Sexuality in the later years — the impact of health and body-image in a sample of older women

Research on sexuality in the elderly is still rather scarce. Quite often, there is an underlying assumption that health problems function as main constraints against sexuality in the later years. This article tries to challenge this view and proposes that health aspects tend to be — at least among women — quite overestimated. The data presented here are from a study on sexuality and ageing. Sixty West German women, born between 1907 and 1936 had been interviewed on their psychosexual development in the context of their life-histories. The results show that health variables are of rather little significance in explaining the development and/or maintenance of sexual interest and activity in old age. More general aspects of the so-called body-image seem to be more valid in shedding some more light on the determinants of psychological well-being and of keeping sexuality alive in old age.     

Toe web intertrigo in Kaposi’s sarcoma patients: a microbiological study in a large cohort of patients

Kaposi ‘s sarcoma (KS) is a rare multifocal angioproliferative disease associated with human herpes virus 8 (HHV-8) infection, characterized by cutaneous nodules or plaques especially on the lower limbs. Some skin modifications, such as chronic lymphedema, plantar hyperkeratosis and interdigital desquamation, may be associated with consequent impairment of the local immunosurveillance and increased risk of some bacterial or mycotic infections. With the objective of evaluating if bacterial or mycotic infections in KS patients are supported by different microorganisms compared to control patients, we performed an observational retrospective study, comparing positive cultural swabs of interdigital intertrigo of KS patients with positive cultural swabs of interdigital intertrigo of patients admitted to our dermatologic unit during the last 10 years. One hundred KS patients and 84 control patients were admitted to this study. Some of the skin swabs from interdigital spaces were positive for more than one microorganism, and therefore we found 187 microorganisms among the KS group and 182 microorganisms in the control group. The most common microrganisms among KS patients were T. mentagrophytes (16%), S. aureus (14.9%), P. aeruginosa (13.9%), S. marcescens (5,9%), while among non-KS patients were S. aureus (26,9%), C. albicans (22%), S. agalactiae (7.7%) and E. coli (9.9%). These differences are statistically significant (p < 0.01). KS patients may be more affected by toe web intertrigo due to other bacteria and dermatophytes than the general population. During clinical examination, a careful inspection is necessary for an early diagnosis of toe web intertrigo, in order to prevent serious complications, such as cellulitis and sepsis. Consequently, a cultural examination with antibiogram is required to identify the causative agent of intertrigo and guide antimicrobial therapy.     

Spermatocytic seminoma: a 21 years’ retrospective study in a tertiary care hospital in Pakistan

Background: Spermatocytic seminoma is a rare testicular germ cell tumor of old men. Accounting for 1-4% of all seminomas, spermatocytic seminomas have distinct pathogenesis, histological features, immunohistochemical profile and comparatively benign clinical behavior which distinguishes them from other germ cell tumors, especially classic seminoma. Aims: The purposes of our study were to assess the patient demographics, pathological features and to evaluate the utility of CD 117 immunostain along with other immunohistochemical stains in distinguishing Spermatocytic seminomas from classic seminomas. Material and methods: All spermatocytic seminomas patients diagnosed during 1992 to 2013 at Section of Histopathology, Department of Pathology and Microbiology, Aga Khan University hospital were included. Patient characteristics, histological details and follow-up data of few patients were available. CD 117 expression was determined by immunohistochemistry. Results: Total 16 cases of Spermatocytic seminomas were reviewed. Median age was 60 years and average tumor size was 10.4 cms. Microscopically, all of the 16 cases showed presence of edema and absence of lymphocytic infiltrate and intratubular germ cell neoplasia. Cytoplasmic glycogen was negative in all 13 cases, PLAP immunostain was negative in all 12 cases, while CD 117 was positive in all 8 cases, where applied. Conclusion: CD 117 is of limited utility in differentiating the spermatocytic seminoma from classic seminoma as it is expressed in significant number of spermatocytic seminomas. However, different histological features, PAS special stain and PLAP immunostain are significantly helpful in distinguishing these two entities.     

Risky sexual behavior among patients on long-term antiretroviral therapy: a prospective cohort study in urban and rural Uganda

Background

While the effects of initiation of antiretroviral treatment (ART) on risky sexual behavior have been extensively studied, less is known about the long-term changes in risky sexual behavior over time in resource-poor settings.

Methods

We conducted a secondary longitudinal analysis of one rural and one urban cohort of patients who initiated ART in Uganda between April 2004 and July 2007 followed up-to 2016. Data on sexual behavior were collected every 6 months for 3.5 years in individuals on ART?≥?4 years (baseline) when a behavioral questionnaire was introduced. Risky sexual behavior was defined as sexual intercourse with?≥?2 partners or inconsistent or no condom use in previous 6 months. We report characteristics overall, and by cohort. We used multivariable generalized estimating equations logistic regression to assess the effects of time on ART on risky sexual behavior.

Results

Of 1012 participants, 402 (39.8%) were urban and 610 (60.2%) were rural residents. Mean age was 42.8 years (SD 8.5). Mean duration of follow-up was 51.3 months (SD 15.3), but longer for urban than rural participants (64.5 vs 36.4 months). Risky sexual behavior declined from 33.1% at baseline to 9.6% after 3.5 years of follow-up in the rural cohort (p?≤?0.01 for the test of trend) and was unchanged from 9.7% at baseline to 9.9% after 3.5 years in the urban cohort (p?=?0.51). Receiving care at a rural clinic (aOR 4.99, 95% CI 3.64–6.84); male gender (aOR 1.66, 95% CI 1.26–2.19) and being younger (aOR 5.60, 95% CI 3.80–8.25 for 18–34 years and aOR 2.34, 95% CI 1.74–3.14 for 35–44 years) were associated with increased odds of risky sexual behavior. Not being married (aOR 0.25; 95% CI 0.19–0.34), and longer time on ART (aOR 0.71 95% CI 0.67–0.76) were associated with reduced odds of risky sex.

Conclusions

We observed a decline in risky sexual behavior in rural people on long-term (≥?4 years) ART. Rural, male and young individuals had higher odds of self-reported risky sexual behavior. ART programs should continue to emphasize risk reduction practices, especially among people receiving care in rural health facilities, males, younger individuals and those who are married.

     

The growth of assisted reproductive treatment-conceived children from birth to 5 years: a national cohort study

Background

Birth weight and early child growth are important predictors of long-term cardiometabolic disease risk, in line with the Developmental Origins of Health and Disease hypothesis. As human assisted reproductive technologies (ARTs) occur during the sensitive periconceptional window of development, it has recently become a matter of urgency to investigate risk in ART-conceived children.

Methods

We have conducted the first large-scale, national cohort study of early growth in ART children from birth to school age, linking the register of ART, held by the UK’s Human Fertilisation and Embryology Authority, to Scottish maternity and child health databases.

Results

In this study of 5200 ART and 20,800 naturally conceived (NC) control children, linear regression analysis revealed the birthweight of babies born from fresh embryo transfer cycles is 93.7 g [95% CI (76.6, 110.6)g] less than NC controls, whereas babies born from frozen embryo transfer (FET) cycles are 57.5 g [95% CI (30.7, 86.5)g] heavier. Fresh ART babies grew faster from birth (by 7.2 g/week) but remained lighter (by 171 g), at 6–8 weeks, than NC babies and 133 g smaller than FET babies; FET and NC babies were similar. Length and occipital-frontal circumference followed the same pattern. By school entry (4–7 years), weight, length and BMI in boys and girls conceived by fresh ART and FET were similar to those in NC children.

Conclusions

ART babies born from fresh embryo transfer grow more slowly in utero and in the first few weeks of life, but then show postnatal catch up growth by school age, compared to NC and FET babies. As low birth weight and postnatal catch-up are independent risk factors for cardiometabolic disease over the life-course, we suggest that further studies in this area are now warranted.

     

Shared decision-making in older patients with colorectal or pancreatic cancer: Determinants of patients’ and observers’ perceptions

Objective

To identify determinants of older patients’ perceptions of involvement in decision-making on colorectal (CRC) or pancreatic cancer (PC) treatment, and to compare these with determinants of observers' perceptions.

Meniscal repair in patients age 40 years and older: A systematic review of 11 studies and 148 patients

Purpose

The purpose of this review is to evaluate published outcomes for reported failure rates following meniscus repair in patients age 40?years or older.

Risks and benefits of UV radiation in older people: More of a friend than a foe?

Incident ultraviolet radiation from sunlight varies in intensity and spectrum with season and latitude and has both deleterious and beneficial effects on health in older people. Sunlight is the major preventable risk factor for skin cancer. Non-melanoma skin cancer is the commonest malignancy in a pale skinned older population, but the mortality is extremely low. Intermittent sun exposure is a risk factor for the more dangerous melanoma but chronic sun exposure and outdoor occupation may be protective. Public health advice has tended to concentrate on the dangers of sun exposure despite the absence of any data that increased sun exposure correlates with raised all-cause mortality.Inadequate sun exposure carries its own risks, and the older population are particularly sun deprived as recorded by low serum Vitamin D levels and lack of outdoor activity. Sunlight has health benefits dependently and independently of vitamin D synthesis. Low serum vitamin D levels correlate with increased morbidity and mortality but the direction of association is not always clear. Vitamin D has a causal role in calcium and phosphate metabolism, in skeletal health and probably reduction of colorectal cancer. Evidence is weak for a role in cardiovascular health, but mobilisation of nitric oxide by UVA radiation from nitrate stores in skin, with consequent reduction in BP, may account for the observed reduction in cardiovascular disease and all-cause mortality with increased sun exposure. Advice on healthy sun exposure needs to be reconsidered, with reduction in all-cause mortality and morbidity as the primary end point.     

Detection of herpesvirus EBV DNA in the lower respiratory tract of ICU patients: a marker of infection of the lower respiratory tract?

Epstein-Barr virus (EBV) is a lymphotropic herpesvirus causing clinically self-limiting but lifelong persisting infections. Although several severe diseases (e.g., Hodgkin′s disease) are associated with EBV, its role in lower respiratory tract infections is still elusive. The prevalence of EBV, herpes simplex virus (HSV) and cytomegalovirus (CMV) in bronchoalveolar fluid (BAL) samples was evaluated in a retrospective study. BAL samples from 135 patients in the intensive or coronary care unit (ICU/ICC) at University Hospital Frankfurt/Main (Germany) were investigated using an in-house real-time PCR to detect EBV-, HSV- and CMV-specific DNA. Overall, herpesvirus DNA was detected in n = 82/135 BAL samples (60.7 %). Besides mono-infections with either EBV or HSV, concomitant infection with EBV and HSV DNA was most frequent, whereby the relative HSV viral load was typically higher. Patients with HSV-positive BAL required mechanical ventilation on average 5 days longer than patients with HSV-negative BAL (p = 0.006). Additionally, the proinflammatory cytokine IL-6 was significantly elevated in sera of patients positive for EBV in comparison with patients with EBV-negative BAL (p = 0.01). This study demonstrates a high prevalence of herpesviruses in BAL samples of ICU/ICC patients. The detection of one or more herpesvirus in BAL is strongly associated with the duration of ventilation and patient′s age. The association between IL-6 levels and EBV detection should be evaluated in further studies.     

Contribution of the FilmArray® Gastrointestinal Panel in the laboratory diagnosis of gastroenteritis in a cohort of children: a two-year prospective study

This study represents a 2-year picture of the epidemiology of enteric pathogens in children suffering from gastroenteritis using the FilmArray® Gastrointestinal Panel (FA-GP), a multiplex molecular assay that allows to simultaneously detect a large panel of pathogens independently of the etiological suspicion and to evaluate its potential contribution to the diagnosis compared to the conventional methods.A total of 1716 stool samples, collected from children with clinical suspicion of bacterial and/or viral gastroenteritis attending the University Hospital of Parma, was submitted to the FA-GP and, when an adequate aliquot was available, to electron microscopy (n = 1163) for virus detection and to an enterovirus-targeting real-time PCR (n = 1703). Specimens with positive results for Salmonella, Yersinia enterocolitica, Vibrio, diarrheagenic Escherichia coli/Shigella, Campylobacter, Plesiomonas shigelloides and/or parasites by the FA-GP were also submitted to conventional diagnostic methods.The FA-GP gave positive results in 958 (55.8%) cases, 64.8% from inpatients: 647 (67.5%) contained a single agent and 311 (32.5%) multiple agents, for a total of 1374 pathogens. Enteropathogenic E. coli, rotavirus, norovirus, toxigenic Clostridioides difficile, and sapovirus were the most commonly detected pathogens. A total of 812 additional agents (344 of which as single pathogen) was detected by the FA-GP and not included in the clinical suspicion. The overall recovery rate of the conventional methods from stools that resulted positive by the FA-GP was 38.6% for bacteria, 50% and 84.2% for Giardia intestinalis and Cryptosporidium, respectively, and ranged from 3.7% to 64.6% for viruses, if excluding all electron microscopy-negative astroviruses. Enterovirus, an agent not targeted by the FA-GP, was revealed in 9.6% (164/1703) of the examined samples, and in 52 cases it was the only agent detected.The results of this study allowed to extend the range of detectable pathogens independently of the clinical suspicion, to detect co-infections in almost one third of children positive for at least one agent and to show that conventional methods would have missed more than half of the enteric agents detected by the FA-GP.