Sexual Health of Older Patients: Attitudes and Perceptions of Healthcare Providers

Background: Recent research has demonstrated an alarming rate of sexually transmitted diseases (STDs) among sexually active heterosexual individuals \u3e age 40 years . Literature suggests that healthcare providers give minimal attention to the sexual health of their older patients and admit to decreased confidence and comfort in broaching the subject of sex with these patients and may not include STDs in a list of differential diagnoses when patients present with uro-genital or other symptoms. Objective: To explore healthcare providers‟ perceptions, awareness, and level of comfort in managing their older patients‟ sexual health. Older patient : individual \u3e age 40 years Methods: Ten health care providers participated in focused guided interviews. Themes, interactions, and sequences in conversations were examined. Results: All of the practitioners indicated sexual health of older patients to be an important aspect of healthcare, but agreed the barriers to discussion with their patients were lack of time in a patient encounter, age and gender of the practitioner, length of time in practice for the practitioner, lack of appropriate education of the practitioner and perceived lack of medical priority. Conclusions: Further research is warranted for this population and increased educational opportunities should be presented to practitioners to decrease barriers to dialogue with their older patients concerning sexual health

Case report: MELAS and concomitant presumed antiphospholipid antibody syndrome in an adult woman

Mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes, and other features (short stature, headaches, seizures, and sensorineural hearing loss) constitute characteristics of MELAS syndrome. MELAS is a rare condition due to mutations in maternally inherited mitochondrial DNA with levels of heteroplasmy possibly related to late adulthood presentation. A previously reported MELAS case coexisted with presumed Antiphospholipid Antibody Syndrome (APLAS), but the connection between MELAS and a potential APLAS is unclear. A 29-year-old woman presented with mild right-sided sensorimotor symptoms and mixed aphasia in November 2021. She presented again in May 2022 for unrelenting headaches and was found to have a new right hemisphere syndrome with mild left-sided sensorimotor symptoms, hemineglect, and anosognosia. Characteristic lab and imaging studies were obtained. During the first presentation (October 2021), the discovery of anticardiolipin IgM antibodies (aCL) (and their replication 3 months later) led to a diagnosis of APLAS, and Warfarin was initiated. During the second admission (May 2022), a new stroke-like lesion on the right hemisphere with characteristic features not suggestive of ischemia was detected, which led to a diagnosis of MELAS (m3243A \u3e G mutation). Although MELAS and APLAS could co-exist, alternatively, it is possible that antiphospholipid antibodies might be generated when the strongly anionic Cardiolipin-Hydroperoxide from the inner mitochondrial membrane is exposed to immune component cells upon cell lysis. Thus, the presence of aCL in patients with stroke-like lesions might masquerade as an APLAS, but should probably be questioned if only aCL are repeatedly found and imaging findings are not characteristic for ischemic lesions. Keywords: MELAS; MRI; MRS; anticardiolipin antibodies; antiphospholipid antibodies; heteroplasmy