46 research outputs found
The physiological and pathophysiological roles of the GH/IGF-axis in the kidney: Lessons from experimental rodent models
No full textA scoping review of the use of e-learning and e-consultation for healthcare workers in low- and middle-income countries and their potential complementarity
No full textObjective: Although the provision of e-learning (EL) training for healthcare workers (HCWs) and provider-to-HCW e-consultation (EC) is considered useful for health outcomes, research on their joint use is limited. This scoping review aimed to create an overview of what is currently known in the literature about the use and implementation of EC and EL by HCWs in LMICs and to answer the question of whether there is evidence of complementarity. Materials and Methods: Scientific databases were searched and peer-reviewed papers were reviewed systematically according to predefined inclusion/exclusion criteria. Data were extracted including the study focus (EC/EL), year of publication, geographical location, target population, target disease(s) under study, type(s) of study outcomes, and article type. Results: A total of 3051 articles were retrieved and screened for eligibility, of which 96 were kept for analysis. Of these, only 3 addressed both EL and EC; 54 studies addressed EL; and 39 addressed EC. Most studies looked at gain in knowledge/skills usability, efficiency, competence, and satisfaction of HCW, or barriers/challenges to implementation. Descriptive studies focused on the application of EL or EC for targeting specific health conditions. Factors contributing to the success of EC or EL networks were institutional anchoring, multiple partnership, and capacity building of local experts. Conclusions: Our review found an important gap in the literature in relation to the complementary role of EL and EC for HCWs in LMICs evidenced by outcome measures. There is an important role for national and international academic institutions, learned medical societies, and networks to support regional experts in providing EL and EC for added value that will help the clinical performance of HCWs and improve health outcomes
Gender change and stigmatization in late-treated Indonesian children, adolescent, and adult patients with DSD
No full textIn Indonesia clinical management of Disorders of Sex Development (DSD) is challenged by limited knowledge and limited diagnostic and treatment facilities. Prior to this study, most patients remained untreated and grew up with ambiguous bodies and doubts about their gen-der. We investigated patients’ experiences of being raised in ambiguity.
118 Indonesian patients, ages 6 – 41, with 46XX DSD (n=27), 46XY DSD (n=77) and chromosomal DSD (n=14) were compared to 118 control subjects matched for gender, age, and living area. Questionnaires for gen-der identity, gender role behavior and social stigmatiza-tion were translated or designed. The psychometric properties were satisfactory. For patient and control group comparisons, Mann-Whitney U and Fisher’s Exact tests were applied.
The results showed that 7% of the children, 8% of the adolescents and 44% of the adults changed gender, parti-cularly non-diagnosed and non-treated patients with 46XY DSD (81%). 95% of the patients changed gender from female to male, including untreated patients with 46,XX CAH-SV. Compared to control groups, cross-gender role behavior was seen in young girls with 46XX CAH-SV (p=.047) and adolescent girls with different types of DSD (p=.01). In girls with DSD, confusion with gender identity was seen (young girls p=.004; adolescent girls p=.01). Adult men reported past cross-gender role behavior (p=.01) and past problems in gender identification (p=.01) prior to female-to-male gender change.
Children with genital ambiguity (p<.006) and cross gender behavior (p<0.001) and adults with ambiguous
1Diponegoro University, Faculty of Psychology, Semarang, Indonesia Full list of author information is available at the end of the article
bodies (p=.001) and adults who changed gender (p<0.03) suffered stigmatization. Rejection or isolation elicited depression and withdrawal from social activities in girls (p=.002), women (p=.009) and youngsters who had changed gender (p=.02).
We conclude that a high percentage of our patients changed gender. The wish for gender change was parti-cularly seen in patients with progressive masculinization. Patients with DSD who had visible ambiguity in physical and behavioral appearance suffered stigmatization. Teas-ing and rejection led to strong emotional reactions. Early clinical evaluation and treatment, patient and parent edu-cation, and teaching coping strategies will improve qual-ity of life
Global Application of Disorders of Sex Development-Related Electronic Resources: e-Learning, e-Consultation and e-Information Sharing
No full textEmotional and behavioral problems in late-identified Indonesian patients with disorders of sex development
No full textObjective: The aim of this study is to investigate emotional and behavioral problems among Indonesian patients with disorders of sex development (DSD) who recently came under clinical management. As diagnostic proce-dures and treatment had been delayed, patients progressively developed ambiguous bodies, difficult to conceal from outsiders.
Method: We compared 118 Indonesian patients with DSD aged 6–41 years (60 children, 24 adolescents, 34 adults) and 118 healthy control subjects matched for age, gender, and residential settings. We used the Child Be-havioral Checklist (CBCL), Youth Self-Report (YSR), and Adult Self-Report (ASR) to examine differences between patient and control groups as well as differences within patients groups.
Results: On the CBCL, parents of young children with DSD reported significantly more emotional and behavioral problems than parents of matched control. Parents of daughters with CAH reported that their daughters withdrew themselves from social interactions. On the ASR, adults with DSD reported significantly more internalizing problems than controls, particularly anxiety and depression. No other differences in emotional functioning were found across different diagnostic groups.
Conclusions: Indonesian patients with DSD who were untreated for most of their lives suffered more emotional and behavioral problems than matched controls. Differences and similarities between our findings and observations in patients from Western countries will be discussed
Fertility of tall girls treated with high-dose estrogen, a dose-response relationship
No full textContext: High-dose estrogen treatment to reduce final height of tall girls increases their risk for infertility in later life. Objective: The aim was to study the effect of estrogen dose on fertility outcome of these women. Design/Setting: We conducted a retrospective cohort study of university hospital patients. Patients: We studied 125 tall women aged 20-42 yr, of whom 52 women had been treated with 100 μg and 43 with 200 μg of ethinyl estradiol (EE) in adolescence. Main Outcomes: Time to first pregnancy, treatment for infertility, and live birth rate were measured. Results: The time to first pregnancy was increased in treated women. Of untreated women, 80% conceived within 1 yr vs. 69% of women treated with 100 μg EE and 59% of women treated with 200 μg EE. This trend of increased time to pregnancy with increasing estrogen dose was significant (log rank trend test, P = 0.01). Compared with untreated women, fecundability was reduced in women treated with both 100 μg EE [hazard ratio = 0.42; 95% confidence interval (CI), 0.19-0.95] and 200 μg EE (hazard ratio = 0.30; 95% CI, 0.13-0.72). We also observed a significant trend in the incidence of treatment for infertility with increased estrogen dose (P = 0.04). Fecundity was affected in women treated with 200 μg EE who had reduced odds of achieving at least one live birth (odds ratio = 0.13; 95% CI, 0.02-0.81), but not in women treated with 100 μg EE. Conclusions: We report a dose-response relationship between fertility in later life and estrogen dose used for the treatment of tall stature in adolescent girls; a higher estrogen dose is associated with increased infertility. Copyrigh
Gene expression of the insulin-like growth factor system during mouse kidney development
No full textVirilization Due to Androgen Hypersecretion in a Patient with Ovarian Leydig Cell Tumor: Diagnostic and Psychosocial Implications
No full textVirilisasi akibat kelebihan hormon androgen yang terjadi pada wanita akan menimbulkan tanda-tanda seperti pembesaran klitoris, perubahan suara, tumbuhnya rambut di wajah dan tubuh yang menjadi ciri khas laki-laki. Virilisasi yang disebabkan oleh tumor ovarium tidak lebih dari 0,5% dari seluruh penyebab. Kami melaporkan kasus virilisasi akibat tumor sel Leydig pada ovarium kiri wanita usia 36 tahun. Kesalahan interpretasi, informasi medis yang saling bertentangan dan saran dari dokter sebelumnya membuat kebingungan dari pasien tersebut. Kami melakukan evaluasi diagnostik yang meliputi gambaran klinik, hormon, pencitraan, pemeriksaan patologi, molekuler serta pemeriksaan psikologi.
Pemeriksaan hormon menunjukkan kadar testosteron yang sangat tinggi. Adanya tumor pada ovarium terdeteksi dari pemeriksaan laparoskopi. Biopsi pada ovarium kiri dilakukan oleh karena pasien menolak dilakukan pengangkatan ovarium. Hasil pemeriksaan patologi menunjukkan tumor sel Leydig tanpa adanya tanda keganasan. Pengelolaan menjadi kurang optimal karena faktor sosial budaya yang menghambat walaupun telah dilakukan konseling secara mendalam. Tumor sel Leydig pada ovarium dicurigai apabila terjadi virilisasi pada wanita usia reproduktif disertai peningkatan hormon androgen, massa ovarium pada pemeriksaan pencitraan dan dibuktikan dengan hasil biopsi. Hal ini penting sebelum memberikan saran maupun pengobatan kepada pasien.
Kata kunci: diagnostik work up, virilisasi, sel tumor Leydig.
ABSTRACT
Virilization due to hyperandrogenism in women causes male signs and symptoms such as swelling of the clitoris, deepening of the voice, facial hair and increase in body hair. Virilization is caused by less than 0.5% of all ovarian tumors. Here we report a case of virilizing Leydig cell tumor of the left ovary in a 36 year old woman. Misinterpretation of symptoms, conflicting medical information and advice from previous doctors had confused the patient. We performed a diagnostic evaluation including clinical, hormonal parameters, imaging, anatomical pathology examinations, and psychological assessment.
Blood analysis showed a high testosterone level. The presence of an ovarian tumor was confirmed by laparoscopy. Since the patient refused ovariectomy, a biopsy of the left ovary was performed. Pathology showed a Leydig cell tumor without histological signs of malignancy. In spite of extensive explanation and psychological counseling, cultural barriers prevented appropriate treatment. An ovarian Leydig cell tumor should always be considered for a woman in the reproductive age with symptoms of virilization. The diagnosis is suspected on the basis of an ovarian mass on examination and further investigation and should be proven by biopsy.
Key words: diagnostic work up, virilization, Leydig cell tumor
