Objectives. Increased incidence of cardiovascular disease (CVD) has been observed in AS. The reasons of this increase are not fully understood (greater prevalence of traditional cardiovascular risks, ...consequences of treatment (NSAID) or biological inflammation). The objectives of this study are to assess intima–media thickness (IMT) and arterial stiffness (i.e augmentation index AIx), markers of sub-clinical atherosclerosis in AS patients and to examine the effects of TNF-α inhibitors on arterial stiffness in active AS patients. Methods. Sixty AS patients were enrolled with 60 healthy controls. Their BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and BASFI (Bath Ankylosing Spondylitis Functional Index) scores, ESR and CRP levels were recorded. Subclinical atherosclerosis was assessed by measurement of AIx by pulse wave analysis and IMT by carotid echography. Results. We found significantly increased IMT in the AS group compared with healthy controls. After adjustment for confounding factors, an underlying trend towards increased IMT was still present (P = 0.06). No difference was found in arterial stiffness between the two groups. AS patients, treated or not with anti-TNF-α at baseline, had significantly increased IMT and AIx or a trend towards increase. IMT was positively correlated with tobacco use, WHR and blood pressure but not correlated with CRP level. Despite improvement in markers of disease activity, arterial stiffness was unchanged after 14 weeks of treatment with TNF antagonists. Conclusion. This study shows a trend towards increased subclinical atherosclerosis in AS patients. TNF-α blockade does not seem to improve arterial stiffness in AS patients, but our results lack statistical power.
Transgender people represent a broad spectrum of individuals that transiently or persistently identify with a gender different from the one assigned at birth (APA, 2013). Transgender healthcare ...issues have become an increased matter of interest over the last years, as shown by the growth of publications on the subject and by the increase of referrals reported worldwide in all age groups. However, transgender people report encountering numerous obstacles in accessing and receiving appropriate health care with professionals being described as not properly trained on specific gender issues. Considering the diversity and complexity of the gender spectrum in the different age groups and in light of the recent changes in the formal psychiatric classification, mental health providers play a critical role in meeting the needs of gender non-conforming children, adolescents and adults, according to individualized paths. This course has the following aims: (1) learn the principles of assessment of gender incongruence in childhood, adolescence and adulthood; (2) address co-occurring psychopathology (if present); (3) identify different treatment paths according to age and individualized psychological and/or medical needs; (4) work in a multidisciplinary team in line with an integrated model.
Disclosure
No significant relationships.
Objective
To clarify sex differences in early axial spondyloarthritis (SpA).
Methods
In total, 475 patients included in the Devenir des Spondylarthropathies Indifférenciées Récentes (Outcome of ...Recent Undifferentiated Spondylarthropathies) cohort, a prospective multicenter French cohort of patients with early inflammatory back pain suggestive of SpA, and fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial SpA were studied. The clinical and imaging features were compared between sexes and according to the clinical or imaging arm of the ASAS criteria using univariate and multivariate analysis.
Results
Comparisons between the 239 men and 236 women showed that women had higher disease activity when measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Patient Global Score and higher fatigue and functional scores despite having less radiographic sacroiliitis and magnetic resonance imaging (MRI) inflammation of sacroiliac joints and the spine than men. Disease activity measured by the C‐reactive protein (CRP)–based Ankylosing Spondylitis Disease Activity Score was not different between men and women. In contrast to patients classified with the clinical arm, disease activity and functional scores did not differ between women and men with sacroiliitis on imaging scans, except for fatigue and the Ankylosing Spondylitis Quality of Life questionnaire. Women with sacroiliitis had more peripheral involvement and more family history, whereas HLA–B27 positivity, elevated CRP, and MRI inflammation of the spine were associated with male sex.
Conclusion
Women with early axial SpA according to the ASAS criteria had greater disease activity when measured by the BASDAI and worse functioning despite fewer radiologic abnormalities than men. The differences in disease expression may be confounding factors to establish the diagnosis of SpA and to assess disease activity in women, suggesting that the imaging arm is a pivotal measure in the ASAS criteria.
Introduction
Disorders of Sex Development (DSD) are a wide range of congenital conditions characterized by an incongruence of components involved in sexual differentiation, including gender ...psychosexual development. The management of such disorders is complex, and one of the most crucial decision is represented by gender assignment. In fact, the primary goal in DSD is to have a gender assignment consistent with the underlying gender identity in order to prevent the distress related to a forthcoming Gender Dysphoria. Historically, gender assignment was based essentially on surgical outcomes, assuming the neutrality of gender identity at birth. This policy has been challenged in the past decade refocusing on the importance of prenatal and postnatal hormonal and genetic influences on psychosexual development.
Aims
(1) to update the main psychological and medical issues that surround DSD, in particular regarding gender identity and gender assignment; (2) to report specific clinical recommendations according to the different diagnosis.
Methods
A systematic search of published evidence was performed using Medline (from 1972 to March 2016). Review of the relevant literature and recommendations was based on authors’ expertise.
Results
A review of gender identity and assignment in DSD is provided as well as clinical recommendations for the management of individuals with DSD.
Conclusions
Given the complexity of this management, DSD individuals and their families need to be supported by a specialized multidisciplinary team, which has been universally recognized as the best practice for intersexual conditions. In case of juvenile GD in DSD, the prescription of gonadotropin-releasing hormone analogues, following the World Professional Association for Transgender Health and the Endocrine Society guidelines, should be considered. It should always be taken into account that every DSD person is unique and has to be treated with individualized care. In this perspective, international registries are crucial to improve the understanding of these challenging conditions and clinical practice, in providing a better prediction of gender identity.
Purpose
To date, few studies have addressed attitudes toward transgender individuals. In addition, little is known about health care providers’ (HCP) attitudes toward sexual minorities. The aim of ...the present study is to compare attitudes toward homosexual and transgender individuals between gender dysphoric individuals (GDs), general population controls (C) and HCP.
Methods
A total of 310 subjects were considered, including 122 GDs (63 transwomen and 59 transmen), 53 heterosexual HCP (26 males and 27 females) and 135 C. Participants completed the Modern Homophobia Scale (MHS) and the Attitudes Toward Transgendered Individuals Scale (ATTI) in order to assess attitudes toward gay men and lesbian women and toward transgender individuals, respectively. In addition, GDs completed the Gender Identity/Gender Dysphoria Questionnaire (GIDYQ-AA) and ATTI to measure, respectively, gender dysphoria levels and internalized transphobia. Religious attitudes were evaluated by means of the Religious Fundamentalism Scale (RFS), and Discrimination and Stigma Scale (DISC-12) was used to measure perceived discrimination.
Results
(1) Men showed significantly higher levels of homophobia and transphobia when compared to women (
p
< 0.001); (2) perceived discrimination was higher in lesbian women compared to gay men and in transwomen compared to transmen (
p
< 0.001 and
p
< 0.05, respectively); and (3) religious fundamentalism was associated with both homophobia and transphobia (both
p
< 0.001).
Conclusions
Our results underline the need to promote awareness and acceptance of the sexual minorities, who are more at risk of discriminatory attitudes, which are strongly dependent on religious precepts and dogma.
Les fractures transversales du rachis sont rares. Elles surviennent sur un rachis ankylosé et exposent à des complications neurologiques. Nous rapportons une série de 18 fractures survenues chez ...17 patients présentant une spondylarthrite ankylosante (SPA). L’objectif de ce travail était de décrire les aspects cliniques, diagnostiques et thérapeutiques de notre série et les comparer à la littérature.
Étude rétrospective de 1975 à 2008 dans les services de neurochirurgie et de rhumatologie du CHU de Clermont-Ferrand.
Dix-sept patients ont eu 18 fractures (une patiente a présenté deux fractures lombaires). Il s’agissait de 13 hommes et quatre femmes d’âge moyen 57,4
±
17,2 ans. La SPA évoluait en moyenne depuis 21,3
±
12 ans (5–40). Tous avaient un rachis ankylosé avec un aspect de colonne bambou. Les motifs d’hospitalisation étaient une évolutivité de la SPA (
n
=
10), une suspicion de fracture après un traumatisme (
n
=
8). Un traumatisme, le plus souvent mineur, était retrouvé chez 15 patients. Quatorze patients avaient des douleurs rachidiennes d’horaire mécanique et trois patients des douleurs d’horaire mixte. Des crises hyperalgiques à la mobilisation étaient présentes chez trois patients. Deux patients avaient un syndrome pyramidal. Le délai diagnostique moyen de la fracture était de 6,8
±
8,4 semaines (0–22). La fracture était cervicale (
n
=
2), thoracique (
n
=
8) et lombaire (
n
=
8). Elle était transdiscale neuf fois et transcorporéale neuf fois. Les radiographies standard (
n
=
18) ont montré le trait de fracture neuf fois. Le scanner (
n
=
13) a toujours visualisé le trait de fracture. L’IRM (
n
=
6) a montré cinq fois le trait de fracture et une fois un hématome épidural. Onze patients ont eu un traitement orthopédique et six un traitement chirurgical. L’évolution a été favorable chez 16 patients. Une patiente paraplégique est décédée d’une embolie pulmonaire.
Les fractures transversales du rachis sont rares et doivent être évoquées devant des douleurs mécaniques du rachis après un traumatisme mineur chez un patient ayant un rachis ankylosé par une SPA. La normalité du bilan radiologique doit amener à poursuivre les explorations par la réalisation d’une IRM ou d’un scanner.
Transverse fractures of the spine are rare. They occur in ankylosed spine and may lead to neurological complications. We report a series of 18 cases observed in 17 patients with ankylosing spondylitis (AS). The objective of this study were to describe the clinical, diagnostic and therapeutic features of our series and to compare our results with those of the literature.
We conducted a retrospective study from 1975 to 2008 in the neurosurgery and rheumatology departments of the university hospital (CHU) of Clermont-Ferrand.
Eighteen transverse spine fractures were documented in 17 patients (one female patient had two fractures of the lumbar vertebrae). The 13 male and four female patients included in this series had a mean age of 57.4
±
17.2 years and AS for a mean time of 21.3
±
12 years (5–40). All patients had spinal ankylosis with a “bamboo” spine appearance. The reasons for hospital admission were suspicion of AS flare (
n
=
10) and suspected traumatic fracture (
n
=
8). Trauma, in most cases minor, was noted in 15 patients. Fourteen patients presented with mechanical spinal pain and three had both mechanical and inflammatory pain. Three patients experienced severe pain on mobilization. Two patients had pyramidal syndrome. The mean time to diagnosis of the fracture was 6.8
±
8.4 weeks (0–22). The fracture was located in cervical spine (
n
=
2), dorsal spine (
n
=
8) and lumbar spine (
n
=
8). It was transdiscal and transcorporeal in nine cases each. Standard radiographs (
n
=
18) identified the fracture in nine cases. The fracture was demonstrated in all CT-scan (
n
=
13). Magnetic resonance imaging (MRI) (
n
=
6) showed the fracture in five cases and epidural hematoma in one. Eleven patients had orthopedic treatment and six underwent surgery. Outcome was favorable in 16 patients. One paraplegic patient died of pulmonary embolism.
Transverse fractures of the spine are rare and diagnosis should be considered in a patient with AS and ankylosed spine who presented mechanical spine pain following even minor trauma. If standard radiographs are normal, further investigations should be performed using MRI, CT-scan, or both.
Objective: To assess changes in the distribution and resistance of the pathogens responsible for septic arthritis over a 20 year period in patients admitted to the same hospital unit. Patients and ...methods: Retrospective study of the hospital records of patients admitted between 1979 and 1998 for septic arthritis with positive microbiological diagnosis after blood or joint cultures, or both. Results: 303 cases of septic arthritis were studied, 141 in the period 1979–88 and 162 in the period 1989–98. The incidence between the first and second period did not vary significantly for the staphylococci (67% v 63%), streptococci (16% v 20%), and Gram negative bacilli (7% v 10%). Tuberculous infections decreased from 9% to 4% (p<0.04). No gonococci were isolated in the second 10 year period. Among the staphylococcal species, there was an increase in the number of coagulase negative staphylococci (10 cases v 21, p<0.05) between the two periods. There was no significant difference in the frequency of occurrence of methicillin resistant pathogens (12.6% v 16.6%). The number of streptococcal B infections increased (2 v 10 cases), and β-lactamine resistant pneumococci emerged. In the second 10 year period, patients were older and were more likely to have co-existing disease, particularly tumoral growth, and less commonly were receiving dialysis. Localisation of joint infection was comparable except for an increase in prosthetic knee infections. Conclusion: The distribution and sensitivity of pathogens causing septic arthritis changed little over a 20 year period.
Purpose
Gender Incongruence (GI) is a marked and persistent incongruence between an individual's experienced and the assigned gender at birth. In the recent years, there has been a considerable ...evolution and change in attitude as regards to gender nonconforming people.
Methods
According to the Italian Society of Gender, Identity and Health (SIGIS), the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE) rules, a team of experts on the topic has been nominated by a SIGIS–SIAMS–SIE Guideline Board on the basis of their recognized clinical and research expertise in the field, and coordinated by a senior author, has prepared this Position statement. Later on, the present manuscript has been submitted to the Journal of Endocrinological Investigation for the normal process of international peer reviewing after a first internal revision process made by the SIGIS–SIAMS–SIE Guideline Board.
Results
In the present document by the SIGIS–SIAMS–SIE group, we propose experts opinions concerning the psychological functioning, gender affirming hormonal treatment, safety concerns, emerging issues in transgender healthcare (sexual health, fertility issues, elderly trans people), and an Italian law overview aimed to improve gender non-conforming people care.
Conclusion
In this Position statement, we propose experts opinions concerning the psychological functioning of transgender people, the gender-affirming hormonal treatment (full/partial masculinization in assigned female at birth trans people, full/partial feminization and de-masculinization in assigned male at birth trans people), the emerging issues in transgender health care aimed to improve patient care. We have also included an overview of Italian law about gender affirming surgery and registry rectification.
Background
Despite the increasing interest in transgender health research, to date little is known about the size of the transgender and gender diverse (TGD) population.
Methods
A web-based ...questionnaire survey was developed, including a collection of socio-demographic characteristics and disseminated online through social media. Gender incongruence was evaluated by using a 2-item approach assessing gender recorded at birth and gender identity. The primary objective of the present population-based study was to estimate the proportion of TGD people across ages among a large sample of people who answered a web-based survey. The secondary endpoints were to identify gender-affirming needs and possible barriers to healthcare access.
Results
A total of 19,572 individuals participated in the survey, of whom 7.7% reported a gender identity different from the sex recorded at birth. A significantly higher proportion of TGD people was observed in the youngest group of participants compared with older ones. Among TGD people who participated in the study, 58.4% were nonbinary, and 49.1% experienced discrimination in accessing health care services. Nonbinary TGD participants reported both the need for legal name and gender change, along with hormonal and surgical interventions less frequently compared to binary persons.
Conclusions
Being TGD is not a marginal condition In Italy. A large proportion of TGD persons may not need medical and surgical treatments. TGD people often experience barriers to healthcare access relating to gender identity.
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