Using an Ishikawa diagram as a tool to assist memory and retrieval of relevant medical cases from the medical literature

<p>Abstract</p> <p>Studying medical cases is an effective way to enhance clinical reasoning skills and reinforce clinical knowledge. An Ishikawa diagram, also known as a cause-and-effect diagram or fishbone diagram, is often used in quality management in manufacturing industries.</p> <p>In this report, an Ishikawa diagram is used to demonstrate how to relate potential causes of a major presenting problem in a clinical setting. This tool can be used by teams in problem-based learning or in self-directed learning settings.</p> <p>An Ishikawa diagram annotated with references to relevant medical cases and literature can be continually updated and can assist memory and retrieval of relevant medical cases and literature. It could also be used to cultivate a lifelong learning habit in medical professionals.</p

Neuroendocrine disturbances in women with functional hypothalamic amenorrhea: an update and future directions

Functional hypothalamic amenorrhea (FHA) is one of the most common causes of both primary and secondary amenorrhea in women of reproductive age. It is characterized by chronic anovulation and the absence of menses that appear as a result of stressors such as eating disorders, excessive exercise, or psychological distress. FHA is presumed to be a functional disruption in the pulsatile secretion of hypothalamic gonadotropin-releasing hormone, which in turn impairs the release of gonadotropin. Hypoestrogenism is observed due to the absence of ovarian follicle recruitment. Numerous neurotransmitters have been identified which play an important role in the regulation of the hypothalamic-pituitary-ovarian axis and of which the impairment would contribute to developing FHA. In this review we summarize the most recent advances in the identification of contributing neuroendocrine disturbances and relevant contributors to the development of FHA

Study on the zona pellucida 4 (ZP4) gene sequence and its expression in the ovaries of patients with polycystic ovary syndrome

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common endocrine disorder of unknown pathology, involving reproductive and metabolic abnormalities. Oocyte-specific genes are a group of genes expressed exclusively in ovarian tissue; therefore, they can play an important role in ovarian pathologies such as PCOS. The zona pellucida 4 (ZP4) gene encodes glycoprotein which is a part of the extracellular matrix of oocyte. MATERIALS AND METHODS: We analyzed 87 patients with PCOS, which were divided into four groups depending on their phenotype. In each patient, we performed profound clinical and biochemical analysis, including the measurement of serum androgens. The ovarian tissue samples were used to perform a real-time polymerase chain reaction and immunohistochemical staining using anti-ZP4 monoclonal antibodies. The ZP4 gene was sequenced from peripheral lymphocytes. RESULTS: The expression of ZP4 was present in early antral follicles and was stronger in mature follicles. The subgroup of patients with eumenorrhea and without hyperandrogenism presented the highest expression of ZP4 in ovarian tissue. In one case, we found a mutation of the ZP4 gene. No correlations were found between the ZP4 expression level and biochemical or clinical indices. CONCLUSIONS: Data from this and animal studies suggest a possible relationship between androgens and ZP4 expression. ZP4 expression is highest among patients with PCOS and a regular cycle, and this is a consequence of the presence of mature follicles in this group. In some patients with PCOS and infertility, ZP4 mutation can be found

PCOS and Obesity: Contraception Challenges

Blazej Meczekalski,1 Melissa Rasi,2 Christian Battipaglia,3 Tiziana Fidecicchi,2 Gregory Bala,4 Anna Szeliga,1 Stefano Luisi,2 Alessandro D Genazzani3 1Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Greater Poland, Poland; 2Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy; 3Gynecological Endocrinology Center, Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Modena, Italy; 4UCD School of Medicine, University College Dublin, Dublin, IrelandCorrespondence: Blazej Meczekalski, Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland, Tel +48 61 65 99 366, Fax +48 61 65 99 454, Email [email protected]: Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine disorders affecting women of reproductive age, with an estimated prevalence of 5– 10%. Women with PCOS are at increased risk for metabolic disturbances. A significant proportion of women with PCOS, ranging from 40 to 85%, are either overweight or obese. Oral contraception is the standard first line treatment for PCOS. However, certain conditions associated with PCOS, such as obesity, must be considered when deciding to prescribe combined oral contraception. It seems that there is no clinical advantage in using high-dose ethinyl estradiol over low-dose formulations. Lower-dose EE formulations may be considered a safer option for obese PCOS patients. Combined oral contraception containing natural estrogens, which have a beneficial effect on metabolic parameters, could also be a viable option for this group. Progestin-only (POPs) formulations have minimal metabolic effects, making them a safe contraceptive choice for patients with obesity and a high risk of coronary artery disease, cerebrovascular disease, venous thromboembolism, or hypertension. Non-oral contraceptive methods, such as transdermal patches and vaginal rings, offer a valuable alternative for women with PCOS who prefer not to use daily oral contraceptives. However, the absence of anti-androgenic progestins in these contraceptive methods may limit their effectiveness, especially for women with moderate to severe clinical signs of androgen excess. The use of LNG-IUDs in women with PCOS may be beneficial in several ways. First, in cases where other contraceptive methods are contraindicated, the LNG-IUD provides effective contraception while also regulating abnormal uterine bleeding. Additionally, the relative hyperestrogenism associated with anovulation in PCOS can lead to endometrial hyperplasia with atypia and, in severe cases, endometrial cancer. Therefore, in women with both PCOS and obesity, the LNG-IUD may be preferred over oral megestrol acetate for endometrial protection.Keywords: PCOS, polycystic ovary syndrome, oral contraception, obesity, IU

Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology

Background: Autistic people are disproportionately vulnerable to anorexia nervosa and other eating disorders (ED), and within the general population, autistic traits correlate with ED psychopathology. A putative mechanism which may underpin this heightened risk is alexithymia, a difficulty identifying and describing emotional states which is observed in both autism and ED. In two experiments with independent non-clinical samples, we explored whether alexithymia might mediate the heightened risk of eating psychopathology in individuals high in autistic traits. Methods: Our first experiment used the PROCESS macro for SPSS to examine relationships between alexithymia (measured by the Toronto Alexithymia Scale (TAS-20)), autistic traits (autism quotient (AQ)), and eating psychopathology (Eating Attitudes Test (EAT-26)) in 121 participants. Our second experiment (n = 300) replicated and furthered this analysis by examining moderating effects of sex and controlling for anxiety and depression as covariates. We also included an additional performance-based measure of alexithymia, the Levels of Emotional Awareness Scale (LEAS). Results: Study 1 suggested that TAS-20 scores mediated the relationship between heightened autistic traits and eating psychopathology. Replication and further scrutiny of this finding, in study 2, revealed that this mediation effect was partial and specific to the female participants in this sample. The mediation effect appeared to be carried by the difficulty identifying feelings subscale of the TAS-20, even when depression and anxiety were controlled for. LEAS scores, however, were not significantly related to autistic traits or eating psychopathology. Limitations: Cross-sectional data prevents any conclusions around the direction and causality of relationships between alexithymia, autistic traits, and eating psychopathology (alongside depression and anxiety), necessitating longitudinal research. Our non-clinical sample was predominantly Caucasian undergraduate students, so it remains to be seen if these results would extrapolate to clinical and/or autistic samples. Divergence between the TAS-20 and LEAS raises crucial questions regarding the construct validity of these measures. Conclusions: Our findings with respect to autistic traits suggest that alexithymia could partially explain the prevalence of ED in autistic people and may as such be an important consideration in the pathogenesis and treatment of ED in autistic and non-autistic people alike. Further research with clinical samples is critical to explore these ideas. Differences between men and women, furthermore, emphasize the importance of looking for sexspecific as well as generic risk factors in autistic and non-autistic men and women