Evaluation of home-based rehabilitation sensing systems with respect to standardised clinical tests

With increased demand for tele-rehabilitation, many autonomous home-based rehabilitation systems have appeared recently. Many of these systems, however, suffer from lack of patient acceptance and engagement or fail to provide satisfactory accuracy; both are needed for appropriate diagnostics. This paper first provides a detailed discussion of current sensor-based home-based rehabilitation systems with respect to four recently established criteria for wide acceptance and long engagement. A methodological procedure is then proposed for the evaluation of accuracy of portable sensing home-based rehabilitation systems, in line with medically-approved tests and recommendations. For experiments, we deploy an in-house low-cost sensing system meeting the four criteria of acceptance to demonstrate the effectiveness of the proposed evaluation methodology. We observe that the deployed sensor system has limitations in sensing fast movement. Indicators of enhanced motivation and engagement are recorded through the questionnaire responses with more than 83% of the respondents supporting the system’s motivation and engagement enhancement. The evaluation results demonstrate that the deployed system is fit for purpose with statistically significant ( ϱc>0.99 , R2>0.94 , ICC>0.96 ) and unbiased correlation to the golden standard

Collection of menopause data in studies of women living with HIV: A systematic literature review.

OBJECTIVES An increasing number of women living with HIV are transitioning through midlife and menopause. Women living with HIV may experience earlier menopause and a higher symptom burden than women without HIV, but more evidence is needed. Data collection on menopause in women living with HIV is scarce and often not standardized. We sought to assess how menopause data are collected in cohorts and studies of women living with HIV. METHODS This was a literature review conducted within the PubMed database. We included original studies and cohorts assessing menopause and/or menopausal symptoms in women living with HIV. Study characteristics and menopause data collection, including the definition of menopause, symptom assessment tools, and measurement of biomedical parameters, were noted and summarized systematically in data tables. RESULTS We included 40 articles describing 37 separate studies published between 2000 and 2023; 27 of these were conducted in high-income countries, the majority in the USA (n = 16). Ten studies were from low- and middle-income countries; four of these were conducted in Brazil. In 20 studies, menopause was defined according to the World Health Organization's definition of over 12 months of amenorrhea. Twelve studies used the Menopause Rating Scale to characterize menopausal symptoms, five studies used other specified symptom assessment tools, and 12 studies used a study-specific tool. CONCLUSIONS Menopause data collection in women living with HIV is heterogeneous. We propose that standardized tools should be used to enable comparisons between studies and countries, thereby improving the quality of research and clinical treatment. Further research into the validity of menopausal symptom scoring tools is warranted

Human Papillomavirus Genotyping and E6/E7 mRNA Expression in Greek Women with Intraepithelial Neoplasia and Squamous Cell Carcinoma of the Vagina and Vulva

A large proportion of vaginal and vulvar squamous cell carcinomas (SCCs) and intraepithelial neoplasias (VAIN and VIN) are associated with HPV infection, mainly type 16. The purpose of this study was to identify HPV genotypes, as well as E6/E7 mRNA expression of high-risk HPVs (16, 18, 31, 33, and 45) in 56 histology samples of VAIN, VIN, vaginal, and vulvar SCCs. HPV was identified in 56% of VAIN and 50% of vaginal SCCs, 71.4% of VIN and 50% of vulvar SCCs. E6/E7 mRNA expression was found in one-third of VAIN and in all vaginal SCCs, 42.9% of VIN and 83.3% of vulvar SCCs. Our data indicated that HPV 16 was the commonest genotype identified in VAIN and VIN and the only genotype found in SCCs of the vagina and vulva. These findings may suggest, in accordance with other studies, that mRNA assay might be useful in triaging lesions with increased risk of progression to cancer

Usage of the levonorgestrel-releasing intrauterine system (LNG-IUS) in adolescence: what is the evidence so far?

The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective method of contraception, while also providing various non-contraceptive benefits. Although targeted primarily to adults, there is increasing experience in its use in adolescence. The aim of this review is to assess the available information on LNG-IUS usage in adolescence

Η σχέση των ορμονικών και βιολογικών παραμέτρων κατά τη χρησιμοποίηση διαφορετικών πρωτοκόλλων πολλαπλής ωοθηλακιορρηξίας στην υποβοηθούμενη αναπαραγωγή

In vitro fertilization (IVF) has revolutionised fertility treatment over the past three decades. However success rates range between 15 and 30%. The aim of this study was to assess different ovulation induction methods in order to improve the number and quality of oocytes that are collected, their fertilisation and ultimately pregnancy rates. Namely, we intended to assess whether human menopausal gonadtorophin (hMG) was better than purified or recombinant FSH in women with tubal factor infertility, polycystic ovarian syndrome (PCOS) and poor ovarian reserve. We also intended to assess whether oestradiol administration improved ovulation induction parameters in poor responders and whether the use of methylprednisolone improved success rates in women with PCOS. We also wanted to identify prognostic factors that correlate well with IVF results and as such can be used for the prediction of infertility treatment. We conducted a retrospective analysis of women attending a tertiary fertility unit between the years 1999 and 2001. We included women undergoing IVF treatment (conventional or ICSI). In total, there were 321 cycles. The mean age of women included in the study was 34.54 (0.32) years and the mean time of infertility was 6 (0.28) years. There were 90 couples with male factor infertility, 77 women with tubal factor infertility, 18 women with PCOS and 14 couples with unexplained infertility. 16 women had basal FSH levels higher than 10 iU/l. Ovulation induction with hMG was more effective in all subgroups of women when compared with rFSH or pFSH in number of fertilised oocytes obtained (6.83 embryos vs. 5.86 and 4.58). Administration of 4 ampoules of hMG during ovulation induction with pFSH was the most effective regime (7.04). Administration of methylprednisolone during ovulation induction in women with PCOS yielded substantially better results as far as oocyte number and quality was concerned, whereas administration of oestradiol patches in women with poor ovarian reserve had no beneficial effect in the outcome of IVF. Age and the number of previous IVF attempts correlated negatively with pregnancy rates. However women undergoing their 2nd IVF attempt had better results, including pregnancy rates, when compared with those undergoing their 1st attempt. We postulate that the LH component of hMG and suppression of circulating androgens in women with PCOS have a favourable effect in the quality of follicles and therefore fertilisation and pregnancy rates. Undergoing a 3rd or 4th IVF attempt can lead to successful results, provided ovulation induction protocols are adjusted accordingly.Η εξωσωματική γονιμοποίηση επιτρέπει την τεκνοποίηση σε ζευγάρια με υπογονιμότητα. Παρά ταύτα, τα ποσοστά επιτυχίας ανά κύκλο κυμαίνονται μεταξύ 15 και 30%. Σκοπός της μελέτης αυτής ήταν η ανεύρεση μεθόδων ωοθηκικής διέγερσης, που θα επέτρεπαν καλύτερα αποτελέσματα, όσον αφορά τον αριθμό ωαρίων και εμβρύων που συλλέγονται, αλλά και για τον αριθμό κυήσεων. Συγκεκριμένα εξετάσθηκαν τα ακόλουθα: 1. Κατά πόσον η εμμηνοπαυσιακή γοναδοτροπίνη είναι πιο αποτελεσματική σε σχέση με την ανασυνδυασμένη ή κεκαθαρμένη γοναδοτροπίνη. 2. Εάν η χορήγηση οιστραδιόλης κατά τη διέγερση βελτιώνει την αποτελεσματικότητα. 3. Κατά πόσον η χορήγηση μεθυλπρεδνιζολόνης κατά την ωοθηκική διέγερση γυναικών με πολυκυστικές ωοθήκες βελτιώνει τα αποτελέσματα της εξωσωματικής γονιμοποίησης. 4. Ποια είναι τα ποσοστά επιτυχίας της εξωσωματικής γονιμοποίησης σε γυναίκες με προηγούμενες αποτυχημένες προσπάθειες. Ως μέτρα σύγκρισης μεταξύ των διαφόρων μεθόδων πρόκλησης, χρησιμοποιήθηκαν χαρακτηριστικά της ωοθηκικής διέγερσης (χρόνος διέγερσης, επίπεδα οιστραδιόλης ορού και αριθμός ωοθυλακίων), ο αριθμός και η ποιότητα των ωαρίων και εμβρύων και τα ποσοστά κυήσεων και γεννήσεων. Στη διάθεσή μας είχαμε δεδομένα για 321 κύκλους τεχνητής γονιμοποίησης από 199 γυναίκες. Η μέση ηλικία των γυναικών ήταν 34.64 με μέσο χρόνο στειρότητας 6 έτη και μέση τιμή FSH 7.8 iu/l. Από τους ελέγχους μας, φάνηκε ότι η χορήγηση εμμηνοπαυσιακής γοναδοτροπίνης κατά την ωοθηκική διέγερση, είτε ως μόνη γοναδοτροπίνη, είτε σε συνδυασμό με ανασυνδυασμένη ή κεκαθαρμένη θυλακιοτρόπο, οδηγούσε σε σημαντική βελτίωση των παραμέτρων διέγερσης, αλλά και στον αριθμό ωαρίων και εμβρύων που συλλέγονταν. Η βελτίωση κατά τη χρησιμοποίηση εμμηνοπαυσιακής γοναδοτροπίνης παρατηρήθηκε σε όλες τις υποκατηγορίες γυναικών, ανεξαρτήτως αιτίας στειρότητας και ηλικίας. Επίσης, διαφάνηκε μικρή βελτίωση στα χαρακτηριστικά της διέγερσης αλλά και στον αριθμό κυήσεων στις γυναίκες με πολυκυστικές ωοθήκες, οι οποίες έλαβαν γλυκοκορτικοειδή. Αντίθετα, δεν υπήρξε βελτίωση στις γυναίκες με πτωχή ωοθηκική απάντηση, οι οποίες έλαβαν οιστραδιόλη διαδερμικά κατά την ωοθηκική διέγερση. ...................................................................................

The Sexuality of Adolescents and Young Women With MRKH Syndrome: A Qualitative Study

Background: Vaginal agenesis, most commonly referred as Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome, is mostly diagnosed as primary amenorrhea in teenage girls; although there is plenty of literature concerning the formation of a neovagina, limited research has focused on the psychological burden of this diagnosis to the girls. Aim: To enlighten health providers into the finer aspects of sexuality through the own words and experiences of girls with MRKH under our care. Methods: Women currently undergoing vaginal dilation or who had completed vaginal dilation within the past year were recruited from February 2019 to January 2020. A gynecologist with training in Sexual Medicine conducted a semistructured interview, which was recorded and then transcribed to identify common themes among interviewees. Outcomes: The main outcome explored was the narrative experiences of women with MRKH. Results: 7 women participated, with a mean age of 19.7 (range 17-22 years). None of the girls felt stigmatized, however one reported significant distress at diagnosis, stemming from the attitude of health care professionals and exacerbated by an earlier age at disclosure. All girls accepted that VDT was successful, when it was initiated after they had felt sexual interest and arousal. Exact quantification of the vaginal length at onset, worried 4 as they felt pressurized to achieve a specific length. A few girls reported anxiety over sharing the diagnosis with an intimate partner. All of them pretended at some point to have menses. Childbearing was an important issue for most of the interviewees, but it did not concern them for the time being. All girls had supporting families. However, 5 did not want to share information about VDT with them. One girl reported that openness in discussing genital anatomy, VDT and sexuality, helped her both in completing treatment and adapting in a sexual relationship. Clinical Implications: A multidisciplinary team should aim for age-appropriate disclosure and consultation and guide women through VDT and their sexual relations. Strengths and Limitations: This is a thorough account of women's perceptions regarding VDT and sexuality in MRKH. However, our conclusions may be limited by the small number of participants. Conclusion: Gradual provision of information at disclosure and adjusted timing at VDT may reduce stress in girls with MRKH. Copyright (C) 2021, International Society of Sexual Medicine. Published by Elsevier Inc. All rights reserved

Labial fusion in adolescence secondary to lichen sclerosus

Labial fusion in adolescence is uncommon and is usually secondary to other skin disorders or trauma of the vulvar area. In a five-year period, we treated five patients with labial fusion in our facility with a mean age of 16.4 years. Based on clinical presentation and biopsy of the vulvar skin, lichen sclerosus (LS) was the causative factor. Four out of five had urinary problems and one suffered from an inflamed inclusion cyst. All of them had a long history of pruritus. In all cases, blunt separation of the labia minora under general anaesthesia was performed, followed by local application of a potent glucocorticoid cream and an emollient agent. One patient received additionally oral and local antibiotics. One recurrence was noted, which resolved after re-separation and more meticulous treatment. Early identification and treatment of LS are crucial to prevent distortion of the vulvar anatomy.Impact Statement What is already known on this subject? Labial fusion is an uncommon problem in adolescence and an underlying cause should always be investigated. Lichen sclerosus typically affects the anogenital area and can lead to fusion of the labia minora. What do the results of this study add? Urinary symptoms may be the presenting feature of LS in adolescents. What are the implications of these findings for clinical practice and/or further research? Delay in diagnosis and appropriate treatment can result in irreversible changes to the vulva

Deferring surgical treatment of ambiguous genitalia into adolescence in girls with 21-hydroxylase deficiency: a feasibility study

International audienceAbstractBackgroundGenital surgery in Disorders of Sex Development (DSD) has been an area of debate over the past 20 years. Emerging scientific evidence in the late 1990s defied the then routine practice to surgically align genitalia to the sex of rearing, as early as possible. However, despite multitude of data showing detrimental effects to genital sensation and sexuality, few patients born with ambiguous genitalia have remained unoperated into adolescence.MethodsWe followed up girls with 21 hydroxylase deficiency (21- OHD) in genital morphology during childhood and acceptability among patients and parents of such an approach.ResultsPreliminary results from 7 children, aged 1–8 years (median 4.5 years), suggest that it is acceptable among patients and families to defer genital operation in 21-OHD. All patients had a Prader stage III and above. Median clitoral length at birth was 24 mm (20-28 mm) and had diminished to a median of 9 mm (5-15 mm) at their last visit. Height and weight have remained strictly normal in all patients. So far girls and their parents have not expressed significant concerns regarding genital ambiguity.ConclusionsWith this encouraging data at hand, we propose to formally address levels of anxiety, adaptation and quality of life during childhood, with an ultimate goal to assess long term satisfaction and effects on sexuality through deferring genital surgery for adolescence

Deferring surgical treatment of ambiguous genitalia into adolescence in girls with 21-hydroxylase deficiency: a feasibility study

Background: Genital surgery in Disorders of Sex Development (DSD) has been an area of debate over the past 20 years. Emerging scientific evidence in the late 1990s defied the then routine practice to surgically align genitalia to the sex of rearing, as early as possible. However, despite multitude of data showing detrimental effects to genital sensation and sexuality, few patients born with ambiguous genitalia have remained unoperated into adolescence. Methods: We followed up girls with 21 hydroxylase deficiency (21-OHD) in genital morphology during childhood and acceptability among patients and parents of such an approach. Results: Preliminary results from 7 children, aged 1-8 years (median 4.5 years), suggest that it is acceptable among patients and families to defer genital operation in 21-OHD. All patients had a Prader stage III and above. Median clitoral length at birth was 24 mm (20-28 mm) and had diminished to a median of 9 mm (5-15 mm) at their last visit. Height and weight have remained strictly normal in all patients. So far girls and their parents have not expressed significant concerns regarding genital ambiguity. Conclusions: With this encouraging data at hand, we propose to formally address levels of anxiety, adaptation and quality of life during childhood, with an ultimate goal to assess long term satisfaction and effects on sexuality through deferring genital surgery for adolescence