012 and 2024. The data included demographics, clinical presentation, laboratory findings, treatments, and outcomes. Statistical analysis compared genders and evaluated treatment strategies and remission outcomes. Results: The cohort had an equal gender distribution with an average age of 62 years (22–102 years). Suspected etiologies included pregnancy (27%), malignancy (23%), autoimmune diseases (5%), and idiopathic causes (45%). The most common presentation was spontaneous cutaneous hematoma (82%). Severe bleeding necessitating hemostatic therapy occurred in 9% of cases. Initial immunosuppressive therapy (IST) with corticosteroids achieved remission in 45% of patients, while additional treatment with Rituximab or Cyclophosphamide was required in others. Emicizumab, a novel FVIII-mimetic, was successfully used in one patient with severe refractory bleeding. Remission was achieved in 64% of patients within a median of 3 months, with a recurrence rate of 14%. No thrombotic events were observed, although corticosteroid side effects, including one hip fracture, were noted. Conclusions: IST remains the cornerstone of AHA treatment, though side effects necessitate individualized care. Emicizumab shows promise, particularly in refractory cases and fragile populations. Future research is needed to evaluate long-term outcomes and spontaneous remission rates, especially in special populations like post-partum women and the elderly. Full article

Myeloproliferative neoplasms (MPNs) are a heterogeneous group of clonal hematopoietic disorders that pose unique challenges in women, particularly regarding thrombosis, bleeding, fertility, and pregnancy. Women with MPN exhibit distinct thrombotic and sometimes contradictory bleeding profiles, including a higher prevalence of unusual thrombosis such as cerebral and splanchnic vein thrombosis and increased risk of hemorrhage from anti-thrombotic medication, acquired von Willebrand syndrome and platelet dysfunction. Estrogen-containing contraceptives should generally be avoided due to thrombotic risk. Around 10–20% of newly diagnosed MPN cases are women of childbearing age and the number is increasing annually. MPN patients when compared to controls have a lower rate of live birth rate of 71% vs. 80% with a hazard ratio of 0.78 (95% CI: 0.68–0.90), and increased preterm birth (14% vs. 4%), low birth weight (<2500 g, 10% vs. 4%), and increased cesarean section rate (32% vs. 17%). Management of MPN-related pregnancy requires specific considerations regarding the prevention of thrombosis, bleeding, and pregnancy-related complications. Management strategies during pregnancy include low-dose aspirin and consideration of low-molecular-weight heparin and interferon. Despite these challenges, most women with MPN can achieve successful pregnancies with optimized care. In this case-based review, we present two cases that illustrate key aspects of managing MPN in women, summarize the current literature, and propose a diagnostic and management framework tailored to these complexities. Full article