Female Genital mutilation/cutting (FGM/C) is associated with enduring psychiatric complications. In this study, we investigate the rates of co-morbid abuses and polyvictimization experienced by survivors of FGM/C. This is a sub-analysis of a cohort study examining the patient population at the EMPOWER Center for Survivors of Sex Trafficking and Sexual Violence in New York City. A retrospective chart-review of electronic medical records was conducted for all consenting adult patients who had FGM/C and had an intake visit between January 16, 2014 and March 6, 2020. Of the 80 participants, ages ranged from 20 to 62 years with a mean of 37.4 (SD?=?9.1) years. In addition to FGM/C, participants were victims of physical abuse (43; 53.8%), emotional abuse (35; 43.8%), sexual abuse (35; 43.8%), forced marriage (20; 25%), child marriage (13; 16.3%), and sex trafficking (1; 1.4%). There was a high degree of polyvictimization, with 41 (51.2%) experiencing 3 or more of the aforementioned abuses. Having FGM/C on or after age 13 or having a higher total abuse score was also found to be strong predictors of depression and PTSD. The high rates of polyvictimization among survivors of FGM/C are associated with development of depression and PTSD. Despite co-morbid abuses, patients still attribute substantial psychiatric symptoms to their FGM/C. Health care providers should understand the high risk of polyvictimization when caring for this patient population.
Extracorporeal photopheresis (ECP) is a cell based immunomodulatory therapy in which the patient is attached intravenously to a cell separating machine. During ECP a patient's blood is collected via either a central venous access device (CVAD) or a peripherally inserted 16G arterial venous fistula needle in either one or both antecubital fossa. However, patients presenting for ECP with GVHD repeatedly present a challenge to the ECP team due to poor venous access resulting from previous therapies and skin changes. The use of peripherally inserted central venous catheters (PICCs) offers an alternative route of vascular access for this cohort of patients. Here we present a case report of a patient successfully treated with ECP following the insertion of a PICC line. 相似文献
Volume amplitude gratings made of mesoporous hydrogels are beneficial for sensing, but are difficult to fabricate because they involve creating high aspect ratio features in soft materials. A novel photofunctionalizable hydrogel is reported and its suitability for fabricating grating sensors is demonstrated comprising of features with an aspect ratio of ≈3.2. To make a photofunctionalizable hydrogel with high optical quality that can be patterned using widely available light sources, a water‐soluble photoactive monomer and sensitizer are synthesized. A transmission amplitude grating is subsequently fabricated in a ≈100 µm thick photofunctionalizable hydrogel film by reaction of the free amines generated in the photoexposed regions with pH‐responsive fluorescein isothiocyanate. The volume hydrogel grating described herein is shown to be suitable for real‐time sensing of pH as an exemplar analyte. This work will have a significant impact on the fabrication of diffractive optical structures in thick films of hydrogels that are highly promising for biomolecular sensing in disease diagnosis and healthcare monitoring. 相似文献
Problematic severe asthma remains a significant challenge to manage, accounting for the majority of healthcare utilization among children with asthma. The heterogeneity is recognized and the clinical phenotypes of “difficult-to-treat” asthma (DA) and “severe therapy-resistant asthma” (STRA) help to guide management. Recent evidence supports molecular distinctions between these phenotypes and shows poor correlations between peripheral and airway markers of inflammation, especially in STRA. Airway neutrophils in the context of childhood severe asthma have been explored, but their role in disease causation, protection, or as bystanders remain unknown, and thus, treatment implications are unclear. Several novel management strategies, including once-daily maintenance therapy, single-device maintenance and reliever therapy, and novel biological treatments are being increasingly used for DA and STRA. However, pediatric data for efficacy of novel treatments is scarce, and when available, is restricted to adolescents. The aim of this review is to highlight recent advances in objective biomarkers that aid stratification and management of childhood severe asthma and to highlight gaps in pediatric evidence. Specifically, the urgent need for efficacy studies to improve the management of problematic severe asthma in children younger than 12 years. 相似文献
In this study we evaluated the role of Doppler sonography in the assessment of central mandibular blood flow. We assessed the characteristics of blood flow in the mental artery, the larger terminal branch of the inferior alveolar artery, in 30 healthy volunteers equally distributed in the age groups 20-39, 40-59 and over 60 years. We used a DWL Multi-Dop X4(R) Doppler sonography machine (DWL GmbH) with an 8 MHz probe applied intraorally. The variables analysed were patency, time averaged maximum velocity (TAMV), pulsatility index (PI), discomfort and the duration of the procedure. All the arteries analysed were patent. The TAMV and PI decreased as age increased and there were significant differences between the age groups: TAMV (P = 0.01), PI (P = 0.006). Pair-wise comparisons also showed significant differences (P< 0.05) between the 20-39 and the over 60 age group, 40-59 and the over 60 age group for TAMV, and between the 20-39 and over 60 age group for PI. The difference in measurements between the right and left sides in individual patients was not significant. The assessment took about 20 minutes and caused little discomfort. The technique is simple and could potentially be used to influence clinical decisions. 相似文献
About 5 % of pediatric intracranial germ cell tumors and 20 % of non-germinomatous germ cell tumors (NGGCT) progress to growing teratoma syndrome (GTS) following chemoradiotherapy. The growing teratoma is thought to arise from the chemotherapy-resistant, teratomatous portion of a germ cell tumor and is commonly benign but may undergo malignant transformation.
Methods
Two pediatric patients whose intracranial NGGCTs progressed to growing teratomas during chemotherapy and later transformed to secondary malignant tumors after partial resection and radiation therapy (RT).
Results
Both tumors were diagnosed by MRI scans and elevated serum and CSF markers. Following normalization of tumor markers with chemotherapy and initial decrease in tumor volume, subsequent imaging showed regrowth during chemotherapy with pathology revealing benign teratoma. RT was administered. Several years following this treatment, further growth was seen with pathology indicating malignant carcinoma in one patient and malignant rhabdomyosarcoma in the other. The patient with carcinoma received palliative care while the patient with the sarcoma received further resection, intensive chemotherapy, and an autologous stem cell transplant and is currently in remission, 36 months since malignant transformation.
Conclusion
Malignant transformation of presumed residual teratoma has been seldom reported. Treatment of NGGCT involves platinum-based chemotherapy with craniospinal RT and boost to the primary site, with cure rates of around 80 %. Teratomas are characteristically chemotherapy and RT resistant and are treated surgically. In the event that residual or growing teratoma is suspected, a complete resection should be considered early in the management as there is a risk of malignant transformation of residual teratoma. 相似文献