Perception of contraceptive counseling and contraceptive use among systemic lupus erythematosus patients

Objectives(1) To evaluate the perception of contraceptive counseling and knowledge regarding the impact of unintended pregnancy and (2) examine the prevalence of, and predictors for contraceptive use among systemic lupus erythematosus (SLE) patients.Study designA cross-sectional survey was conducted at the Rheumatology Clinic of a university hospital. SLE patients who attended the clinic from April 2018 to January 2019 and at risk for unintended pregnancy and were invited to be interviewed. The structured interview guide consisted of three parts: personal and obstetric information, perception of contraceptive counseling and knowledge about the impact of unintended pregnancy, and contraceptive use.ResultsThe mean age of the 137 patients who gave informed consents was 34 ± 8 years, with 47 patients (34%) stating that they had received contraceptive counseling. Seventy-five patients (52%) reported practicing contraception. The intention to not become pregnant (Odds Ratio; 95% CI = 7.28; 1.75–30.27), perception of adequate contraceptive counseling (2.77; 1.06–7.20) and discussion with partners and physicians about contraception (3.95; 1.64–9.50) were predictors for contraceptive use (p < 0.05).ConclusionMost patients reported no contraceptive counseling with approximately half of the patients using contraceptive methods within the past three months. Desire to avoid pregnancy, perception of adequate contraceptive counseling, and the influence of partners and physicians were significant predictors for contraceptive use.ImplicationsContraceptive counseling should be routinely included in discussions about disease processes and treatment plans, including access issues. Best practices for contraceptive counseling and integrated, multi-disciplinary team services should be developed and provided in clinical settings.     

Validity and Test-Retest Reliability of a Thai Stroke Physical Activity Questionnaire

Background and objectivesThis study evaluated the validity and reliability of the Stroke Physical Activity Questionnaire (SPAQ), a Thai self-report questionnaire for assessing physical activity (PA) in participants with chronic stroke.MethodsThe validity of the SPAQ was tested by correlating PA data from the SPAQ with data obtained from a waist worn accelerometer which participants wore for seven days. The participants completed the SPAQ twice, one week apart and test-retest reliability was calculated using intraclass correlation coefficient.ResultsForty-one participants, at least 3 months post-stroke (24 men and 17 women) were enrolled. The average age was 55.3 years (SD 11.9). Correlation coefficients of 0.58 and 0.57 were found between SPAQ and the accelerometer data for moderate PA and moderate to vigorous PA (MVPA), respectively. There was no significant correlation between light PA determined from SPAQ and accelerometer. The intraclass correlation coefficients were 0.56, 0.91 and 0.90 for light, moderate PA and MVPA, respectively.ConclusionsThe validity of the SPAQ for moderate and MVPA was acceptable and the test-retest reliability of the SPAQ was excellent. This suggests the SPAQ is a useful tool for assessing moderate PA and MVPA among chronic stroke participants. However, it cannot be used to quantify light PA.     

Outcomes in HIV-infected patients on antiretroviral therapy with tuberculosis

HIV-infected patients with active tuberculosis (TB) having CD4 counts < 100/mm3 and who were antiretroviral therapy (ART) na?ve were reviewed retrospectively to determine the outcomes of their tuberculosis infection. All patients received ART at or after receiving anti-TB treatment. Clinical manifestations, treatment regimens and outcomes were analyzed. Of 101 patients, 62 (61.4%) completed TB treatment. Of these, 53.2% were treated with a 6-month standard TB regimen, while the rest were treated with prolonged TB regimens. The median interval between anti-TB treatment and ART was 68 days (range: 0-381). Among the clinically cured patients 66.1% received rifampin concomitantly with nevirapine, and 32.3% received rifampin concomitantly with efavirenz. The treatment success rate was 75.6%, with a mortality rate of 6.1%. The risk factors for death were resistant TB (p = 0.03) and poor compliance (p < 0.05). Seven point nine percent had multi-drug resistant TB. Possible or probable immune reconstitution inflammatory syndrome (IRIS) was seen in 15 cases (14.9%). No life-threatening IRIS was reported, and it did not affect disease outcome (p = 0.5). A shorter time between anti-TB treatment and ART onset was associated with the occurrence of IRIS (31 days vs 90 days; p < 0.05). Regarding adverse drug effects, 44.6% had side effects due either to anti-TB drugs or ART. Sixty-six point one percent of them occurred within the first 2 months of TB treatment, and 43 (76.8%) had to stop or change either anti-TB treatment or ART. The mortality rate with TB and HIV on ART was low and the occurrence of IRIS did not carry any additional mortality.     

Female urinary incontinence: a cross-sectional study from a Thai rural area

The aims of this study were to investigate the prevalence and associated factors of female urinary incontinence in a Thai rural area and to investigate the impact of female urinary incontinence on quality of life. A population-based cross-sectional survey was performed from September 2003 to February 2004. A total of 1,126 women completed the questionnaires. The overall prevalence of urinary incontinence was 36.50%, i.e. stress urinary incontinence (33.60%), urge urinary incontinence (11.00%) and mixed urinary incontinence (8.07%). Urinary incontinence adversely affected quality of life; the mixed urinary incontinence group reported significantly greater impairment than the stress and urge urinary incontinence groups. Advancing age, labouring occupation, postmenopausal status, years since menopause, medical diseases, childbirth and vaginal delivery were associated with this problem.     

Resolution of Primary Immune Defect in 22q11.2 Deletion Syndrome

Purpose

Patients with 22q11.2 deletion syndrome have a variable decrease in immunological parameters, especially regarding T cell counts. The aim of this study was to investigate immunological change over time and factors associated with immunological recovery among patients with 22q11.2 deletion syndrome.

Methods

Patients with 22q11.2 deletion syndrome diagnosed by fluorescence in situ hybridization (FISH) were studied. Immunological parameters were evaluated every 6 months until patients returned to normal. Infection and vaccination histories were recorded and analyzed, and Kaplan-Meier survival curves were plotted to describe resolution of immunodeficiency.

Results

Forty-nine patients with an age range of 4 to 222 months were included. Twenty-five (51%) patients were female. In hypocalcemia, the odds ratio for CD4 lymphopenia was 17.03 (95%CI 1.82–159.23; p value = 0.01). Thirty patients (61.2%) exhibited decreased CD4+ T cell numbers, which returned to normal level in 18 (60%) patients. Median age of CD4+ T cell resolution was 2.5 years. T cell functions were abnormal in three patients. T cell functions returned to normal in all patients at a median age of 1.1 years. Six patients (13.5%) had abnormal serum immunoglobulin levels, with levels improving in four patients at 1.4 years of age. The most common infection was pneumonia (69.4%). BCG vaccination was administered in 47 of 49 patients at birth. Among 32 patients who had T cell defect, one patient developed BCGitis and one developed disseminated BCG.

Conclusion

Immunodeficiencies identified among patients with 22q11.2 deletion syndrome were T cell defect (65.3%) and decreased immunoglobulin levels (12.2%). Median age of CD4 resolution was 2.5 years.

     

The inter-system association between the simplified pelvic organ prolapse quantification system (S-POP) and the standard pelvic organ prolapse quantification system (POPQ) in describing pelvic organ prolapse

Introduction and hypothesis  

The objective of this study is to determine the association between the POPQ and a simplified version of the POPQ.     

The effect of a soy-rich diet on urogenital atrophy: a randomized, cross-over trial

OBJECTIVE: To evaluate the effect of a soy-rich diet on urogenital symptoms, vaginal health index, and vaginal cytology in perimenopausal and postmenopausal women. MATERIALS AND METHODS: Thirty-six perimenopausal and postmenopausal women (mean age 52.5+/-5.1 years) participated in a randomized, cross-over trial with two 12-week diet periods and two 4-week washout periods before and between treatments. The study diet consisted of a control diet (soy-free diet) and an isocaloric soy-rich diet (25 g soy protein in various forms of soy food containing more than 50 mg/day of isoflavones substituted for an equivalent amount of animal protein). Subjects were assessed for urogenital symptoms, vaginal health index, vaginal pH and vaginal cytology. The single physician and the single cytopathologist were blinded with regard to onset, period and randomization number. Statistical analyses were performed using paired t-test or Wilcoxon Signed Ranks Test, significance was set as P<0.05. RESULTS: Good compliance to the diet was shown by the significant elevation of serum levels of daidzein and genistein during the soy-rich diet period. The symptoms of urge incontinence and vaginal dryness had significantly increased after 12-week of soy-free diet. All other urogenital symptoms did not change in both periods. The vaginal health index, the vaginal pH, the karyopyknotic index, and the maturation value were not significantly changed in both periods. CONCLUSION: A soy-rich diet did not relieve the urogenital symptoms or restore the vaginal epithelium or improve the vaginal health in perimenopausal and postmenopausal Thai women.     

The efficacy and safety of a combined multipolar radiofrequency with pulsed electromagnetic field technology for the treatment of vaginal laxity: a double-blinded,randomized, sham-controlled trial

Lasers in Medical Science - Non-invasive vaginal rejuvenation with radiofrequency (RF) and lasers devices have gained popularity, but well-designed studies confirming their effectiveness are...