Considerations in Adolescent Use of the Etonogestrel Subdermal Implant: A Cohort Study

Objectives: To describe bleeding patterns and other side effects in adolescent implant users and characterize their impact on early discontinuation of the implant.Study Design: This is a retrospective cohort study of female patients under 18 years who had an implant placed from 2013 to 2018. Data were collected on demographics, medical history, and side effects.Results: Of 212 adolescents, the average age at insertion was 16 years and 84% desired placement for contraception. Common side effects included AUB (80%), mood changes (10%), and perceived weight gain (9%). Most (76%) used the implant for at least 12 months. Average time to removal was 22.1 months (SD 13.0 months) and this did not depend on presence of side effects. Twenty-seven percent of teens were able to achieve amenorrhea. Adolescents with frequent or prolonged bleeding were more likely to have implant removal prior to 12 months than those with other bleeding patterns (p = 0.003). Early removal was also more common in girls reporting weight or mood issues than those who did not (p < 0.001 and p = 0.045, respectively). BMI increased in 64% of adolescents. Average percentage change in BMI was 3.2% (0.87 kg/m2). There was no difference in baseline use of any mood-modulating medications in patients who did and did not complain of mood side effects following implant placement (p = 0.801).Conclusion: Characterization of bleeding patterns following implant placement in adolescents have not previously been reported. Prolonged or heavy bleeding, mood issues, and perceived weight gain were associated with earlier removal of the implant. A relatively small number had early removal of the implant due to weight or mood complaints. Therefore, a history of obesity, depression, or other mood disorders should not be a deterrent to implant placement.

Metabolic Associated Fatty Liver Disease in Children—From Atomistic to Holistic

Non-alcoholic fatty liver disease has become the most common chronic liver disease in children due to the alarmingly increasing incidence of pediatric obesity. It is well-documented that MAFLD prevalence is directly related to an incremental increase in BMI. The multiple hits theory was designed for providing insights regarding the pathogenesis of steatohepatitis and fibrosis in MAFLD. Recent evidence suggested that the microbiome is a crucial contributor in the pathogenesis of MAFLD. Aside from obesity, the most common risk factors for pediatric MAFLD include male gender, low-birth weight, family history of obesity, MAFLD, insulin resistance, type 2 diabetes mellitus, obstructive sleep apnea, and polycystic ovarium syndrome. Usually, pediatric patients with MAFLD have nonspecific symptoms consisting of fatigue, malaise, or diffuse abdominal pain. A wide spectrum of biomarkers was proposed for the diagnosis of MAFLD and NASH, as well as for quantifying the degree of fibrosis, but liver biopsy remains the key diagnostic and staging tool. Nevertheless, elastography-based methods present promising results in this age group as potential non-invasive replacers for liver biopsy. Despite the lack of current guidelines regarding MAFLD treatment in children, lifestyle intervention was proven to be crucial in the management of these patients.

How do overweight people dropout of a weight loss diet? A qualitative study

Background The growing trend of overweight and obesity in many developed and developing countries in recent years has made obesity one of the most significant health problems in the world. The treatment of overweight and obese people is challenging, as patients have difficulty adhering to a weight-loss diet. Thus, the present study aimed to identify the reasons for the dropout of weight-loss diets. Methods This qualitative study using content analysis was conducted in a comprehensive health center in Shiraz, southern Iran, between April and October 2020. The study was performed on 27 participants with a history of obesity and diet dropout selected via purposive and theoretical sampling. The data were gathered through semi-structured interviews and were thematically analyzed. Results The participants included 25 females (92.6%) and two males (7.4%) with a mean age of 33.4 ± 8.4 years. Data analysis resulted in the emergence of three themes and 14 sub-themes. The first theme was personal reasons for diet dropout, which included six sub-themes; i.e., misunderstanding of diet, not having enough motivation, stress and hormonal disorder, having the feel of “being harmful to health”, lack of mental and psychological preparation, and personal taste. The second theme was familial and social reasons for diet dropout, including two sub-themes, i.e., social and familial problems. Finally, the third theme was the reasons related to diet characteristics, including six sub-themes: ineffectiveness of diet, expensiveness of diet food and dietary supplements, family problems, unavailability of food, unscientific and unconventional diets feeling bad about the diet, and unpalatable diet food. All the concepts were related to each other and resulted in a pattern revealing the experiences of overweight people and who had dropped out of weight-loss diets. Conclusion The reasons for diet dropout were divided into three levels: personal reasons, familial and social reasons, and diet characteristics. Overall, clinicians should pay attention to the complexity of diets to increase the success rate of weight management. Based on the current study findings, a guideline is recommended to guide patients who dropout of weight-loss diets.

GAMBARAN KEJADIAN DISMENORE PADA REMAJA PUTRI DI FAKULTAS ILMU KESEHATAN UNIVERSITAS PASIR PENGARAIAN

Dysmenorrhea is a painful condition that occurs during menstruation that can interfere with activities, causing pain in the lower abdomen, which spreads to the lower back and legs. The incidence of dysmenorrhea is experienced by young women around the world on average. The cause of pain is due to an imbalance of the hormone progesterone in the blood. Several factors triggering the occurrence of dysmenorrhea include the first menstruation at an early age, endocrine factors, psychological disorders, allergic, long menstrual periods, heavy menstrual blood flow, smoking, a history of obesity and alcohol consumption. Efforts to overcome dysmenorrhea can be done by non-pharmacological and pharmacological methods. This study aims to describe the incidence of dysmenorrhea in adolescent girls. This study used a descriptive survey method with a questionnaire that was distributed via google form to 73 students of the Faculty of Health Sciences, Pasir Pengaraian University. The results showed that the average menarche at the age of 13-16 years was 39 people (53.43%), the most experienced dysmenorrhea was 52 people (71.23%), the efforts made to reduce dysmenorrhea with rest were 35 people. (47.95 %) and 38 people (52.05%) who tried to reduce the feeling of dysmenorrhea, respondents used drugs to reduce dysmenorrhea, namely 26 respondents (35.62%). The conclusion of this study is that the average age of menarche for adolescent girl is 13-16 years, the majority experience dysmenorrhea, most of the adolescent girl make efforts to reduce dysmenorrhea pain with non-pharmacological and pharmacological methods.

Hubungan Obesitas dengan Usia, Jenis Kelamin, Genetik, Asupan Makanan dan Kebiasaan di Dusun Bangkan

Background: Obesity is a condition of excess fat accumulation in the body's adipose tissue which can be influenced by physical activity, food intake, genetic factors, sleep habits, age and gender. The incidence rate in Indonesia tends to increase as seen from the Riskesdas 2007, 2013 and 2018 data, namely 10.5%, 14.8%, and 21.8%. Objective: To determine the relationship between obesity and age, gender, level of physical activity, eating habits, genetics and sleep duration. Methods: This research is a quantitative study with a cross sectional approach. Data collection was carried out through a questionnaire. The research sample is a sample with overweight and obesity obtained a sample of 80 samples. The data analysis was conducted, namely univariate and bivariate analysis using the chi-square test. Results: 36.3% of respondents are overweight and 63.8% obese. Most of the respondents were> 18 years old. The results showed that obesity was significantly associated with age (p = 0.016), gender (p = 0.010), physical activity (p = 0.025), frequency of eating (p = 0.015), frequency of heavy eating (p = 0.040), drinking- sugary drinks (0.025), fast food (p = 0.025) daily portions of food (p = 0.025) and a family history of obesity (p = 0.007). Conversely, consumption of snacks (p = 0.731), consumption of fibrous foods (p = 0.089), the relationship between breakfast (p = 0.776), the relationship between sleep time (p = 0.243). Conclusion: Age, gender, physical activity, frequency of eating, frequency of heavy eating, drinking sugary drinks, consumption of fast food, daily food portions and a family history of obesity have a significant relationship which can be a contributing factor to obesity

Massive Myocardial Calcification—A Heart Of Stone!

A 71-year-old female was admitted in the emergency room after effort-related syncope. She had past medical history of obesity and hypertension treated with lercanidipine. No relevant family history. Physical examination revealed systolic murmur (grade 2/6). ECG showed sinus rhythm and left bundle brunch block (Supplementary figure). Lab results were unremarkable including troponin I. Transthoracic echocardiography (TTE) revealed moderate left ventricular (LV) hypertrophy [septal thickness 14 mm (normal: 6–9mm)], extensive mitral annulus calcification (MAC) with exuberant myocardial calcification at the level of posterior leaflet that invaded adjacent LV walls, systolic anterior motion of the anterior mitral leaflet causing LV outflow tract (LVOT) obstruction (maximum gradient 34 mmHg) and moderate mitral regurgitation (MR) (Panel A). Exercise echocardiogram provoked LVOT gradient >100mmHg and severe MR. Continuous ECG monitoring during 13 days demonstrated no arrhythmic events. Cardiac CT showed multiple calcifications extending from mitral annulus to LV anterior and lateral walls and cardiac MRI was compatible with caseous MAC (Panels B-F). Coronary angiography showed 50% stenosis of mid left anterior descending artery. Normal thoracic CT and ACE, and negative IGRA excluded sarcoidosis and tuberculosis. Comprehensive study, including calcium metabolism and autoantibodies, excluded metabolic and inflammatory aetiologies of myocardial calcification, which was assumed as dystrophic in the context of MAC. No syncope occurred after bisoprolol 2.5 mg, oral rehydration and discontinuation of lercanidipine. However, rest and exercise TTE failed to show improvement of LVOT gradient or MR and patient remained on NYHA class II-III, despite maximal tolerated dose of bisoprolol (5 mg), being therefore referred to cardiac surgery.

The Cyberball task in people after obesity surgery: preliminary evaluation of cognitive effects of social inclusion and exclusion with a laboratory task

Background Social cognition and temperamental and interpretative styles could play a role in the outcome of bariatric surgery. This study aims to assess preliminary evidence about how obesity surgery patients evaluate social inclusion and exclusion through a ball-tossing game called Cyberball, looking at the influence of early maladaptive schemas. Methods Thirty-four patients with a history of obesity surgery interventions and 44 controls were recruited for this study. A psychological evaluation was performed before and after the Cyberball task with self-report questionnaires. Results In the ostracism condition, significant differences were seen across all the patients’ fundamental psychological needs with less perceived ostracization (p = 0.001) even if they recognized less interaction via fewer ball tosses than controls. Moreover, the ostracism paradigm resulted in patients experiencing a higher urge to binge (p = 0.010) and a higher urge to restrain (p = 0.012) than controls. Looking at differences due to the Cyberball paradigm applied, clear differences emerged only between controls subgroups at the specific self-report scales applied, corroborating the reduced perception of the exclusion. As evidenced by the schema domains, the study found a connection between the impaired limits-schema domain and the drive to binge. Conclusion The results show that obesity surgery patients reported different effects of the Cyberball task than controls. Different possible interpretations are discussed, and future directions for studies are exposed, both for the evaluation of social interactions effects and in the assessment of the role of specific cognitive schemas. Level of evidence Level III: evidence obtained from well-designed cohort or case–control analytic studies.

Cryptogenic Cirrhosis may be Nonobese Nonalcoholic Steatohepatitis—Risk Factors of Liver Steatosis After Liver Transplantation for Cryptogenic Cirrhosis: A Retrospective Study

Background As the diagnosis of non-alcoholic steatohepatitis (NASH) has become more accurate, the number of patients with cryptogenic cirrhosis (CC) has decreased. Despite this, there are patients in the liver transplant registry who are currently listed as having CC. Therefore, knowledge of the natural course of CC after liver transplantation (LT) is important. However, the natural course of CC after LT is unknown. We aimed to clarify the natural course post LT for CC and to infer the etiology of CC. Methods Eighteen patients who underwent LT for CC were included. To rule out the possibility of including NASH patients with CC patients, those with obesity (body mass index [BMI] ≥ 25 kg/m2) and type-2 diabetes mellitus or liver steatosis found on pretransplantation images, were excluded. Liver biopsy was performed 1 year after LT, and annually thereafter. Results Liver steatosis and steatohepatitis were identified in 61% and 39% of the patients after LT, respectively with a median time to onset of 12 and 27 months, respectively. No other pathological findings could identify the etiology of CC. The BMIs after LT were significantly higher in the steatosis group than in the non-steatosis group (28.5 vs. 22.4 kg/m2; P = 0.002). The mean muscle attenuation (MA) at the time of LT was significantly higher and the postoperative hospitalization period was shorter in the steatosis group than in the non-steatosis group (MA: 33.3 vs. 25.8 Hounsfield unit, P = 0.03; hospitalization: 50 vs. 102 days, P = 0.02). Recipients were significantly younger in the steatohepatitis subgroup than in the simple steatosis subgroup (55.0 vs. 63.5 years, P = 0.04). Conclusions Despite excluding patients with a history of obesity from our cohort of patients with CC, we observed that patients with CC had a high prevalence of steatosis after LT. Young patients with a favorable postoperative course were noted to have a high risk of NASH after LT for CC. Patients with CC may represent cases of non-obese NASH.

736 Current Management Strategies, Perceptions, and Attitudes of the Paediatricians on Childhood Obesity: An Experience from the Middle East

Background Childhood obesity is a public health concern that in expanding globally. Of those aged between 5-19 years in Oman, 32% were found to be overweight in 2016. Method An electronic survey was distributed to in-training and post residency paediatricians in Oman. Results A total of 69 responses met the inclusion criteria and were analysed. 50% of participants were less than 30 years-old (53.6% female). 70% were in training residency (R1, R2 24.6%, R3, R4 36.2%,) and 30% were post residency. 72% had their training in Oman. About half of participants measure child’s weight and Height, however, only 24.4% document BMI and compare with previous records. 75% regularly obtain family history of obesity and related conditions along with dietary intake. More than half of participants were not confident on discussing weight and related complication with the child, but 62.3 % were confident in discussing it with the parents. 50% were confident in initiating treatment for childhood obesity and providing dietary advice. Attitudes towards exposure to childhood obesity and management varied and overall excellent exposure accounted for less than one third of responses (Medical school 21.7%, Residency 26.1%, 27.5%). In general, only 20.6% believe they are confident in managing childhood obesity and only 29% attended seminar or training on childhood obesity. 93% believe there is a need for a more focused training on childhood obesity prevention and management. Conclusions Great efforts need to be targeted towards strengthening Paediatricians’ confidence in childhood obesity prevention and management via in residency-training and continuous professional development.