Search Results (3,403)

Background and Objectives: Ofatumumab (OFA) is the first fully human anti-CD20 monoclonal antibody approved for the treatment of RRMS classified as a high-efficacy treatment agent. Real-world evidence is essential for evaluating the effectiveness and safety of OFA. Materials and Methods: A total of 184 patients (72.3% women, mean age 38 years (±10.9), 51 naïve patients and 133 after switch. Among them, 142 patients were evaluated after first 12-months of treatment according to relapse rate, neurological status expressed by Expanded Disability Status Scale (EDSS), new T2-weighted (T2-w) lesions and gadolinium-enhancing lesions (GELs) in magnetic resonance imaging (MRI), confirmed disability progression, as well as adverse events. Logistic regression identified factors associated with disease activity at ofatumumab initiation, including age, sex, disease duration, prior treatment, and baseline EDSS. Results: After the first 12 months of OFA treatment, relapses occurred in 12.0% of patients; new or enlarging T2-w lesions were observed in 12.7%; GELs in 3.5%; EDSS progression in 12.7%; and EDSS improvement in 14.2%. The No Evidence of Disease Activity-3 (NEDA-3) status was achieved in 76.1% of patients overall—75.8% in those who switched from another disease-modifying therapy (DMT), and 76.6% in treatment-naïve individuals. No significant differences were observed between the naïve and switch groups. Baseline EDSS at ofatumumab initiation was a significant predictor of relapse activity, while age was significantly associated with MRI activity (GELs) at 12 months. Conclusions: Real-world data confirmed high efficacy and safety of ofatumumab in RRMS. NEDA-3 was achieved more often than in registration trials. No efficacy differences between naïve and switch patients were observed. Full article

Introduction and Hypothesis: Pregnancy-specific urinary incontinence (PS-UI) is defined as any onset of new urinary leakage during pregnancy. The study aims to analyze the prevalence and risk factors of PS-UI. We hypothesized that demographic and clinical factors, including Gestational Diabetes, may contribute to the development of PS-UI. Methods: We recruited pregnant women from the Diamater cohort study. We evaluated the maternal characteristics, demographics, anthropometrics, hyperglycemic status, and the PS-UI occurrence. A logistic regression model was performed considering the clinical variables to determine the predictive factors for PS-UI occurrence. Results: PS-UI was prevalent in 62.1% of women. Among these, 58.85% began leaking urine between 24–28 gestational weeks. Additionally, 51% developed PS-UI at the end of pregnancy. The pregestational BMI is a risk factor for PS-UI, and physical activity is a protective factor that halves the risk of PS-UI developing. Conclusions: Weight management and encouragement to engage in physical activity during pregnancy should be emphasized in prenatal care to reduce the risk of PS-UI. Further studies are suggested to evaluate the impact of the association due to UI later in life. Full article

Background: Namibia is experiencing a generalized HIV epidemic, with 7.5% of the population living with HIV. Adolescent girls and young women (AGYW) aged 15–24 account for 28.6% of new infections annually. Various factors increase AGYW’s vulnerability to HIV. To address this, Project HOPE Namibia (PHN)-led consortium implemented the PEPFAR/USAID-funded DREAMS project in Khomas, Oshikoto, and Zambezi regions from 2018 to 2023. This study estimated the AGYW population most in need of HIV prevention and assessed geographic and age-specific gaps to improve program effectiveness and efficiency. Methods: This secondary data analysis utilized the Namibia Population-Based HIV Impact Assessment (NamPHIA) 2017, the Namibia census, and service data from the DREAMS project, which includes entry points for recruitment, screening, and enrolment. We used Python to conduct unadjusted and adjusted Poisson regression and UpSet plots for data visualization. Results: Analysis of NamPHIA data revealed low HIV prevalence in 10–14-year-olds, with only Oshikoto showing a detectable rate of 2.76%, mostly attributed to perinatal HIV transmission. Of the 12 DREAMS eligibility criteria, three could be mapped to 10–14-year-olds, while all except sexually transmitted infections could be mapped for 15–19 and 20–24-year-olds. Nationally, 17.3% of 10–14-year-old AGYW, 48.0% of 15–19-year-olds, and 50% of 20–24-year-olds met at least one DREAMS eligibility criterion. Among 15–19-year-olds, a history of pregnancy, no/irregular condom use, and out-of-school status were positively associated with HIV status. For 20–24-year-olds, transactional sex was positively associated with HIV status. Overall, 62% of screened individuals were eligible, and 62% of eligible individuals enrolled. PHN screened 134% of the estimated 37,965 10–14-year-olds, 95% of the estimated 35,585 15–19-year-olds, and 57% of the 24,011 20–24-year-olds residing in the five districts where DREAMS was implemented. Conclusions: We recommend the refinement of the DREAMS eligibility criteria, particularly for AGYW 10–14, to better identify and engage those at risk of HIV acquisition through sexual transmission. For 15–19-year-olds, PHN efforts should interrogate geographic variability in entry points for recruitment and screening practices. PHN should enhance the recruitment and engagement of AGYW 20–24, with a particular focus on those engaged in transactional sex. Full article

Background/Objectives: GaBHA syndrome (gastric bypass hyperammonemia) is an emerging new syndrome primarily in women who had prior Roux-en-Y gastric bypass surgery (RYGB) and then developed non-cirrhotic hyperammonemia with a high case–fatality ratio. Genetic and nutritional deficiencies have been implicated in the pathogenesis of this clinical condition, but none has been proven. We present an illustrative case and do a scoping review of the current literature in 58 patients with this diagnosis. Methods: A retrospective scoping literature review was utilized to identify patients who fulfilled 1. RYGB surgery, and 2. Hyperammonemic encephalopathy following the PRISMA extended checklist. We searched PubMed, MedLine, SCOPUS, and Web of Science databases. Results: We described the classic presenting symptoms and laboratory findings of this syndrome. We confirmed the female predominance (93%) and the high case–fatality ratio (32%). We then presented a novel hypothesis contending that arginine deficiency ultimately leads to a functional deficiency of the ornithine transcarbamolyase (OTC) enzyme, leading to the non-cirrhotic life-threatening hyperammonemia. Our hypothesis may also explain the high incidence of hypoglycemia found in these patients as we found in our search. Our proposed hypothesis may also be relevant to the occurrence of hyperammonemia in some solid organ transplant recipients. Conclusions: GaBHA syndrome is emerging as an important potential adverse outcome after RYGB surgery. It has a female predominance and a high case–fatality ratio. Arginine deficiency may explain the emergence of a functional OTC deficiency, which then leads to the severe hyperammonemia, and may also explain the frequent occurrence of hypo-glycemia in these patients. Full article

Gynecological cancer, especially breast, cervical, and ovarian cancer, are significant health issues affecting women worldwide. When screened they are mostly detected at later stages because of non-specific signs and symptoms as well as the unavailability of reliable screening methods. The improvement of early oncologic prediction methods is therefore needed to work out the survival rates, guide individualized treatment, and relieve healthcare pressures. Outcome forecasting and clinical detection are rapidly changing with the use of machine learning (ML), one of the promising technologies used to analyze complex biomedical data. Artificial intelligence (AI)-based ML models are capable of determining low-level trends and making accurate predictions of disease risk and outcomes, because they can combine different datasets (clinical records, genomics, proteomics, medical imaging) and learn to identify subtle patterns. Standard algorithms, including support vector machines, random forests, and deep learning (DL) models, such as convolutional neural networks, have demonstrated high potential in identifying the type of cancer, monitoring disease progression, and designing treatment patterns. This manuscript reviews the recent developments in the use of ML models to advance oncologic prediction tasks in gynecologic oncology. It reports on critical domains, like screening, risk classification, and survival modeling, as well as comments on difficulties, like data inconsistency, inability of interpretation of models, and issues of clinical interpretation. New developments, such as explainable AI, federated learning (FL), and multi-omics fusion, are discussed to develop these models and to make them applicable in practice because of their reliability. Conclusively, this article emphasizes the transformative role of ML in precision oncology to deliver improved, patient-centered outcomes to women who are victims of gynecological cancers. Full article

Background: COVID-19 has been associated with multisystemic sequelae, including persistent neurocognitive impairment and emerging metabolic alterations. Growing evidence suggests that glial dysfunction and inflammation may play a pivotal role in both cognitive decline and new-onset diabetes following SARS-CoV-2 infection. Objectives: This study aimed to assess the prevalence and characteristics of cognitive impairments in post-COVID-19 patients and to explore their correlation with new-onset diabetes, neuroanatomical changes, and psychological symptoms, with a specific focus on gender differences. Methods: A total of 245 patients (mean age 56.8 ± 12 years), previously diagnosed with COVID-19, were enrolled between April 2021 and August 2023. Participants underwent a comprehensive neuropsychological assessment (MMSE, Rey-Osterrieth Figure, FAB, Hamilton, STAI, IES-R), structured interviews, and, in a subset, brain MRI. Individuals with pre-existing neurological disorders were excluded. Data were analyzed for cognitive performance, neuroimaging abnormalities, and metabolic outcomes, including new-onset diabetes. Results: Cognitive dysfunction was identified in 87% of participants: mild in 47%, moderate in 21.6%, and severe in 10.8%. Glial alterations on MRI were observed in 51%, hippocampal atrophy in 9%, and temporal lobe reduction in 4%. Notably, 12% of patients developed new-onset diabetes post-COVID, of whom 80% exhibited mild to moderate cognitive deficits. Depressive symptoms were present in 80.9%, and anxiety in 93.5%, with significantly higher incidence in female patients. PTSD symptoms correlated with greater cognitive impairment. Ongoing research into the mechanisms underlying these persistent cognitive impairments in subjects with and without types 1 and 2 diabetes. This paper presents the final data of the research published in the previous article referenced in the bibliography. Conclusions: This study highlights a significant association between cognitive decline and new-onset diabetes in post-COVID patients, likely mediated by systemic inflammation and glial dysfunction. Particularly noteworthy are the findings of neuroanatomical alterations, including nonspecific glial signal changes, hippocampal atrophy, and temporal lobe volume reductions, suggesting post-infectious cerebral vulnerability with potential long-term consequences. These results support the need for integrating cognitive screening, brain neuroimaging, and metabolic monitoring into post-COVID care pathways—especially for women and individuals presenting with anxiety or depressive symptoms. An early and interdisciplinary approach is essential to address the neuro-metabolic and cerebral sequelae of long COVID. Full article

Background/Objectives: This study aimed to examine the dynamic thermal variations that occur in the posterior body regions of pregnant women by employing thermal imaging techniques. Methods: The study involved the participation of 34 women in various stages of pregnancy. The skin temperature (Tsk) distribution in specific body areas, including the spinal region and lower limbs, was analyzed under standard conditions. Results: The most considerable increase in body temperature (Tsk) recorded in female volunteers was achieved during the second trimester of pregnancy in physiologically stressed areas, such as the upper back (0.4 °C), lower back (0.77 °C), thighs (0.94 °C) and calves (0.32 °C). Contrastingly, a decrease in Tsk of noteworthy magnitude was observed in all body regions during the third trimester, with an average decrease of 1.7 °C. The lower back’s most substantial decrease was observed (1.95 °C). Furthermore, a disparity was observed in the Tsk distribution of the calves, with the highest ∆T_mean value recorded at approximately 0.5 °C, and the thighs exhibiting a ∆T_mean value of 0.25 °C. Conclusions: Preliminary studies have demonstrated the potential of thermal imaging as a reliable and safe method to support prenatal diagnosis. Its application can facilitate the early detection of health complications, including inflammatory states or posture and circulatory system disorders, thereby enhancing the standard of prenatal care. Full article

Preeclampsia (PE) is not merely a pregnancy complication but a clinical manifestation of underlying vascular dysfunction with long-term health implications. It is diagnosed after 20 weeks of gestation as new-onset hypertension with proteinuria or organ involvement. The condition arises from impaired placental development, particularly defective spiral artery remodeling, which leads to placental ischemia and the release of antiangiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng). These circulating factors contribute to systemic endothelial dysfunction, resulting in hypertension, inflammation, and multiorgan stress. Histopathological findings, including acute atherosis and abnormal vascular remodeling, further reflect the cardiovascular damage underlying PE. This review synthesizes emerging evidence on the vascular and histological mechanisms of PE, highlighting novel biomarkers such as microRNAs and neprilysin, and the potential of advanced diagnostic tools, including machine learning. Importantly, PE is now recognized not only as an obstetric disorder but also as an early marker of future cardiovascular disease. This paradigm shift emphasizes the need for personalized prevention strategies, close surveillance of high-risk women, and long-term cardiovascular follow-up. Pregnancy thus represents a critical window for early detection and intervention in women’s cardiovascular health. Full article

Rheumatoid arthritis (RA) is a highly prevalent chronic inflammatory rheumatic disorder leading to functional impairment and sequels. The search for new biomarkers helping in detecting RA subjects of high risk of functional disability is required. Studies showing high follistatin levels in RA have been described; however, none of them have placed focus on the role of follistatin as marker of deteriorated functionality. We aim to identify whether follistatin concentrations could be a potential biomarker of physical disability and disease activity in RA patients. Fifty-seven female RA subjects and 20 age–gender-matched controls were included in a cross-sectional evaluation. An assessment of clinical characteristics, grip strength, gait speed, and muscle mass was conducted. In RA subjects, disability was assessed using HAQ-DI and active disease using the DAS28-ESR. Follistatin levels were measured by ELISA. We compared (a) RA + functional disability and (b) RA + preserved physical function. Serum follistatin levels were increased in RA subjects compared to controls (175 ± 119 vs. 133 ± 47; p = 0.030). Follistatin levels correlated with deteriorated physical function levels (r = 0.491; p < 0.001) and severe activity (r = 0.344; p = 0.009). The RA + functional disability group, as compared to the RA + preserved physical function group, had higher serum follistatin levels (218 ± 159 vs. 141 ± 59; p = 0.030), lower grip strength (7.9 ± 4.6 vs. 14.5 ± 5.1; p < 0.001), reduced gait speed (0.77 ± 0.20 vs. 0.92 ± 0.20; p = 0.010), as well as higher proportions of tender joints ≥4 (48% vs. 16%; p = 0.008), and higher disease activity scores (3.8 ± 1.5 vs. 2.8 ± 1.2; p = 0.008). We concluded that higher follistatin levels are associated with physical functional impairment and the severity of disease activity in women with RA. Future studies are required to evaluate whether these follistatin levels can be related to other outcomes such as labor disability, hospitalization, and falls. Full article

Background/Objectives: High-grade serous carcinoma (HGSC) is the leading cause of ovarian cancer-related mortality. It usually arises from fallopian tube epithelium, with a smaller subset arising in non-tubal sites including the ovary or peritoneum. The origin of HGSCs without evidence of tubal involvement remains unclear. Moreover, in women with genetic predisposition to developing HGSC, the additional protection afforded by prophylactic removal of the ovaries in addition to the fallopian tubes has not yet been established. Methods: We used a well-characterized genetically engineered mouse model (GEMM) of oviductal HGSC based on conditional, somatic inactivation of the Brca1, Trp53, Rb1, and Nf1 tumor suppressor genes (BPRN mice) to compare preventive effects for HGSC via bilateral salpingectomy versus bilateral salpingo-oophorectomy. We also explored the origins of non-tubal HGSCs in ectopic tubal-type epithelium (endosalpingiosis) present in the mouse ovaries and peritoneum. Results: While bilateral salpingectomy significantly reduced the incidence of HGSCs in the GEMM model, bilateral salpingo-oophorectomy completely prevented tumor development. We identified an example of HGSC with apparent origin in endosalpingiosis, implicating endosalpingiosis as a likely precursor for non-tubal HGSC. Conclusions: Our findings confirm the superiority of bilateral salpingo-oophorectomy over salpingectomy alone in reducing HGSC risk and affirm the rationale for surgical strategies to reduce HGSC risk in women carrying pathogenic variants of BRCA1/2 and other genes associated with homologous recombination deficiency. Our findings also illustrate how work with GEMMs can advance new insights into HGSC pathogenesis. Full article

Rubella is typically a mild viral illness, but it can lead to severe complications when contracted during pregnancy, such as pregnancy loss or developmental defects in the fetus (congenital rubella syndrome). Therefore, it is crucial to develop and maintain protective immunity in women of childbearing age. In this study, we assessed the transcriptional factors associated with rubella-specific immune outcomes (IgG binding antibody and avidity, neutralizing antibody, and memory B cell ELISpot response) following a third MMR vaccine dose in women of reproductive age to identify key factors/signatures impacting the immune response. We identified baseline (Day 0) and differentially expressed (Day 28–Day 0) genes associated with several RV-specific immune outcomes, including the transferrin receptor 2 (TFR2), which is an important factor regulating iron homeostasis and macrophage functional activity, and a close functional homolog of TFR1, the cellular receptor of the New World hemorrhagic fever arenaviruses. We also identified enriched KEGG pathways, “cell adhesion molecules”, “antigen processing and presentation”, “natural killer cell-mediated cytotoxicity”, and “immune network for IgA production”, relevant to immune response priming and immune activation to be associated with RV-specific immune outcomes. This study provides novel insights into potential biomarkers of rubella-specific immunity in women of childbearing age. Full article

Some of Spain’s greatest humanists—Juan Luis Vives, Antonio de Nebrija, Juan de Ávila, Luis de León, and Benito Arias Montano—were from a converso background. Recent scholarship suggests that two of the three most influential religious movements in sixteenth-century Spain—Juan de Ávila’s evangelical movement and Teresa of Ávila’s Barefoot Carmelites—were founded by conversos and presented converso membership, whose winds of religious innovation to tame Christian Orthodoxy and Counter-Reformation Spanish society, through the influence of Italian Humanism and reform, prioritized spiritual practice, social toleration, and religious concord. Indeed, Santa Teresa de Ávila, a major innovator within the Spanish Church, was herself from a converso family with Jewish ancestry. She became a key female theologist who transcended as an identity marker of the Spanish Baroque, conceived as quintessential of the Spanish Golden Age. Coopted in different periods, she “reappeared” in the 1930s as Patron of the Sección Femenina de la Falange y de las JONS, the women’s branch of the new radical right, turning into a role model of femininity for highly conservative religious women. Consecrated as “Santa de la Raza”, she became the undisputable womanized icon of the so-called “Spanish Crusade”, the slogan which General F. Franco implemented, with the approval of the Spanish Catholic Church, to re-cast in a pseudo-theological narrative the rebellion against the Spanish Second Republic in July 1936. This article examines different appropriations of the figure of Teresa de Ávila as a pillar of “Hispanidad”, in the last centuries within the changing sociopolitical contexts and theological debates in which this instrumentalization appeared. By highlighting the plasticity of this converso figure, the article suggests possible lines of research regarding the Jewish origins of some national icons in Spain. Full article

Background/Objectives: Preoperative sarcopenia in liver transplantation (LT) recipients is an important prognostic factor of LT outcomes. Systemic inflammatory status (SIS) has been proposed as a unifying mechanism for skeletal muscle loss; thus, considering SIS and sarcopenia together may enhance prognosis assessment in patients undergoing LT. Herein, we aimed to describe the relationship between the SIS and skeletal muscle index (SMI) with short-term and long-term mortality post-living donor LT (LDLT). Methods: In total, 3387 consecutive adult LDLT recipients were retrospectively evaluated. The neutrophil-to-lymphocyte ratio (NLR, using a cut-off of 3) was utilized as an SIS. SMI was calculated using computed tomography scans, measured at the third lumbar vertebra; sex-specific cut-offs were determined from contemporary donors. Univariate and multivariable Cox proportional hazard analyses were performed. Results: Decreasing SMI was associated with increasing NLR. Increasing NLR and decreasing SMI both showed dose-dependent relationships with a risk of 90-day mortality. Within sarcopenic patients, NLR > 3 (vs. NLR ≤ 3) was associated with higher 90-day (9.3% vs. 3.5%, p = 0.049) and overall mortality (28.4% vs. 19.1%, p = 0.045). Sarcopenia and NLR > 3 (vs. neither) were independent predictors of 90-day mortality (hazard ratio [HR] 2.48 [1.40–4.40], p = 0.002) and overall mortality (HR, 1.81 [1.37–2.38], p < 0.001) after multivariable adjustment. When stratified by age, sex, and MELD score, the association between sarcopenia and overall mortality persisted in all subgroups, with the highest risk observed in women (HR 3.43, 95% CI 1.83–6.43). Conclusions: Sarcopenia, with the systemic inflammatory response, nearly doubled the risk of 90-day and overall mortality post-LT, proposing that these readily available biomarkers are a practical index for predicting survival post-LT. Considering that these are potentially modifiable factors, our result may provide a new therapeutic target to improve survival post-LT. Full article

Background. Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening condition typically presenting as heart failure with reduced ejection fraction in the last month of pregnancy or in the first five months following delivery in women without other known causes of heart failure. PPCM incidence and prevalence are highly variable in different populations and geographical areas. The etiology of PPCM is likely multifactorial, with genetic predisposition, autoimmune conditions, nutritional deficiencies, hormonal and metabolic changes, myocardial inflammation, enhanced oxidative stress, vascular dysfunction, and angiogenic imbalance all listed as possible contributing factors. Objectives. The complexity and multifactorial nature of PPCM can be explored by large-scale “omics” investigations, and their integration has the potential to identify key drivers and pathways that have the largest contribution to the disease. The scarcity of relevant knowledge and experience with most rare diseases raises the unique need for cooperation and networking. Methods and results. In the context of PPCM, we hypothesize that the creation of prospective patient registries could represent an answer to this criticality. Therefore, we created a multicenter national registry of PPCM in different geographical areas in Italy. Conclusions. We expect that the integration of clinical, imaging and omics-based data might provide novel insights into PPCM pathophysiology and allow in the future early detection, risk assessment, and patient-specific therapeutic interventions, thereby offering new perspectives in precision medicine. Full article

The impacts of the COVID-19 pandemic and post-pandemic recovery in urban communities in the Arctic have been substantial, but their gendered aspects remain largely unknown. The goal of this study was to enhance the understanding of the gender-based impact on women in the urban areas of Alaska by exploring strengths and constraints to resilience in the social and economic domains of gender equality during and in the aftermath of the COVID-19 pandemic. Drawing on grounded theory methodology, this study is based on 29 in-depth, semi-structured interviews. The study methodology utilized a conceptual framework that integrated deficit-based and strength-based analytical perspectives. The paper implemented a voice-centered approach that drew on thematic interviews conducted with women in Anchorage and Nome. Alaska’s urban women demonstrated resilience rooted in self-empowerment and community caregiving. This was reflected in their critical re-evaluation of social and economic gendered structures, a reassessment of priorities in family and social relationships, and the mobilization of support networks. These acts of reflection and care transformed into processes of constructing new meanings of life during dramatic events and became a source of personal strength. The crisis also enabled a re-evaluation of entrenched gender dynamics and women’s ability to challenge gendered divisions in both the workplace and at home. Despite signs of resilience, the pandemic signified a setback for gender equality. It exacerbated pre-existing gender disparities within households, disrupted established pre-pandemic social support networks, increased unpaid domestic labor and a motherhood penalty, and deepened unemployment and income gaps. To further adapt to post-pandemic conditions, women need empowerment and greater representation in decision-making roles, which are critical to strengthening resilience in both the social and economic domains of gender equality. Full article