scholarly journals Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals

2020 ◽  
Vol 9 (6) ◽  
pp. 1609 ◽  
Author(s):  
Carlotta Cocchetti ◽  
Jiska Ristori ◽  
Alessia Romani ◽  
Mario Maggi ◽  
Alessandra Daphne Fisher
Keyword(s):  
Treatment Strategies ◽  
Hormonal Treatment ◽  
Well Being ◽  
Clinical Approach ◽  
Treatment Protocols ◽  
Treatment Regimens ◽  
Transgender Persons ◽  
Standardized Treatment ◽  
Current Guidelines

Introduction: To date no standardized hormonal treatment protocols for non-binary transgender individuals have been described in the literature and there is a lack of data regarding their efficacy and safety. Objectives: To suggest possible treatment strategies for non-binary transgender individuals with non-standardized requests and to emphasize the importance of a personalized clinical approach. Methods: A narrative review of pertinent literature on gender-affirming hormonal treatment in transgender persons was performed using PubMed. Results: New hormonal treatment regimens outside those reported in current guidelines should be considered for non-binary transgender individuals, in order to improve psychological well-being and quality of life. In the present review we suggested the use of hormonal and non-hormonal compounds, which—based on their mechanism of action—could be used in these cases depending on clients’ requests. Conclusion: Requests for an individualized hormonal treatment in non-binary transgender individuals represent a future challenge for professionals managing transgender health care. For each case, clinicians should balance the benefits and risks of a personalized non-standardized treatment, actively involving the person in decisions regarding hormonal treatment.

scholarly journals Prolonged Survival of a Patient with Advanced-Stage Combined Hepatocellular-Cholangiocarcinoma

2020 ◽  
Vol 14 (3) ◽  
pp. 658-667
Author(s):  
Sven H. Loosen ◽  
Nadine T. Gaisa ◽  
Maximilian Schmeding ◽  
Christoph Heining ◽  
Sebastian Uhrig ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Primary Liver Cancer ◽  
Advanced Stage ◽  
Rare Type ◽  
Treatment Protocols ◽  
Genetic Landscape ◽  
Standardized Treatment ◽  
Genomic Studies ◽  
Combined Hepatocellular Cholangiocarcinoma

Combined hepatocellular-cholangiocarcinoma (cHCC/CCA) represents a rare type of primary liver cancer with a very limited prognosis. Although just recently genomic studies have contributed to a better understanding of the disease’s genetic landscape, therapeutic options, especially for advanced-stage patients, are limited and often experimental, as no standardized treatment protocols have been established to date. Here, we report the case of a 38-year-old male patient who was diagnosed with extensive intrahepatic cHCC/CCA in an otherwise healthy liver without signs of chronic liver disease. An interdisciplinary stepwise therapeutic approach including locoregional liver-targeted therapy, systemic chemotherapy, liver transplantation, surgical pulmonary metastasis resection, and next-generation sequencing-based targeted therapy led to a prolonged overall survival beyond 5 years with an excellent quality of life. This case report comprises several provocative treatment decisions that are extensively discussed in light of the existing literature on this rare but highly aggressive malignancy.

scholarly journals Nanotechnology as an Anti-Infection Strategy in Periprosthetic Joint Infections (PJI)

2021 ◽  
Vol 6 (2) ◽  
pp. 91
Author(s):  
Pier Francesco Indelli ◽  
Stefano Ghirardelli ◽  
Ferdinando Iannotti ◽  
Alessia Maria Indelli ◽  
Gennaro Pipino
Keyword(s):  
Joint Infection ◽  
Treatment Strategies ◽  
High Morbidity ◽  
Treatment Protocols ◽  
Joint Infections ◽  
Prevention And Treatment ◽  
Efficient Control ◽  
Cement Joint ◽  
Clay Nanotubes

Background: Periprosthetic joint infection (PJI) represents a devastating consequence of total joint arthroplasty (TJA) because of its high morbidity and its high impact on patient quality of life. The lack of standardized preventive and treatment strategies is a major challenge for arthroplasty surgeons. The purpose of this article was to explore the potential and future uses of nanotechnology as a tool for the prevention and treatment of PJI. Methods: Multiple review articles from the PubMed, Scopus and Google Scholar databases were reviewed in order to establish the current efficacy of nanotechnology in PJI preventive or therapeutic scenarios. Results: As a prevention tool, anti-biofilm implants equipped with nanoparticles (silver, silk fibroin, poly nanofibers, nanophase selenium) have shown promising antibacterial functionality. As a therapeutic tool, drug-loaded nanomolecules have been created and a wide variety of carrier materials (chitosan, titanium, calcium phosphate) have shown precise drug targeting and efficient control of drug release. Other nanotechnology-based antibiotic carriers (lipid nanoparticles, silica, clay nanotubes), when added to common bone cements, enhanced prolonged drug delivery, making this technology promising for the creation of antibiotic-added cement joint spacers. Conclusion: Although still in its infancy, nanotechnology has the potential to revolutionize prevention and treatment protocols of PJI. Nevertheless, extensive basic science and clinical research will be needed to investigate the potential toxicities of nanoparticles.

scholarly journals Graves' disease: pathophysiological aspects and considerations about using the chemometric analysis in the study of the disease

Folia Medica ◽  
2021 ◽  
Vol 63 (4) ◽  
pp. 467-474
Author(s):  
Pavlina M. Koseva ◽  
Zdravko A. Kamenov ◽  
Mariana M. Nikolova ◽  
Pavlina A. Andreeva-Gateva
Keyword(s):  
Treatment Strategies ◽  
Well Being ◽  
Chemometric Analysis ◽  
Observation Group ◽  
Public Concern ◽  
High Prevalence ◽  
Societal Problem ◽  
System Disorder ◽  
Individualised Treatment

Graves’ disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Thyroid disorders are a societal problem of great public concern because of their high prevalence. This problem can affect the well-being and quality of life of patients. The predisposing factors leading to this disease are not yet fully established and are likely to be interconnected in a complex way.  Chemometric analysis allows for the detection of specific relationships between the medical parameter measurements obtained from the patients in an observation group, and the identification of patterns of similarity between these patients. It is not commonly used in clinical trials; however, it can provide reliable information which may help in creating more successful, individualised treatment strategies for established groups (patterns) of patients. The aim of this review is to summarize the latest knowledge about the risk factors for Graves’ disease and considerations about using the chemometric analysis in the study of the disease.

scholarly journals Key Factors Contributing to Quality of Life for Breast Cancer Patients in Latvia: Supplementing Quantitative Surveys with Qualitative Interviews

2012 ◽  
Vol 12 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Agnese Dzērvīte ◽  
Maruta Pranka ◽  
Tana Lace ◽  
Ritma Rungule ◽  
Edvins Miklasevics ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Patients ◽  
Qualitative Interviews ◽  
Treatment Strategies ◽  
Well Being ◽  
University Hospital ◽  
Breast Cancer Patients ◽  
Key Factors

Summary Introduction. Health related quality of life is a much debated topic in medicine with much quantitative and qualitative research contributing to the understanding of how to improve the lives of patients, yet little has been published in relation to the quality of life of Latvian breast cancer patients. Aim of the Study. To gather base measurements of subjective and objective quality of life factors for breast cancer patients in Latvia and discover which key factors contribute most to quality of life of Latvian breast cancer patients at the start of treatment. Materials and Methods. This paper presents data collected from April 2010 to June 2011 at the Pauls Stradins Clinical University hospital on key factors influencing quality of life for breast cancer patients: health and physical well-being; state of surroundings and environment; social support and functionality; financial state, employment and leisure. Quantitative survey material has been supplemented with insight from qualitative in-depth interviews to better explain the objective and subjective implications for breast cancer patients’ quality of life. Results. Interviewed breast cancer patients rated their quality of life as being average or good at the beginning of treatment. Negative factors contributing to lowered quality of life were mainly linked to patient financial, social and emotional state at the first weeks of treatment and correspond to previous research done in Latvia on quality of life issues. Conclusions. Further follow-up surveys will contribute to the evaluation of breast cancer patients’ needs while undergoing treatment to further improve treatment strategies, especially if validated quality of life measurement surveys were to be implemented in Latvian hospitals.

Impact of treatment strategies on local control and survival in uterine carcinosarcomas.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16526-e16526
Author(s):  
Selim Yalcin ◽  
Omer Dizdar ◽  
Nadire Kucukoztas ◽  
Samed Rahatli ◽  
Ozlem Ozen ◽  
...  
Keyword(s):  
Uterine Cancer ◽  
Treatment Strategies ◽  
Stage Iv ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Uterine Carcinosarcoma ◽  
Treatment Regimens ◽  
Stage Iv Disease ◽  
Standardized Treatment

e16526 Background: Carcinosarcoma is a biphasic neoplasm composed of a mixture of malignant epithelial and mesenchymal components. Uterine carcinosarcomas comprise only 3% of all uterine malignancies, however they account for a disproportionally higher rate of mortality from uterine cancer because of their agressive nature. No standardized treatment has yet been established. The purpose of this study was to determine the clinical characteristics, patterns of recurrence and survival outcomes in patients with uterine carcinosarcoma treated in our institution. Methods: Records of the patients with uterine carcinosarcoma were retrospectively evaluated and 29 pts with carcinosarcoma diagnosed between 2007 and 2012 were identified. All patients were initially treated surgically by the same surgeon with comprehensive staging, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy , bilateral pelvic and paraaortic lymph node dissection and omentectomy. Demographic features, tumor characteristics, treatment regimens and patient outcomes in terms of relapse-free survival (RFS) and overall survival (OS) were analyzed. Results: Median age was 63 (range 43-78). 13 patients (45%) had stage I disease, 5 patients (17%) had stage III and 11 patients (38%) had stage IV disease at diagnosis. Median tumor size was 6 cm (range 1.7-20 cm) and lymphovascular invasion was present in 17 patients 59%). Twenty patients (69%) received chemotherapy (90% with paclitaxel and carboplatin) for 6 cycles. One patient received radiotherapy. Median follow up was 13 mos. Seventeen patients (59%) relapsed and 20 patients (69%) died on follow up. Two patients had vaginal cuff recurrence, 4 had pelvic, 4 had abdominal and 7 had distant recurrences. All recurrences were fatal. 3 year RFS was 31%. 3 year OS was 15%. Conclusions: Our data show that uterine carcinosarcomas tend to be more at more advanced stage at diagnosis and despite the use of chemotherapy and radiotherapy, overall prognosis is poor. Surgery remains the mainstay of treatment. More effective adjuvant strategies are needed to reduce relapse and death rates because recurrences are generally fatal.

scholarly journals Different insulin treatment regimens in patient with diabetes mellitus type 1: Effects on quality of life

2012 ◽  
Vol 69 (7) ◽  
pp. 569-575 ◽  
Author(s):  
Jelena Stojanovic ◽  
Dragoslav Milosevic ◽  
Ilija Antovic ◽  
Goran Sekulic ◽  
Teodora Beljic-Zivkovic
Keyword(s):  
Glycemic Control ◽  
Metabolic Control ◽  
Insulin Treatment ◽  
Vascular Complications ◽  
Well Being ◽  
Insulin Analogues ◽  
Treatment Regimens ◽  
Type 1 Dm

Background/Aim. Despite of contemporary diabetes mellitus (DM) treatment, one half of patients do not achieve an optimal metabolic control. Considering great psychological burden of diabetic patients, the purpose of this study was to assess the effect of different insulin treatment regimens, glycemic control and the presence of vascular complications on self-reported well-being and quality of life (QoL) of subjects with type 1 DM. Methods. The patients with type 1 DM (n = 122) recruited from the outpatient Diabetes Endocrinology Clinic of Zvezdara University Medical Center were divided into 4 groups according to the specific treatment regimen: 26 were on continuous subcutaneous insulin infusion (CSII), 30 on conventional insulin therapy, 33 on multiple daily injections (MDI) with human insulins, and 33 on MDI with insulin analogues. QoL was assessed by self-reported well-being with the following questionnaires: WHO-5 item Well Being Index (WHO- 5), 36 item Short Form (SF-36) survey, and Insulin Treatment Appraisal Scale (ITAS). Objective metabolic control was assessed by glycosylated hemoglobin (HbA1c), lipid levels and the presence of vascular complications. Statistical analyses used in this crosssectional study included: descriptive statistics, Student?s t-test, Chisqare test, contingency tables, ANOVA and correlation methods. Results. The patients on CSII had significantly better metabolic control than all other treatment groups, especially when compared to the one on conventional therapy (CSII HbA1c 7.07 ? 1.48% vs conventional therapy, HbA1c 10.04 ? 1.44; p = 0.000). No significant difference in glycemic control was observed between patients on MDI with human insulins and insulin analogues. Good glycemic control significantly influenced the reported QoL. The patients with retinopathy and nephropathy reported significantly lower physical well-being, and the patients with polyneuropathy and cardiovascular complications reported also lower psychological well being. Conclusions. Insulin treatment regiment selection affects not only objective metabolic control, but also QoL.

scholarly journals Sleep Disturbance in Gynaecologic Malignancies-an Overview

2020 ◽  
Vol I (2) ◽  
pp. 29-32
Author(s):  
Pavan Deepak
Keyword(s):  
Quality Of Life ◽  
General Population ◽  
Sleep Disturbance ◽  
Cancer Patients ◽  
Sleep Disturbances ◽  
Treatment Strategies ◽  
Well Being ◽  
Systematic Research ◽  
Gynaecologic Cancer

Sleep plays a pivotal role in maintaining homeostasis and one of a few foremost determinants of Quality of Life. Quality of life is a well-studied topic in oncology and various measures are taken to improve quality of life in this setting, in order to achieve therapeutic outcome and compliance in general in cancer patients. Sleep disturbances and disruption in circadian rhythm is among a few common presenting complaints of patients with malignancy and affects between 30% to 75% of newly diagnosed or recently treated cancer patients,1 which are reported as double that of the general population, paving the way for decreased compliance and inefficacy of therapy and pose as a detriment to general well-being, and quality of life. It is evident that mood disorders and sleep disturbances are more prevalent in females (1.3 to 1.8 times more than men),2 one may theorize that the prevalence of sleep disturbance in gynaecologic malignancies is greater than that of general population. Sleep disturbances in gynaecologic cancer patients often include difficulty in initiation of sleep, frequent awakening, difficulty in staying asleep, and restless leg syndrome. Systematic research on various sleeps disorders and their therapeutic approach in gynaecologic cancers in general is lacking. This article aims at elucidating and giving overview of sleep pattern changes in gynaecologic malignancies and therapeutic approaches to foster better sleep in this subset of population. This article also emphasizes the need to envisage the treatment strategies targeting cytokines and cortisol in improvement of sleep parameters in gynaecologic malignancies.

scholarly journals Factors associated with Oral Health Related Quality of Life in children. Literature Review.

2019 ◽  
Vol 6 (1) ◽  
pp. 22-25
Author(s):  
Yanara Nauduam ◽  
Gabriela Sandoval
Keyword(s):  
Quality Of Life ◽  
Oral Health ◽  
Treatment Strategies ◽  
Well Being ◽  
Health Related Quality ◽  
Individual Level ◽  
Factors Associated ◽  
Related Quality ◽  
Health Related

Quality of Life (QoL) refers to a concept that might comprise different levels, which are able to identify the biological, economic, social and psychological demands from individual level up to community level. The concept of oral health-related quality of life (OHRQoL) refers to the ability of performing daily activities and considers subjective aspects such as happiness, social well-being and emotional well-being, in order to know people’s perception about their life. The aim of this article is to review the main factors associated with OHRQoL in children. Socioeconomic status, family structure, overcrowded homes, number of children, parent’s educational attainment and psychological factors, among others, were significant predictors for children’s OHRQoL. In Chile, there is a scarcity of OHRQoL in children and adolescents. The knowledge of OHRQoL might help to improve the development of programs and the effectiveness of oral health services, since it allows the assessment of small children, perceived needs and effectiveness of treatment strategies.

Scoring Adherence in Hemophilia Care and Comparing It to Quality of Life (QofL).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2260-2260 ◽  
Author(s):  
Sue duTreil ◽  
Janet Rice ◽  
Cindy A. Leissinger
Keyword(s):  
Quality Of Life ◽  
Treatment Regimen ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Clotting Factor ◽  
Chi Square ◽  
Treatment Regimens ◽  
Adherence Score ◽  
The Relationship

Abstract Non-adherence to home based treatment even 10% of the time in hemophilia care may portend a poor outcome and long-range quality of life issues, despite a still enormous financial cost. This study was a rigorous effort to quantify adherence and then compare it to QofL. 79 subjects with hemophilia (48 >18-years and 31<18-years) participated in the study and completed the SF-36 or Child Health Questionnaire (validated QofL forms). Subjects were either using on-demand (OD) treatment regimens or on high intensity (HI) treatment strategies i.e. prophylaxis or immune tolerance therapy. Physician’s specific treatment order for dose and frequency of clotting factor concentrate (CFC) were collected. Factor infusion logs kept by patients were reviewed to determine how factor use matched treatment recommendations. Infusion logs were maintained by 47 of 79 subjects (59%). The amount of CFC used was entered into a database along with the date of the infusion and the reason for the infusion. Due to vial size variability doses that were within 80% to 150% of the prescribed dose for children and 80% to 120% for adults were considered adherent. A scoring system was developed for both OD and HI users based on documented usage patterns. A given subject’s adherence score could range from 0 (representing total non-adherence) to 100% (representing perfect adherence). A subject’s adherence percentile was then ranked accordingly: 0% to 33% = Low Adherence, 34% to 66% = Moderate Adherence, 67% to 100% = High Adherence. Chi Square was used to determine the relationship between adherence and treatment regimen and a two-way analysis of variance was used to compare QofL in subjects with treatment logs to adherence and treatment regimen. Subjects on HI had lower adherence patterns than those on OD (p=. 018). Significant findings related to QofL included that body pain in children was higher with OD compared with HI (p=. 036), however this was not demonstrated in adults. Adults with low adherence patterns had higher mean scores in mental health then high (p=. 021) and moderate (p=. 068) adhering adults. Quantifying adherence and attempting to understand the relationship between adherence and QofL is an important component in the management of hemophilia.

scholarly journals Timely Euthanasia in the United States Dairy Industry–Challenges and a Path Forward

Animals ◽  
2019 ◽  
Vol 10 (1) ◽  
pp. 71 ◽  
Author(s):  
Jennifer B. Walker ◽  
I. Noa Roman-Muniz ◽  
Lily N Edwards-Callaway
Keyword(s):  
Dairy Cattle ◽  
Employee Training ◽  
Well Being ◽  
The United States ◽  
Management Tool ◽  
Critical Component ◽  
Treatment Protocols ◽  
Human Animal Bond ◽  
On Farm

Euthanasia is a valuable management tool utilized on dairies to end the suffering of sick or debilitated cows. Euthanasia should be implemented if an animal’s pain cannot be adequately alleviated and if there is a limited chance of recovery. To be humane, euthanasia should be quick, painless, and administered by a trained individual. Despite its importance in ensuring cow well-being, the timeliness with which euthanasia decisions are made for dairy cattle is often overlooked or neglected. The timeliness of euthanasia is as important as the efficient, rapid administration of euthanasia itself. Timely euthanasia is a critical component of many on-farm animal care and verification programs yet opportunities exist within the industry to improve how effectively the industry is executing this critical component of cow management. There are challenges associated with performing euthanasia in a timely manner, such as inconsistencies in treatment protocols, inadequate employee training, difficulties assessing a cow’s quality of life, and impacts of the human–animal bond on decision-making. The objective of this paper is to explain the importance of timely euthanasia to dairy cattle welfare, identify the challenges that can prevent the timeliness of euthanasia, and provide solutions and practical suggestions for improving the management of timely euthanasia on dairies.

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