Search Results (595)

Background: Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory breast condition that poses diagnostic and therapeutic challenges. While corticosteroids are standard first-line therapy, some patients require additional immunomodulation, such as methotrexate. Predictive factors for step-up therapy remain poorly characterized. This study aimed to identify clinical, imaging, and pathological factors predictive of step-up therapy in IGM and evaluate associations between treatment approach and outcomes. Methods: A retrospective cohort study of women diagnosed with IGM was conducted between May 2022 and June 2024 at a tertiary center in Singapore. Data on demographics, clinical presentation, imaging, histopathology, and treatment were extracted. Step-up therapy was defined as methotrexate use following corticosteroids. Primary outcome was predictors of step-up therapy; secondary outcomes included treatment success, relapse, surgery, and time to remission. Statistical analyses included chi-square/Fisher’s exact tests, Cox models, and Kaplan-Meier analysis. Results: Fifty-two women (median age 39 years) were included; 26 (50%) required step-up therapy. Predictors included oral contraceptive (OCP) use (RR 1.92; 95% CI 1.45–2.53; p < 0.001), smoking (RR 2.00; 95% CI 1.49–2.69; p < 0.001), flares (RR 2.33; 95% CI 1.44–3.79; p = 0.002), and percutaneous aspiration (RR 2.10; 95% CI 1.53–2.88; p = 0.025). Patients receiving methotrexate had lower relapse rates (RR 1.23; 95% CI 1.12–1.36; p < 0.001) but longer time to remission (adjusted HR 0.09; 95% CI 0.02–0.46; p = 0.004). Conclusions: OCP use, smoking, flares, and aspiration need may predict step-up therapy in IGM. Early identification could guide a more personalized, potentially top-down treatment. Full article

Background/Objectives: Fungal colonization and biofilm formation on intrauterine device (IUD) strings are known to contribute to recurrent infections and decreased contraceptive efficacy. This study aims to develop a novel approach to prevent Candida reservoir and biofilm formation on IUD strings, thereby lowering the risk of IUD-associated vulvovaginal candidiasis (VVC). Methods: Cervicovaginal samples were collected from human cervix using a sterile cytobrush, avoiding microbial contamination. Cytological examination using the Papanicolaou method was performed to detect the presence of Candida. The antifungal effect of the essential oils (EOs) was determined by broth dilution and disk diffusion methods. Antifungal and biofilm inhibitory effects of Thymus zygis (Tz) EO-coated IUD strings were determined by agar diffusion and crystal violet binding assays, while fungal growth on the coated strings was assessed using Scanning Electron Microscopy (SEM) and Energy-Dispersive X-ray (EDX) analysis. Results: Tz EO exhibited significantly lower minimum inhibitory concentration (MIC ≤ 0.06 µL/mL) and minimum fungicidal concentration (MFC = 0.24 µL/mL) values compared to Melaleuca alternifolia (Ma) EO (MIC > 0.24 µL/mL, MFC = 1.95 µL/mL), along with larger zones of inhibition (ZOI) against both Candida albicans (110.0 ± 6.0 mm vs. 91.3 ± 7.0 mm) and Candida glabrata (84.0 ± 13.1 mm vs. 50.0 ± 9.2 mm), indicating a stronger antifungal potential. On IUD strings coated with 4% (40 μL/g) Tz EO in hypromellose ointment, the biofilm formation of both C. albicans and C. glabrata strains was inhibited by 58.9% and 66.7%, respectively, as confirmed by SEM and EDX. Conclusions: Tz EO-coated IUD strings effectively inhibit Candida growth, suggesting a promising natural strategy to reduce recurrent IUD-associated fungal infections. However, before these results can be translated to clinical practice, additional research is needed. Future investigations may encompass an extended number of Candida isolates, stability and release studies of the EO in relation to the formulation, toxicity to vaginal mucosa, epithelial cells and sperm motility, and the effect on vaginal microbiotia. Full article

To counter the high unmet need for family planning in urban areas of Sindh province, Pakistan, Greenstar Social Marketing began implementation of The Challenge Initiative (TCI) in collaboration with the government departments of Population Welfare and Health in eight urban districts of Sindh province. This study aimed to assess the effectiveness of TCI’s Community Health Volunteers (CHVs) on public sector service provision of family planning services in eight urban districts of Sindh province, Pakistan. The Contraceptive Logistics Management Information System (cLMIS) and District Health Information System 2 (DHIS2) were used to obtain monthly contraceptive data from June 2022 to December 2024. CHVs began implementation at different time points in each district, starting from January 2023 to October 2023, when CHVs became operational in all eight districts. Descriptive statistics and two-sample t-tests were used for data analysis. CHVs significantly improved family planning service provision, particularly for short- and long-acting methods at the facility level, with greater change observed in Department of Health facilities. This study provides preliminary evidence of the effectiveness of CHVs in increasing public sector service provision of contraceptives, particularly for Department of Health facilities. CHVs bridge the gap between the community and the facility, particularly in areas uncovered by the government’s existing mobilization staff. Full article

Background/Objectives: Medroxyprogesterone acetate (MPA) is a synthetic contraceptive that can be used orally or as a once-every-three-month injection (i.e., depot MPA [dMPA]). Prior research has reported an increased association between dMPA and cerebral meningioma but has been limited in generalizability to meningioma cases treated with surgery or cases derived from an administrative database of commercial insurance enrollees. The current study builds upon prior research by examining the association among public insurance enrollees utilizing both a non-active and active comparator. Methods: Utilizing Alabama Medicaid data, cases of cerebral meningioma were matched to up to ten controls based on age and year of Medicaid enrollment. A conditional logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between MPA and dMPA exposure and cerebral meningioma were compared to both an active and non-active comparator. Results: Among 469 cases and 4690 matched controls, there was no association between oral MPA and cerebral meningioma. Associations for dMPA exposure were similar when using a non-active (OR 1.87, 95% CI 1.16–3.00) or active comparator (OR 1.93, 95% CI 01.01–3.69). These associations were strongest for prolonged exposure compared to a non-active (OR 3.80, 95% CI 1.88–7.68) and active comparator (OR 3.67, 95% CI 1.09–12.29). Conclusion: The current results are consistent with the prior literature that dMPA exposure is associated with an increased likelihood of meningioma for prolonged use. More research is needed to examine whether the association is limited to a certain histology or grade of meningioma. Clinicians should consider discussing with patients these reported associations prior to using dMPA. Full article

Background: Endometrial proliferative lesions are common in the menopausal transition and carry a measurable risk of carcinoma. Early risk stratification may guide evaluation and follow-up. Methods: We performed a single-center retrospective study of 315 women aged 45–55 years (May 2021–May 2024) at a private clinic in Bucharest. Lesions were classified per WHO 2014 as hyperplasia without atypia, atypical hyperplasia/endometrial intraepithelial neoplasia (AH/EIN), or adenocarcinoma; “advanced pathology” was defined as AH/EIN or adenocarcinoma. Clinical comorbidities and transvaginal ultrasound endometrial thickness were recorded. Associations were tested with χ²; odds were estimated with multivariable logistic regression (adjusted ORs), with a modified Poisson sensitivity analysis for adjusted relative risk. Thickness differences were compared by one-way ANOVA, and severity correlations by Spearman’s ρ. Internal validation used 1000-bootstrap resampling. Results: Hyperplasia without atypia comprised 74.6% of cases, AH/EIN 20.0%, and adenocarcinoma 5.4% (advanced pathology 25.4%). Diabetes was independently associated with advanced pathology (aOR 2.75; 95% CI 1.14–6.61; p = 0.0237), while a history of non-atypical hyperplasia was inversely associated (aOR 0.31; 95% CI 0.13–0.72; p = 0.0068). Obesity showed a borderline association (aOR 1.79; 95% CI 0.98–3.26; p = 0.058), and long-term oral contraceptive use also approached significance (aOR 0.42; 95% CI 0.18–1.00; p = 0.051). Endometrial thickness increased stepwise with histopathological severity (ANOVA p < 0.0001; η² = 0.44) and correlated with ordered severity (ρ = 0.634). The multivariable model showed moderate discrimination (AUC 0.68; optimism-corrected 0.66) with acceptable calibration (slope 0.92; Hosmer–Lemeshow p = 0.052) and overall accuracy (Brier 0.18). Conclusions: In perimenopausal abnormal bleeding, metabolic comorbidities—especially diabetes—together with increased endometrial thickness identify women at higher risk of AH/EIN or carcinoma. Histopathology remains the diagnostic reference. The model can aid clinical prioritization but requires external validation and should not be used as the sole basis for decisions. Full article

Background: The COVID-19 pandemic disrupted essential health services globally, including contraceptive provision. This study examined barriers to contraceptive access in Nigeria during the national lockdown and lessons for future health crisis preparedness. Methods: A cross-sectional online survey of 1273 respondents was conducted during the COVID-19 lockdown. Descriptive statistics and multivariate logistic regression were used to identify predictors of unmet contraceptive need. Online convenience sampling may limit representativeness. Results: Fear of contracting COVID-19 at health facilities (76.6%), closure of drug and chemist shops (53.7%), movement restrictions (48.4%), and inability to reach healthcare providers (43.5%) were the most reported barriers. Adults aged 26–33 years (AOR = 2.00, 95% CI: 1.05–3.73), those married or cohabiting (AOR = 3.87, 95% CI: 2.58–5.68), and Yoruba respondents (AOR = 1.70, 95% CI: 1.04–2.58) were significantly more likely to report unmet need. Tertiary education (AOR = 0.28, 95% CI: 0.13–0.55) and rural residence (AOR = 0.57, 95% CI: 0.37–0.86) were protective factors. Conclusion: COVID-19-related restrictions exposed systemic weaknesses in Nigeria’s contraceptive delivery. Addressing fragile supply chains, strengthening community-based alternatives, and embedding reproductive health into emergency preparedness plans will be critical to building resilient systems for future crises. Full article

Background/Objectives: Health literacy has an impact on students’ reproductive health. Therefore, the objective of our study is to systematically examine, identify, and summarize all research on the role of health literacy in fertility awareness and reproductive health among university students in order to understand how health literacy influences reproductive health outcomes in this population. Methods: Using the PRISMA guidelines, a comprehensive systematic search was conducted using electronic databases, such as PubMed, EMBASE, CINAHL, Scopus, and Google Scholar. The protocol was registered in the Prospective Register for Systematic Reviews (PROSPERO, CRD 42024566268). All studies were imported into EndNote software and screened using a two-level title/abstract screening process. The included studies were narratively summarized. Results: The database search identified 1360 articles; 116 duplicates were removed, and thus, 1244 were initially screened, leading to 1133 exclusions. A total of 111 articles underwent full screening, and 94 were then excluded. A total of 14 articles were included for data extraction. Health literacy impacts university students’ behaviour, fertility awareness, and reproductive health knowledge. Students with higher health literacy show more understanding of critical topics such as fertility and emergency contraception. Socioeconomic factors play a crucial role in shaping health literacy and reproductive choices, while gender disparities highlight the need for targeted educational interventions, particularly for male students. Effective educational programs have been shown to enhance health literacy. Additionally, technology integration serves as a valuable tool for disseminating reproductive health information. Cultural context also plays a vital role in influencing health literacy. Conclusions: The findings of this study emphasize the importance of comprehensive strategies to enhance health literacy among university students, and future research should focus on developing and evaluating targeted educational programs that address gender disparities and socioeconomic factors influencing health literacy. Full article

This study examined the association between formal sex education (FSE), sensory disability status, and contraceptive use among U.S. women. Women with disabilities face barriers to contraceptive decision-making, such as limited accessible FSE content and topics. Data were weighted and analyzed from the 2011–2019 National Survey of Family Growth among women 15–25 years of age. Multivariable logistic regression and moderation analysis examined the association between sensory disability status, contraceptive use during last sexual encounter, and FSE topics. Women with hearing loss or both hearing loss and vision loss were less likely to use contraceptives during last sexual encounter than women without sensory disability (hearing loss: adjusted odds ratio (aOR): 0.36; 95% confidence interval (CI): 0.14, 0.96; both: aOR: 0.28; CI: 0.08, 0.91). Exploratory moderation analysis showed women with vision loss who received FSE on birth control methods (aOR: 6.14; 95% CI: 1.70, 22.23) and on sexually transmitted infections (aOR: 28.24; 95% CI: 1.71, 46.63). The estimates were based on small numbers of individuals within each subgroup and wide confidence intervals, and thus should be interpreted with caution. The findings point to differences in contraceptive use according to sensory disability status, indicating future studies need larger sample sizes to better understand the role of FSE for women with sensory disability. Full article

Background: Female sexual dysfunction (FSD) is an underrecognized issue in women with systemic sclerosis (SSc), influenced by physical and psychological factors. Data on FSD in reproductive-age SSc patients, especially those with diffuse cutaneous SSc (dcSSc), remain limited. Objectives: This study aimed to determine the prevalence of FSD and identify its associated factors among reproductive-age women with SSc. Methods: A cross-sectional study (May 2019–March 2020) included sexually active women with SSc aged 18–45. Patients with surgical amenorrhea, prior radiation, hormonal contraceptive use within 12 weeks, or pregnancy were excluded. Sexual function was assessed using the Female Sexual Function Index (FSFI). Results: Among 27 women of reproductive age, 66.7% had the dcSSc subset. The mean age was 39.4 ± 5.2 years (range: 22–45 years), with a mean disease duration of 9.9 ± 7.9 years. FSD was identified in 51.9% of patients (95%CI: 31.9–71.3), with a higher prevalence in the dcSSc subset (71.4%) compared to limited cutaneous SSc (28.6%). Patients with FSD were more likely to be older at disease onset, exhibit telangiectasia, and have longer exposure to cyclophosphamide (CYC), although these findings were not statistically significant. Women with FSD showed significantly lower FSFI scores in arousal, lubrication, orgasm, sexual satisfaction, and total sexual function (p < 0.01 for all). Conclusions: FSD is highly prevalent among SSc women of reproductive age, particularly in those with dcSSc. Disease severity, older age at onset, and prolonged CYC treatment may contribute to the risk of FSD. Early recognition and management of sexual health issues are essential in this patient population. Full article

In Austria, community pharmacists may dispense prescription-only drugs in exceptional emergency cases. Hospital pharmacists are permitted to adapt or discontinue therapy with prior physician approval. This mixed-methods study explores how Austrian pharmacists interpret and apply these frameworks, their readiness for expanded roles, and the systemic conditions required to support broader clinical engagement. A cross-sectional design was used with two online surveys targeting community and hospital pharmacists. Additionally, 15 semi-structured interviews were conducted (ten community, five hospital pharmacists). Quantitative data were analyzed descriptively; qualitative data were examined using Mayring’s content analysis. Data integration followed a triangulation design via mixed-methods matrices. A total of 238 community and 53 hospital pharmacists responded. Findings show that community pharmacists frequently apply clinical judgment in urgent situations and navigate regulatory grey zones. Over 88% support expanded roles, particularly in continuing contraceptives, managing chronic diseases, and treating infections using point-of-care testing. Hospital pharmacists report limited implementation of their framework, hindered by institutional inertia, staffing shortages, and poor access to patient data. Confidence in clinical pharmacotherapy decisions was limited. Targeted training and policy support are essential. Full article

Background/Objectives: This study examined how reproductive factors—such as oral contraceptive (OC) use, age at menarche, number of pregnancies, and age at first delivery—are related to the risk of metabolic syndrome (MetS) in Korean women aged 30–69, based on their menopausal status. Methods: Data from the Korea National Health and Nutrition Examination Survey 2010–2023 were analyzed, including 31,178 women with complete data. Survey-weighted logistic regression and restricted cubic spline analyses were conducted, adjusting for sociodemographic, lifestyle, and reproductive covariates. Results: OC use was associated with higher MetS risk in both pre-menopausal (adjusted OR 1.40, 95% CI 1.13–1.72) and post-menopausal women (adjusted OR 1.16, 95% CI 1.03–1.29). This association was observed primarily in relation to elevated blood pressure in both groups and high triglycerides in post-menopausal women. Other reproductive factors, including age at menarche, number of pregnancies, and age at first delivery, showed no significant associations with MetS risk. Conclusions: OC use was associated with higher MetS risk in this cross-sectional study of Korean women. These observational findings suggest a potential relationship that warrants further investigation through longitudinal studies to establish temporal relationships and explore underlying mechanisms. Full article

Potential variability in neuromuscular function or physiology throughout the menstrual cycle (MC) or a cycle of using hormonal contraceptives may affect muscular performance variables that are relevant to exercise, training, or sport. Collegiate softball players (n = 11) that reported using and not using hormonal contraceptives completed three testing sessions during their respective early follicular, ovulatory, and mid luteal phases of the MC or early, mid, or late phases of their hormonal contraceptive cycle (HCC). Each testing session included a series of performance tests: countermovement jump on a force plate, 15-yard sprints, velocity assessment of the back squat performed at 70% of one-repetition maximum (1-RM), one-repetition maximum bench press, and 70% 1-RM repetitions to failure testing on the bench press. No significant differences were found for any of the performance tests between the three phases, though performance on most tasks peaked during the mid luteal/late phases of the MC/HCC. It is important to note that this study was underpowered and this could have masked any observed differences. Collectively, muscular performance was not significantly different throughout phases of the MC or HCC in these athletes, indicating that potential hormonal variability throughout the MC or HCC did not seem to have an effect on performance outcomes in this study. Full article

Background/Objectives: Hormonal contraceptives are widely used, but their effects on respiratory health remain underexplored. This systematic review examined the impact of oral contraceptive pills (OCPs) on pulmonary function, with an emphasis on asthma-related outcomes and underlying mechanisms. Methods: MEDLINE (PubMed), EMBASE (Ovid), CINAHL, AMED, SPORTDiscus, and PEDro were searched from January 2000 to December 2024. Pulmonary outcomes assessed included PEFR, FEV₁, airway hyperresponsiveness, and exhaled nitric oxide levels. Results: Twelve peer-reviewed studies were included. Most studies reported that OCPs do not impair lung function and may even improve respiratory parameters. Women using OCPs showed enhanced peak expiratory flow and reduced symptom variability, particularly in asthma and cystic fibrosis. Potential mechanisms include the stabilization of airway reactivity and modulation of inflammatory pathways. Heterogeneity across study populations and contraceptive types limited a meta-analysis, and few studies stratified outcomes by hormonal composition or comorbidities. Conclusions: Hormonal contraceptives may provide protective or regulatory effects on pulmonary function in specific populations. Larger precision-based studies are needed to clarify mechanisms and guide contraceptive counseling for women with respiratory conditions. Full article

Background and Clinical Significance: Non-palpable migrated contraceptive implants pose significant challenges for removal and are associated with neurovascular complications. Traditional open surgery near nerves is associated with postoperative morbidity. Migrated or deeply embedded implants near critical structures can result in severe complications, such as neuropathy, and their removal typically requires open surgical intervention. Case Presentation: We report a novel, minimally invasive, ultrasound (US)-guided technique for removing a migrated etonogestrel Implanon^® implant that caused ulnar neuropathy. A 38-year-old woman presented with severe neuropathic pain and paresthesia (NPRS 10/10; QuickDASH 55) along her left ulnar nerve following multiple failed removal attempts that induced deep migration. US confirmed the proximity of the implant to the ulnar nerve. Initial US-guided removal exacerbated her symptoms. Hydrodissection (HD) with 50 mL of 5% dextrose in water (D5W) without local anesthetic (LA) was performed to reduce inflammation and achieve separation. The implant migrated proximally during extraction. An additional HD with 50 mL of D5W without LA distally repositioned the implant. Percutaneous stabilization using a 25-gauge needle enabled secure removal. The intact 4 cm implant was extracted under real-time US guidance without open surgery. The patient experienced immediate symptom relief (NPRS 2/10; QuickDASH 4.5 at one month) and full resolution (NPRS 0/10; QuickDASH 0) with no motor deficits at one year. Conclusions: This case represents the first documented percutaneous removal of a nerve-adherent implant using combined US-guided D5W HD and needle stabilization, marking a paradigm shift in the management of such cases. This approach confirms the safety of US-guided foreign body removal using HD for nerve-adjacent implants and demonstrates the efficacy of combining D5W HD with needle stabilization. Surgical morbidity was avoided, while excellent long-term outcomes were achieved. Full article

The use of hormonal contraceptives is essential to ensure effective and safe contraception. However, factors such as inadequate prescription, poor adherence, or lack of information can lead to drug-related problems (DRPs) and negative outcomes associated with medication (NOMs). Methods: An observational, descriptive, cross-sectional study was conducted between January and June 2024 in two community pharmacies in Tenerife. It included 316 users of hormonal contraceptives over the age of 18. The main instrument was a structured questionnaire, administered through individual interviews conducted in the Personalized Care Area (PCA). Results: Combined Oral Contraceptives (COCs) were the most frequently used method (72.2%). Adverse reactions were reported by 47.2% of participants, mainly psychiatric disorders (28.1%). Emergency contraception had been used at least once by 43.8% of the respondents. Among COC users, 68.9% reported difficulties with daily adherence, and only 36.7% had adequate knowledge in case of missed doses. Conclusions: Community pharmacists may play a key role in reproductive health by providing personalized counselling, referring patients to other levels of care, and promoting the rational and safe use of hormonal contraceptives. Full article