109 research outputs found
Διερεύνηση των παραγόντων που επηρεάζουν την επιβάρυνση των φροντιστών ηλικιωμένων ασθενών με ακράτεια ούρων: μια συγχρονική μελέτη στην Ελλάδα
No full textΠεριέχει βιβλιογραφικές παραπομπές.Η πληθυσμιακή γήρανση συνδέεται άμεσα με την αύξηση της εμφάνισης ασθενειών που συνδέονται με την τρίτη ηλικία, όπως η ακράτεια ούρων. Αυτή δεν επιβαρύνει μόνο την ποιότητα ζωής των ηλικιωμένων ασθενών που ζουν στην κοινότητα, αλλά ταυτόχρονα αποτελεί σημαντικό στοιχείο που επιδρά στην ψυχική υγεία και την ποιότητα ζωής των φροντιστών των ασθενών αυτών.
Η παρούσα μελέτη έχει ως σκοπό την εκτίμηση του βαθμού επιβάρυνσης που βιώνουν οι φροντιστές ηλικιωμένων ασθενών με ακράτεια σε μία ελληνική κοινότητα της περιοχής Μαγνησίας και η διερεύνηση της συσχέτισής της με ορισμένα δημογραφικά και κοινωνικοοικονομικά τους χαρακτηριστικά.
Έλαβε χώρα το χρονικό διάστημα 02/2012-04/2013 και οι φροντιστές επιλέχθηκαν μετά από σκόπιμη δειγματοληψία. Ο πληθυσμός τους απαρτιζόταν από 300 άτομα και χωρίσθηκαν σε τρεις ομάδες. Ο πληθυσμός αναφοράς ήταν 100 φροντιστές ηλικιωμένων (ομάδα Ι) με διάφορες παθήσεις χωρίς ακράτεια ούρων. Στην ομάδα ΙΙ, 100 φροντιστές ηλικιωμένων που παρουσίαζαν εκτός από τις παραπάνω παθήσεις και ακράτεια ούρων. Τέλος, αξιολογήθηκαν οι φροντιστές άλλων 100 ηλικιωμένων με σοβαρού βαθμού ακράτεια ούρων (ομάδα ΙΙΙ) που δεν ήταν δυνατό να αντιμετωπισθεί. Για τους σκοπούς της έρευνας χρησιμοποιήθηκε το ερωτηματολόγιο Zarit.
Η πλειονότητα των φροντιστών ήταν γυναίκες (από 76% στην ομάδα Ι έως 85% στην ομάδα ΙΙΙ) με μέση ηλικία τα 53,1 έτη. Μεταξύ των τριών ομάδων, στην ομάδα ΙΙΙ υπήρχαν οι περισσότεροι από τους φροντιστές (73%) που συγκατοικούσαν με τους ασθενείς τους. Στις ομάδες Ι και ΙΙ περίπου οι μισοί βίωσαν «μέτρια έως σοβαρή επιβάρυνση» με την παρατεταμένη χρονικά διάρκεια φροντίδας και την έλλειψη εργασίας να αναδεικνύονται ως παράγοντες αυξημένου κινδύνου της επιβάρυνσης. Στην ομάδα ΙΙΙ παρουσιάζεται το μεγαλύτερο ποσοστό φροντιστών με υψηλού βαθμού επιβάρυνση (37%). Οι μέσες τιμές ως προς το συνολικό βαθμό επιβάρυνσης στις τρεις ομάδες διαφέρουν στατιστικά σημαντικά μεταξύ τους (p=0,024).
Η μελέτη ανέδειξε την ανάγκη ψυχοκοινωνικής και οικονομικής στήριξης των φροντιστών των ασθενών με ακράτεια, ώστε να μειωθεί η επιβάρυνση που υφίστανται. Για την επίτευξη αυτού του στόχου, θα ήταν σκόπιμη μια πολιτική υγείας σε εθνικό πλαίσιο, η οποία θα ενεργοποιούσε και θα συντόνιζε κοινωνικές υπηρεσίες, δομές και φορείς της πρωτοβάθμιας φροντίδας υγείας ενώ παράλληλα θα ευαισθητοποιούσε τους λειτουργούς τους.Incontinence is a major problem of public health due to the ageing population and its increasing appearance in older people. In addition, these epidemics have a negative influence on the caregivers’ quality of life.
The purpose of the present study is to evaluate the caregivers’ burden of patients suffering from urinary incontinence in the community (Magnesia perfecture). The study took place during a time span from 02/2012-04/2013 and the population studied consisted of three groups. Group I consisted of 100 caregivers of old patients suffering from diseases due to ageing. Group II consisted of 100 caregivers of patients suffering from diseases due to ageing and incontinence treated with anticholinergics. Group III consisted of 100 caregivers of patients suffering from diseases due to ageing and untreated incontinence. Semi-structured interviews were conducted based on the Zarit Burden Interview (ZBI). ZBI is a short valid and reliable method which has been used since 1986, widely, throughout the world.
The majority of caregivers were women (from 76% in group I to 85% in group III) with a mean age of 53,1 years. In group III there is the higher percentage of caregivers (73%) that lived with their patients. In groups I and II approximately half of them experienced “moderate to severe burden”. Factors, attributing to higher risk levels of burden, were the prolonged time period of care and unemployment. In group III was recorded the higher percentage of caregivers with severe burden (37%). The mean values differences are statistically significant (p=0,024).
The present study indicates the necessity for the minimization of caregivers’ burden of patient with urinary incontinence. This can be possible through certain national health care and social policy strategies, since the public section of health care considers that home care of incontinent patients is more cost-effective than their isolation in a mental institution or a home for the aged people
Comparative Analysis of Fluorescence In Situ Hybridization and Next-Generation Sequencing in Sperm Evaluation: Implications for Preimplantation Genetic Testing and Male Infertility
No full textPre-implantation genetic testing (PGT) is a crucial process for selecting embryos created through assisted reproductive technology (ART). Couples with chromosomal rearrangements, infertility, recurrent miscarriages, advanced maternal age, known single-gene disorders, a family history of genetic conditions, previously affected pregnancies, poor embryo quality, or congenital anomalies may be candidates for PGT. Preimplantation genetic testing for aneuploidies (PGT-A) enables the selection and transfer of euploid embryos, significantly enhancing implantation rates in assisted reproduction. Fluorescence in situ hybridization (FISH) is the preferred method for analyzing biopsied cells to identify these abnormalities. While FISH is a well-established method for identifying sperm aneuploidy, NGS offers a more comprehensive assessment of genetic material, potentially enhancing our understanding of male infertility. Chromosomal abnormalities, arising during meiosis, can lead to aneuploid sperm, which may hinder embryo implantation and increase miscarriage rates. This review provides a comparative analysis of fluorescence in situ hybridization (FISH) and next-generation sequencing (NGS) in sperm evaluations, focusing on their implications for preimplantation genetic testing. This analysis explores the strengths and limitations of FISH and NGS, aiming to elucidate their roles in improving ART outcomes and reducing the risk of genetic disorders in offspring. Ultimately, the findings will inform best practices in sperm evaluations and preimplantation genetic testing strategies
Reproductive Health in Women with Major β-Thalassemia: Evaluating Ovarian Reserve and Endocrine Complications
No full textThalassemia is an autosomal recessive hereditary chronic hemolytic anemia characterized by a partial or complete deficiency in the synthesis of alpha- or beta-globin chains, which are essential components of adult hemoglobin. Mutations in the globin genes lead to the production of unstable globin chains that precipitate within cells, causing hemolysis. This shortens the lifespan of mature red blood cells (RBCs) and results in the premature destruction of RBC precursors in the bone marrow. Regular red blood cell transfusions are the standard treatment for thalassemia. However, these transfusions can lead to increased iron overload, which can impair vital systems such as the liver, heart, ovaries, and endocrine system. Focusing on female reproductive endocrinology, recurrent blood transfusions can cause iron accumulation in the pituitary and hypothalamus, leading to hypogonadotropic hypogonadism (HH), the most common endocrinopathy in these patients, affecting 40–91% of women. Recurrent transfusions and the resulting iron overload can also lead to oxidative stress and ovarian damage in patients with beta-thalassemia major (BTM). Despite advancements in iron chelation therapy, hypothalamic–pituitary damage associated with HH contributes to subfertility and sexual dysfunction, often with little to no recovery. In women exposed to gonadotoxic drugs, particularly those with BTM, anti-Mullerian hormone (AMH)—a marker of ovarian reserve—is frequently used to assess ovarian damage. This review aims to explore the pathophysiology of β-thalassemia and its major clinical manifestations, with a focus on endocrine complications and their impact on ovarian reserve. It also investigates how metabolomics can provide insights into the disease’s metabolic alterations and inform current and emerging therapeutic strategies to mitigate complications and optimize patient outcomes, potentially leading to more effective and personalized treatments
Oxidative-Stress-Mediated Epigenetic Dysregulation in Spermatogenesis: Implications for Male Infertility and Offspring Health
No full textMale reproductive health is governed by an intricate interplay of genetic, epigenetic, and environmental factors. Epigenetic mechanisms-encompassing DNA methylation, histone modifications, and non-coding RNA activity-are crucial both for spermatogenesis and sperm maturation. However, oxidative stress, driven by excessive reactive oxygen species, disrupts these processes, leading to impaired sperm function and male infertility. This disruption extends to epigenetic modifications, resulting in abnormal gene expression and chromatin remodeling that compromise genomic integrity and fertilization potential. Importantly, oxidative-stress-induced epigenetic alterations can be inherited, affecting the health and fertility of offspring and future generations. This review investigates how oxidative stress influences epigenetic regulation in male reproduction by modifying DNA methylation, histone modifications, and non-coding RNAs, ultimately compromising spermatogenesis. Additionally, it discusses the transgenerational implications of these epigenetic disruptions and their potential role in hereditary infertility and disease predisposition. Understanding these mechanisms is vital for developing therapeutic strategies that mitigate oxidative damage and restore epigenetic homeostasis in the male germline. By integrating insights from molecular, clinical, and transgenerational research, this work emphasizes the need for targeted interventions to enhance male reproductive health and prevent adverse outcomes in progeny. Furthermore, elucidating the dose-response relationships between oxidative stress and epigenetic changes remains a critical research priority, informing personalized diagnostics and therapeutic interventions. In this context, future studies should adopt standardized markers of oxidative damage, robust clinical trials, and multi-omic approaches to capture the complexity of epigenetic regulation in spermatogenesis. Such rigorous investigations will ultimately reduce the risk of transgenerational disorders and optimize reproductive health outcomes.Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Journal content freely available via Open Access. Some content may be unavailable due to publisher embargo. Click on the 'Additional link' above to access the full-text
High-Risk Outcomes in In Vitro Fertilization Pregnancies for Women of a Very Advanced Maternal Age: Insights from a Multi-Hospital Study in Greece
No full textBackground: In vitro fertilization (IVF) has transformed infertility treatment, yet it is associated with increased risks of adverse perinatal outcomes, particularly in women of advanced maternal age. This study aimed to investigate the prevalence of complications such as preeclampsia (PE), gestational diabetes mellitus (GDM), preterm labor (PTL), low birth weight (LBW), and placental abnormalities (PA) among women over 50 undergoing assisted reproductive technology (ART) in Greece, where the eligibility age limit has been recently raised to 54 years. Methods: We conducted a retrospective analysis of pregnancy outcomes in women over 50 compared to those under 50, utilizing medical records mainly from University Hospital of Ioannina but also from other public hospitals and private clinics in Greece. Results: Our findings indicate that women over 50 face an increased risk of developing preeclampsia (PE) by 4.61 times, GDM by 1.69 times, PTL by 1.82 times, LBW by 1.67 times, and PA by 3.92 times. Conclusions: These results underscore the need for heightened awareness and the monitoring of pregnancy complications in this demographic, informing clinical strategies to improve maternal and neonatal outcomes.This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Journal content freely available via Open Access. Some content may be unavailable due to publisher embargo. Click on the 'Additional link' above to access the full-text
Impact of Reductive Stress on Human Infertility: Underlying Mechanisms and Perspectives
No full textAntioxidants have a well-established effect on general health and are essential in preventing oxidative damage to cells by scavenging free radicals. Free radicals are thought to be neutralized by these substances, which include polyphenols, β-carotene, and vitamins C and E, reducing cellular damage. On the other hand, recent data indicates that consuming excessive amounts of antioxidants may have side effects. Apoptosis and cell signaling are two beneficial physiological processes that are affected by excessive supplementation. Other negative effects include paradoxical enhancement of oxidative stress and unbalanced cellular redox potential. Overdosing on particular antioxidants has been associated with increased medication interactions, cancer progression, and fatality risks. Additionally, the complex impacts they may have on fertility might be both useful and adverse, depending on the quantity and duration of usage. This review delves into the dual role of antioxidants and emphasizes the importance of employing antioxidants in moderation. Antioxidant overconsumption may disrupt the oxidative balance necessary for normal sperm and oocyte function, which is one of the potential negative effects of antioxidants on fertility in both males and females that are also investigated. Although modest usage of antioxidants is generally safe and useful, high levels of antioxidants can upset hormonal balance, impair sperm motility, and negatively impact the outcomes of assisted reproductive technologies (ART). The findings emphasize the need to use antioxidant supplements in a balanced way, the importance of further research to optimize their use in fertility treatments, and the importance of supporting reproductive health to avoid adverse effects
The effect of extended release tolterodine used for overactive bladder treatment on female sexual function
No full textUrodynamic and rationale evaluation of lower urinary tract symptoms in males
No full textAIM Benign prostate hyperplasia is the most common benign disease in men. For many years the diagnosis and the cure of BPH was simple. Last years with the introduction of less invasive procedures and new drugs for treatment it is necessary to determine the cause, pathophysiology and natural history of the disease. METHOD The patients’ group with watchful waiting revealed that cystometry, pressure flow study and maximal frow rate can be used to predict the results of obstruction in the lower urinary tract. That’s why it is useful to enclose the urodynamic studies in the diagnosis of disease. The first group of patients had an urodynamic evaluation and then underwent an operation, the second group received oral medication - alfusozine 5 mg twice daily. RESULTS An important conclusion is that using urodynamic studies we can understand the reason of obstruction of lower urinary system. When pressure flow studies showed obstruction and IPSS score revealed obstructive or obstructive and urge symptoms possible operation leads to cure. When pressure flow studies showed urgency and IPSS score revealed urgency too, possible operation wouldn’t relief patient from disease. Furthermore, simple uroflowmetry, which is part of urodynamic studies, can be useful. Evaluation of average and maximal flow rates are enough. It is found the the delay of beginning of urination and low maximal flow rate are enlist patients in the obstructive group. It is clear then that patients with urgency wouldn’t undergo operations. Pressure flow studies helps urologists a lot to discriminate patients with obstruction of lower urinary system and utgency.ΣΚΟΠΟΣ Η καλοήθης υπερπλασία του προστάτη είναι η συχνότερη καλοήθης εξεργασία στους άνδρες. Για πολλά χρόνια η διάγνωση και η θεραπεία της ΚΥΠ ήταν μια απλή και ξεκάθαρη υπόθεση. Τα τελευταία χρόνια με την εισαγωγή λιγότερο επεμβατικών μεθόδων και με την ανάπτυξη των φαρμάκων για τη θεραπεία της ΚΥΠ, είναι απαραίτητο να ερευνήσουμε σε βάθος την αιτιολογία, την παθοφυσιολογία και τη φυσική εξέλιξή της. ΜΕΘΟΔΟΛΟΓΙΑ Από την ομάδα των ασθενών με απλή παρακολούθηση η κυστεομανομέτρηση, η σύγχρονη μέτρηση πίεσης ροής και η μέγιστη ταχύτητα ροής μπορούν να χρησιμοποιηθούν για να προβλέψουμε την πορεία της αποφρακτικής νόσου στο κατώτερο ουροποιητικό. Ενσωματώνοντας στον αρχικό έλεγχο των ανδρών με απόφραξη τις παραπάνω ουροδυναμικές παραμέτρους μπορούμε να προβλέψουμε την εξέλιξη της απόφραξης. Ο χωρισμός των ασθενών σε επιμέρους ομάδες έγινε προκειμένου να αξιολογηθούν οι ουροδυναμικές παράμετροι σε σχέση με την απόφραξη του κατώτερου ουροποιητικού καθώς και με το είδος της θεραπευτικής αντιμετώπισης. Η πρώτη περιλαμβάνει ασθενείς που αφού αξιολογήθηκαν ουροδυναμικά αντιμετωπίστηκαν χειρουργικά με διουρηθρική προστατεκτομή. Η δεύτερη περιλαμβάνει ασθενείς που έλαβαν φαρμακευτική θεραπεία με αλφουζοσίνη 5 mg δύο φορές ημερησίως. ΣΥΜΠΕΡΑΣΜΑΤΑ Ένα σημαντικό συμπέρασμα που προκύπτει από την αξιολόγηση των συμπτωμάτων και ουροδυναμικών παραμέτρων είναι ότι με βάση τον ουροδυναμικό έλεγχο μπορούμε να κατανοήσουμε το στοιχείο που κατά κανόνα προκαλεί τη συμπτωματολογία του ασθενή. Όταν ο ουροδυναμικός έλεγχος κατάτασσε τον ασθενή στην ομάδα της απόφραξης τότε και η συμπτωματολογία σύμφωνα με το IPSS κατεδείκνυε ότι ο ασθενής παρουσιάζει απόφραξη ή μικτού τύπου αποφρακτικά και ερεθιστικά συμπτώματα. Σε αυτούς η επέμβαση θα παρουσιάσει τα αναμενόμενα αποτελέσματα όπως αποδεικνύεται παρακάτω. Όταν ο ουροδυναμικός έλεγχος κατατάσσει τον ασθενή στη μη-αποφρακτική ομάδα η συμπτωματολογία κατά IPSS δείχνει ότι υπερισχύουν τα ερεθιστικά συμπτώματα και δεν υπάρχει απόφραξη. Με αυτό τον τρόπο ο ουροδυναμικός έλεγχος αποτελεί σίγουρο και ασφαλή τρόπο επιλογής ασθενών για επέμβαση και αποτρέπει περιττές προστατεκτομές. Αλλά και η απλή μόνο ουροροομετρία, κομμάτι του πλήρους ουροδυναμικού ελέγχου μπορεί να φανεί χρήσιμη. Η αξιολόγηση των μέσων όρων της μέγιστης ταχύτητας ροής των ούρων αρκεί αφού βρέθηκε ότι η δυσκολία στην έναρξη και η χαμηλή μέγιστη ταχύτητα ροής συνδέονται με την ομάδα των αποφρακτικών ασθενών. Πέρα λοιπόν από τις απόλυτες ενδείξεις προστατεκτομής που αναφέρονται στα συγγράμματα οι ουρολόγοι θα πρέπει να περιορίσουν τις προστατεκτομές που δε χρειάζονται, ιδιαίτερα σε ασθενείς με έντονη συμπτωματολογία ερεθιστικού τύπου. Η σύγχρονη μέτρηση πίεσης ροής προσφέρει πολύτιμη βοήθεια στην περίπτωση αυτή και κρίνεται απαραίτητη κυρίως στους ασθενείς με καλοήθη υπερπλασία προστάτη και ερεθιστικά συμπτώματα, γιατί η ομάδα των ασθενών αυτών υπάρχει πιθανότητα να μην παρουσιάζει απόφραξη. Εάν λάβουμε υπόψη ότι οι επιπτώσεις της απόφραξης στο κατώτερο ουροποιητικό είναι το μείζον πρόβλημα στην καλοήθη υπερπλασία προστάτη και ότι υπάρχει πτωχή συσχέτιση μεταξύ μεγέθους του αδένα, της απόφραξης και της συμπτωματολογίας ο ουροδυναμικός έλεγχος μπορεί να σταθεί πολύτιμος βοηθός
The effect of extended release tolterodine used for overactive bladder treatment on female sexual function
No full textABSTRACT Introduction Overactive bladder (OAB) is a common condition, especially in middle aged women, requiring long term therapy with anticholinergics to maintain symptoms relief. The aim of the study was to determine the effect of tolterodine extended release (ER) used for OAB treatment on the sexual function of women. Materials and Methods Between August 2010 and August 2014, 220 women with confirmed OAB, attended Urogynecology Outpatient Clinic and were prospectively enrolled in this study. 158 women were evaluated, with a comprehensive history, physical examination, urodynamic studies and Female Sexual Function Index (FSFI) questionnaire. 73 patients of group A (control group) received no treatment and 85 patients of group B received an anticholinergic regimen – tolterodine ER 4mg once daily. Data were evaluated again in accordance with FSFI after three months, using SPSS software. Results A statistically significant increase was noted in group B in domains of desire (pre-treatment 2.5±0.2 to 4.5±0.2 post-treatment), arousal (3.1±0.2 to 3.1±0.2 respectively), lubrication (3.4±0.3 to 4.3±0.3 respectively), orgasm (3.5±0.3 to 4.5±0.3 respectively), satisfaction (2.6±0.2 to 4.2±0.3 respectively) and pain (2.4±0.2 to 4.6±0.4 respectively) after three months treatment with tolterodine ER. In group A there were no statistically significant changes in pre and post treatment values (p>0.05). Total FSFI score for group B was significantly higher after tolterodine treatment (26.5±1.5) compared to pre-treatment values (17.4±1.4, p0,05) respectively. Conclusions This preliminary study demonstrates that treatment of OAB with tolterodine ER was found to have positive effect on sexual function of patients with OAB
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