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Francesca Raffi, MBChB, MRCOG; Saad Amer, MBChB, MSc, MRCOG, MD, 01 Jun 2012

Endometriosis is a common gynaecological condition affecting about 6–10% of women of reproductive age and can be a debilitating disease. It is the second most common reason for surgery in premenopausal patients. It is defined as the presence of endometrial-like tissue outside the uterine cavity, leading to a chronic inflammatory reaction. The exact aetiology is unknown, but the retrograde menstruation model is the most widely accepted theory explaining the development of pelvic endometriosis. According to this model, menstrual blood containing endometrial fragments passes through the fallopian tubes into the pelvic cavity, resulting in the formation of peritoneal endometrial deposits. There are three distinctive pathological types of pelvic endometriosis: superficial peritoneal implants, ovarian endometriomas, and deep infiltrating nodular lesions. The extent of the disease is very variable and often does not correlate with the severity of symptoms. Although it can sometimes be asymptomatic (in about 20% of cases), endometriosis is frequently associated with severe pain and infertility. Several management options exist for endometriosis and the choice depends on several factors such as age, fertility, severity of the symptoms, and extent of the disease. This review presents three different cases of endometriosis with different complexities and presentations. The diagnosis and various medical and surgical treatment options available to the clinician will be discussed.

 

Combined variables potentially outperform OSTA in predicting spinal osteoporosis in Asian women

Roshini Claire Anthony
09 Nov 2016

The combination of age, weight, menopausal status, chronic joint pain, and right handgrip strength is a good tool to predict spinal osteoporosis in midlife Asian women, and may be an improvement over the Osteoporosis Self-assessment Tool for Asians (OSTA), according to a study presented at the 6th Asia-Pacific Osteoporosis Meeting (IOF Regionals 2016) held recently in Singapore.

Multivariate analysis demonstrated that age (p<0.05), menopausal status (p<0.05), chronic joint pain (p<0.01), weight (p<0.001), and right handgrip strength (p<0.01) were independently associated with spinal osteoporosis (T score ≤-2.5 standard deviation [SD]). [IOF Regionals 2016, abstract OC16]

Combining these variables demonstrated an area under the curve (AUC) value of 84 percent, while OSTA had an AUC of 79 percent.

“At the moment there is no optimal screening tool that is available to identify osteoporosis,” said Dr Susan Logan from the Department of Obstetrics and Gynaecology at the National University Hospital in Singapore, who presented the findings. “Combining these variables may outperform OSTA in predicting spinal osteoporosis in midlife Singaporean women.”

The aim of the study was to identify variables that were significantly associated with spinal low bone mineral density and to use them to create a tool that would help screen for osteoporosis in midlife women. The efficacy of this tool was then compared with OSTA, considered the gold standard in screening for osteoporosis in Asian women.

Study participants were 512 women aged 45–69 years who attended gynaecology clinics for well-woman checks and noncancer-related gynaecological symptoms between 2014 and 2015. Most women (80 percent) were married and parous (96 percent), and spinal osteoporosis was detected in 6.8 percent (n=35) of the participants. The multifaceted assessment included testing for fasting blood glucose levels, physical assessment, questionnaires, and a full-body dual energy X-ray absorptiometry (DXA) scan.

More than 280 variables were collected including sociodemographic features, physical assessments (eg, Short Physical Performance Battery, blood pressure, height, weight, body mass index, waist and hip circumference), and questionnaires that validated symptoms and medical history (eg, Menopause Rating Scale, Generalized Anxiety Disorder, Global Physical Activity Questionnaire).

The high number of variables collected and the use of validated questionnaires were among the study strengths, while the small sample size and self-reporting of variables presented limitations.

According to Logan, bone loss in the spine appears to precede that of the hip in women and may be a better location for identifying younger women at risk of osteoporosis. 

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Most Read Articles
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In pregnant women, adherence to recommended dietary intake of fat and fibre is associated with a more beneficial and richer gut microbiota which, in turn, decreases levels of the inflammation marker glycoprotein acetylation (GlycA), a study has shown.
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