RESUMO
Although Cushing's syndrome has been described in association with various neuroendocrine tumors producing ectopic adrenocorticotropin (ACTH), primary ovarian carcinoma rarely causes this syndrome. We hereby report the case of a 61-year-old woman presented with abdominal distension, facial swelling and skin pigmentation. Clinical and diagnostic evaluation revealed a right ovarian tumor with hypercortisolemia, high plasma ACTH, extremely high plasma ACTH precursors and lack of dexamethasone suppression. Removal of the tumor led to normalization of ACTH, ACTH precursors and cortisol levels. In addition, hypokalemia, hyperglycemia and elevated serum CA 125 were noted, which were also normalized after resection of the tumor. Histopathological examination indicated a primary ovarian carcinoma with a mixed pattern of differentiation. Immunohistochemistry showed immunoreactivity for chromogranin A, synaptophysin and ACTH. Hence, the diagnosis of Cushing's syndrome arising from an ovarian carcinoma secreting ectopic ACTH was made. The case was managed successfully, with subsequent good recovery and no evidence of recurrence at 4 years of follow-up.
Assuntos
Hormônio Adrenocorticotrópico/metabolismo , Carcinoma/complicações , Síndrome de Cushing/etiologia , Neoplasias Ovarianas/complicações , Carcinoma/metabolismo , Carcinoma/patologia , Síndrome de Cushing/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/patologiaRESUMO
BACKGROUND: Common variable immunodeficiency (CVID) is a primary immunodeficiency disease characterized by recurrent infections and increased susceptibility to autoimmunity and malignancy. OBJECTIVES: This study was performed to estimate the burden of CVID in Iran during 1985-2008 based on incidence, mortality, and disability-adjusted life-years (DALY). METHODS: The methods developed by the World Health Organization for national burden of disease studies were applied to estimate the incidence of disease and thus calculate the years of life lost due to premature mortality (YLL), years living with disability (YLD), and DALYs. RESULTS: The average age-adjusted incidence of CVID was 1 case per 200 000 per year; the average age-adjusted prevalence was 1 case per 91 000 per year. The burden of CVID (DALYs) was 25.21 years per 100000 individuals (17.86 for YLL and 7.35 for YLD). DALYs increased significantly in patients aged 5-14 years and in those with polyclonal lymphocytic infiltration phenotypes (P < .001). CONCLUSIONS: Based on the measurement of DALY in patients with CVID, reducing the rate of premature death in the polyclonal lymphocytic infiltration phenotype and the rate of infectious episodes in patients with the infectious only phenotype and appropriate management with regular intravenous immunoglobulin represent the best approach to decreasing the burden of CVID.
Assuntos
Imunodeficiência de Variável Comum/epidemiologia , Efeitos Psicossociais da Doença , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Política de Saúde , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Prevalência , Adulto JovemRESUMO
OBJECTIVE: Establishment of a primary healthcare network in Iran has provided free and universal access to primary health care. Although the health status of Iranians has improved since this network was established, the low-birthweight rate has not decreased. The objective of the present study was to describe socio-economic and medical factors related to low birth weight in the context of free and universal access to primary health care. DESIGN: Descriptive, hospital-based prospective study. METHODS: Data about socio-economic, reproductive and prenatal condition of 4510 live singleton births from June to October 2004 were gathered using a standard questionnaire by interview and record review. The effect of these conditions on birth weight was investigated using a logistic regression model. RESULTS: Of 4510 newborns, 305 (6.8%) were low birth weight. Among these low-birthweight newborns, there were 159 preterm and 146 term newborns. Mothers with a primary and secondary education [odds ratio (OR) 6.83, 95% confidence interval (CI) 2.35-7.34 and OR 4.81, 95%CI 1.95-6.37, respectively], who lived with farmer and unskilled worker husbands (OR 2.52, 95%CI 1.12-4.66 and OR 2.91, 95%CI 1.35-2.52, respectively), with a birth interval of 1 year or less (OR 3.54, 95%CI 1.80-5.95) and height less than 155cm (OR 1.82, 95%CI 1.12-3.31) were more likely to have low-birthweight infants. CONCLUSION: In the context of free and universal access to health care, it is recommended that policy makers should place more emphasis on education as it imparts knowledge and thus influences dietary habits and birth-spacing behaviour. This will lead to a better nutritional status, particularly in dealing with pregnancy, resulting in lower rates of low birth weight.
Assuntos
Recém-Nascido de Baixo Peso , Atenção Primária à Saúde/organização & administração , Adulto , Antropometria , Intervalo entre Nascimentos , Intervalos de Confiança , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Modelos Logísticos , Idade Materna , Pessoa de Meia-Idade , Razão de Chances , Paridade , Gravidez , Cuidado Pré-Natal , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: The need to provide high quality prenatal care services, which take account of women's views and specifically address their need for information, support and communication, has been advocated and group prenatal care, had been suggested as one of the ways to achieve this objective. The purpose of this study was to examine the impact of group versus individual prenatal care on satisfaction and prenatal care use. METHODS: This was a cluster-randomized controlled trial with the health center as the randomization unit that conducted in 2007. Satisfaction was measured through a standardized questionnaire, and the Kotelchuck Adequacy of Prenatal Care Utilization Index was used to measure prenatal care utilization. RESULTS: We recruited 678 women (group prenatal care, (N= 344) and individual prenatal care, (N=334) in the study. Women in group prenatal care model were more satisfied than women in individual prenatal care model in all areas evaluated, including information, communication, co-ordination and quality of care. Group care women were significantly more likely to have adequate prenatal care than individual care women were (OR=1.35 95% CI=1.26-1.44). CONCLUSIONS: Group prenatal care was associated with a significant improvement in client satisfaction and prenatal care utilization. This model of care has implications for the planning and provision of prenatal services within public health system, which is moving toward a better quality health care, and increasing use of services.
RESUMO
OBJECTIVE: To study whether there is an increased risk of glucose intolerance and hypertensive complications during pregnancy in women with polycystic ovarian syndrome (PCOS) who conceived after laparoscopic ovarian drilling and to investigate if there is an adverse pregnancy outcome. METHODS: This prospective study took place at Salmaniya Medical Complex in Bahrain, between June 1996 and June 2003. We compared the pregnancy and neonatal outcomes of 134 patients with PCOS who were treated with laparoscopic ovarian drilling with 479 pregnant women without PCOS (controls). We used the multiple logistic regression analysis to assess the risk of PCOS on impaired glucose tolerance (IGT), gestational diabetes mellitus (GDM), hypertensive disorders in pregnancy (HDP) and premature delivery. RESULTS: Subjects with PCOS had a significantly greater prepregnancy body mass index, prevalence of obesity and nulliparity as compared with controls. The incidence of IGT (p=0.007), GDM (p=0.01) and HDP (p=0.001) were significantly higher in pregnant PCOS compared with the control group. There were no significant differences in the neonatal outcomes and prevalence of premature delivery between the 2 study groups. When non-obese PCOS patients were compared with non-obese controls, the incidence of GDM (p=0.04) and HDP (p=0.004) were still significantly higher in the former. The prevalence of pregnancy complications were not significantly different when obese PCOS were compared with obese control patients. The PCOS was demonstrated as a risk factor for IGT (p=0.05), GDM (p=0.03) and HDP (p=0.03), but not for premature delivery. CONCLUSION: Women with PCOS who conceived after the drilling were at higher risk of IGT, GDM and HDP, and this risk seemed to be independent of maternal obesity.
Assuntos
Diabetes Gestacional/epidemiologia , Intolerância à Glucose/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Laparoscopia , Síndrome do Ovário Policístico/cirurgia , Resultado da Gravidez , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Incidência , Gravidez , Estudos ProspectivosRESUMO
A 32-year-old Bahraini lady with a large fetal intra-abdominal cyst detected antenatally on ultrasound examination at 16 weeks of gestation. The cyst was simple anechoic, increasing in size and causing progressive displacement of the fetal thoracic organs. A successful intrauterine needle aspiration was carried out under ultrasound guidance at 30 weeks gestation without maternal or fetal morbidity. Cytology of the cyst fluid showed luteinized granulosa cells and biochemistry demonstrated high concentrations of estradiol, progesterone, and testosterone that confirmed the etiology of the cyst as ovarian. There was no evidence of recurrence following aspiration and no further need for postnatal surgery.
Assuntos
Descompressão Cirúrgica , Doenças Fetais/cirurgia , Neoplasias Ovarianas/cirurgia , Adulto , Feminino , Doenças Fetais/diagnóstico por imagem , Humanos , Neoplasias Ovarianas/diagnóstico por imagem , Sucção , Ultrassonografia Pré-NatalRESUMO
OBJECTIVE: To study the effects of laparoscopic ovarian drilling on the serum hormone levels in clomiphene citrate resistant women with polycystic ovarian syndrome (PCOS) and to determine the criteria which influenced their clinical response. METHODS: A prospective study that was carried out at Salmaniya Medical Complex in Bahrain. One hundred and eighty-one women with clomiphene citrate-resistant PCOS were treated with laparoscopic ovarian drilling, all procedures were performed over a 4-year period between June 1996 and June 2000. Fasting blood samples for determination of the serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH-FSH ratio, testosterone and prolactin were taken during the follicular phase before and one month after laparoscopic ovarian drilling. RESULTS: Responders who ovulated spontaneously after the drilling were obese and had higher preoperative LH levels and the LH-FSH ratio. Both responders and non-responders showed a significant decline in LH, LH-FSH ratio and testosterone with a significant increase in FSH but no significant change in prolactin mean values compared with pretreatment levels. The magnitude of change was significantly higher for LH and the LH-FSH ratio (p<0.05) in responders, while there were no significant differences in the corresponding values of the other hormones between the 2 groups. Moreover, the decrease in LH (p<0.01) and the LH-FSH ratio (p<0.05) was significantly greater in obese than non-obese women and this was only observed in the responders group. CONCLUSION: Laparoscopic ovarian drilling is an effective procedure in women with clomiphene citrate resistant PCOS. It produces significant endocrine changes with better results in obese patients with higher preoperative LH values and LH-FSH ratio. The magnitude of these changes was the highest in obese responders.
Assuntos
Clomifeno/uso terapêutico , Resistência a Medicamentos , Hormônios/metabolismo , Laparoscopia/métodos , Síndrome do Ovário Policístico/cirurgia , Adulto , Clomifeno/efeitos adversos , Sistema Endócrino/metabolismo , Feminino , Hormônio Foliculoestimulante/sangue , Seguimentos , Humanos , Hormônio Luteinizante/sangue , Ciclo Menstrual/fisiologia , Obesidade/complicações , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/diagnóstico por imagem , Síndrome do Ovário Policístico/tratamento farmacológico , Prolactina/sangue , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Testosterona/sangue , Resultado do Tratamento , Ultrassonografia DopplerRESUMO
A 37-year-old Pakistani lady, who had previously undergone one cesarean delivery and one uterine curettage, was admitted to the labor ward at 29 weeks of gestation with history of a sudden severe painless vaginal bleeding from a sonographically diagnosed placenta previa. An immediate cesarean section was performed and a live male infant was delivered. The placenta was morbidly adherent to the lower uterine segment and attempts at removal caused torrential bleeding, necessitating cesarean hysterectomy. In addition, attempts to dissect the bladder from the lower uterine segment were unsuccessful and, hence, the diagnosis of placenta percreta with involvement of the urinary bladder was made. A modified posterior approach to the hysterectomy was carried out, with subsequent good recovery.