ABSTRACT
@#Disorders of sexual development (DSD) defined as congenital conditions associated with atypical development of anatomical, gonadal or chromosomal sex, is a rare condition that may present with ambiguous genitalia. Included in the varied classes of DSD is mixed gonadal dysgenesis which is known to be due to mosaicism, a chromosomal aberration. Mosaic individuals may have concerns on growth, hormone balance, gonadal development, sex of rearing and fertility. This case report presents an 18-year old student who presented with primary amenorrhea, delayed secondary sexual characteristics and phenotypic features of Turner syndrome who, on chromosomal analysis revealed 45X0/46XY mosaicism. The patient underwent operative laparoscopy with bilateral gonadectomy on the basis of the increased risk of development of gonadal malignancy in phenotypic females with Y-chromosome material. Histopathological analysis revealed bilateral streak gonads. Hormone replacement therapy was then initiated for the induction of secondary female sex characteristics, as treatment for estrogen deficiency, for the induction of pubertal growth spurt and for optimization of bone mineral accumulation. Management of disorders of sexual development is challenging, thus the need for a multidisciplinary approach involving experts in endocrinology, gynecology, psychology and genetics.
Subject(s)
Gonadal Dysgenesis, Mixed , Mosaicism , Turner Syndrome , CastrationABSTRACT
Objective@#To determine the impact of endometriosis on the quality of life, risk of anxiety and depression among Filipino women in a tertiary hospital. @*Methods@#A cross-sectional study was conducted among 210 patients aged 18-50 diagnosed clinically and sonographically with pelvic endometriosis. Verbal and written consent were secured. Descriptive statistical analysis was used to describe the baseline characteristics of the population. Short Form McGill Pain Questionnaire (SF-MPQ) was used to assess the degree of pain symptoms of the patients. WHO Quality of Life Tool (WHOQOL-BREF), Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D) in Filipino version were used to evaluate the quality of life, anxiety and depression of the respondents. Series of paired t-tests were performed to determine the differences in the average outcomes (i.e. level of depression, anxiety, quality of life and subscales, pain scores and types of pain). McNemar’s chi-square test was utilized to determine the differences in the frequency of mild to severe anxiety and depression before and after treatment. Spearman’s rho rank correlation was performed to determine the relationship of the level of pain to the outcome measures. One-way analysis of variance was performed to determine differences in the current mean levels of depression, anxiety, quality of life and its subscales across disease conditions (i.e. endometriosis alone, myoma uteri, adenomyosis, other gynecologic conditions, infertility). The level of significance was set at a p-value < 0.05 using two-tailed comparison. @*Results@#The most common symptoms reported were the presence of dysmenorrhea (90.95%) and pelvic pain (88.57%), which were both rated at pain scale 8/10. Majority (73.8%) of patients have some form of depression (mild-28.57%, moderate-27.13%, severe-13.33%, very severe-4.76%) with an average level of depression at 12.39 ± 6.5. Majority (54.76%) of patients likewise have some form of anxiety (mild-15.24%, moderate-20.95%, severe-18.57%) with an average level of anxiety at 15.44 ± 10.38. Depression and anxiety scores significantly decreased after medical treatment. In terms of overall quality of life and perceived level of health, respondents demonstrated an average score of 3.25 ± 0.91 and 2.86 ± 0.96, respectively. These post-treatment scores showed significant improvement from baseline. The sub-domains (i.e. physical, psychological, social and environmental) also have relatively high scores ranging from 13.44 ± 2.39 to 15.60 ± 2.63. These are indicative of very satisfactory quality of life.Other gynecologic conditions, such as infertility, myoma uteri, and adenomyosis, do not contribute significantly to the outcomes measured.@*Conclusion@#Pelvic endometriosis is a chronic, life-long, inflammatory disease that presents mainly as pelvic pain. This debilitating pain can significantly affect patients’ psychological well-being and mental health, which is manifested by the very high incidence of anxiety and depression among Filipino women with endometriosis. Management of endometriosis is complex, hence a multi-disciplinary approach that includes psychiatric counseling may be necessary.
Subject(s)
Anxiety , Depression , Pelvic Pain , Quality of LifeABSTRACT
@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the risk of postpartum hemorrhage among patients who were treated with nifedipine for tocolysis of preterm labor.</p><p style="text-align: justify;"><strong>METHODS:</strong> A prospective cohort study was conducted with 66 pregnant women admitted for preterm labor. One group of women was given nifedipine to give time for the administration of corticosteroids for fetal lung maturity and/or control of preterm labor and another group was not given nifedipine as they were admitted in advanced stage of labor (ie, more than or equal to 4 cm cervical dilatation). Independent/paired sample t-test, Mann-Whitney U/Wilcoxon signed rank test, and Fisher's exact test were used to determine the difference of mean, median, and frequency between and within groups, respectively. STATA 12.0 was used for data analysis.</p><p style="text-align: justify;"><strong>RESULTS:</strong> There was more blood loss during delivery, which was statistically significant, among those who received nifedipine compared to those who have not taken the medicine (350 mL versus 250 mL, p = 0.021). Furthermore, the decreases in hemoglobin and hematocrit were also lower among those who did not receive nifedipine compared to those who received nifedipine for tocolysis (8.5 mg/dL versus 16.0 mg/dL, p = 0.014 and 0.03 versus 0.05, p = 0.010), again, statistically significant.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Nifedipine used as tocolytic appear to increase blood loss during delivery, which was statistically significant. Greater amount of blood loss may be anticipated among those with nifedipine intake thus helping the obstetrician in preparing for active management of postpartum hemorrhage and preventing maternal morbidity and mortality.</p>