Polycystic ovarian syndrome and its associated endocrine abnormalities comprise one of the most common metabolic spectrum disorders within the human race. Because of the variance in phenotypic expression among individuals and within family lineages, attention has been turned to genetic and epigenetic changes in which the root cause of the disorder may lie. Further understanding of DNA/histone methylation and microRNA patterns may help to improve the accuracy of diagnosis and lead to future treatment options.
SARS CoV-2, otherwise known as Corona virus 2019 (COVID-19) has left >300,000 dead without a definitive cure in sight. Significant research has been conducted regarding the use of currently available pharmacotherapies and multiple clinical trials are underway to bring new treatments to market. While supportive treatment remains the standard of care, additional therapeutic regimens including antivirals, monoclonal antibodies, antibiotics, anti-inflammatories, immunoenhancers, vitamins, systemic steroids, inhalants, anticoagulants, and convalescent plasma are showing promise.
Current war-fighting environments have shifted dramatically over the past decade, and with this change, new types of injuries are afflicting American soldiers. Operative Enduring Freedom and Operation Iraqi Freedom have noted an increased use of sophisticated improvised explosive devices by adversaries. Injuries not frequently seen in previous conflict are dismounted complex blast injuries, which involve multiple proximal amputations, pelvic fractures, and extensive perineal wounds. Thus, an unforeseen consequence of the decreased mortality rate after these complex blast injuries is a new wave of U.S. service members facing the challenges of recovering from the catastrophic amputations and genitourinary injuries. New applications of sperm retrieval methods may be used in these specific populations, as they recover and wish to purse family-building goals. Spinal cord injuries, traumatic brain injuries, and considerations unique to the female soldier are explored in this review of urologic care in wounded veterans.
In the personal statements of medical students applying for obstetrics and gynecology residencies, many comment that the combination of both medical and surgical care is a primary driver of their choice of specialty. The increasing emphasis on putting the "M" back in maternal-fetal medicine is another example of commitment by obstetrician-gynecologists to provide the full scope of care for women. To do so, we must be prepared to care for the complications faced by women who are currently obese or who have undergone bariatric surgery before pregnancy. Data from the National Health Interview Survey show that 30.4% of U.S. adults are obese, exceeding 30% for the first time. 1 With rates of obesity this high, we will no doubt see increasing numbers of women with prior bariatric surgery. In this month's issue, in a case series and systematic review of 52 women, Vannevel et al explore a relatively common and possibly lethal complication of Roux-en-Y surgery-internal herniation.The nonspecific symptoms and signs of pregnant women with internal herniation were commonly associated with delay in diagnosis in the patients in this review, about 4% of whom died. Vannevel reminds us how important it is to think of a broad differential diagnosis to include bariatric surgery complications when an afebrile woman in her third trimester who has had prior bariatric surgery presents with vague pain, nausea, vomiting, and a normal white count. It is reasonable to consider consulting our surgical colleagues in such cases; they can help us to consider the whole picture and avoid maternal mortality and morbidity.Sometimes it is what we don't know that is critical to providing excellent care. This article helps to close this gap going forward so we can continue to provide informed surgical and medical care for pregnant women.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.