Risultati per: Transgender – Competenze e ruoli del medico di medicina generale

Dopo un osteosarcoma si specializza in ortopedia al Rizzoli

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Alessandro Vespignani: «siamo in una fase di accelerazione esponenziale che è vissuta in una scala temporale che non ha precedenti. Quindi, per evitare di creare un’altra generazione di medici incapaci di usare questi strumenti, l’urgenza di rivedere la formazione è ora, tra 5 anni sarà tardi»

Sosterrà i giovani ricercatori. Focus sulla neuroinfiammazione

Donelli, permette diagnosi precoci e terapie più tempestive

Circulation, Volume 148, Issue Suppl_1, Page A18991-A18991, November 6, 2023. BackgroundThe medical transition of transgender individuals involves the administration of exogenous sex steroids to induce desired changes in secondary sexual characteristics. In the case of female-to-male (FtM) transgender individuals, the use of testosterone therapy is common. The impact of testosterone on lipid metabolism and dyslipidemia in this specific population is not well understood. Our study combines all the previous studies to study the impact of sex steroids in FtM transgender population.AimTo assess the effects of sex steroids on lipid profile in FtM transgender patients.Methods:PubMed, Cochrane, and Embase were searched from inception till May 2023 for all randomized control trials (RCTs) and observational studies. Primary outcomes were changes in basal metabolic profile (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride levels (TG), HDL, and LDL. All the baseline values before and after utilization of sex steroids were studied. A meta-cont module was used along with Inverse-variance method to calculate the pooled standard mean difference (SMD) for continuous outcomes with a probability value of p < 0.05 considered to be statistically significant.Results:A total of 21 studies with 1208 FtM transgender patients were included. Sex steroids resulted in statistically significant elevation in LDL-C (SMD 0.2850 [0.1169; 0.4531] p < 0.0009), TG (SMD 0.4312 [0.2522; 0.6101] p < 0.0001), TC (SMD 0.1754 [0.0536; 0.2972] p < 0.0048), and BMI (SMD: 0.2429 [0.0983; 0.3875] p < 0.0010) while HDL levels were significantly reduced from the baseline. However, no significant relationship between SBP and DBP was studied(Figure 1).Conclusion:In conclusion, sex steroids increase lipid levels in transgender patients, potentially contributing to dyslipidemia and cardiovascular risk.

Circulation, Volume 148, Issue Suppl_1, Page A12959-A12959, November 6, 2023. Background:The long-term effects of gender-affirming hormone therapy (GAHT) is an area of priority in transgender (TG) health research. Also, there is a great gap in our understanding of sex hormone and sex chromosomes and their role in Metabolic Syndrome (MetS) and therefore atherosclerosis risk.Hypothesis:sex hormones, (estradiol and Testosterone) affect the development of MetS and therefore heart disease.Methods:Using International Classification of Diseases ninth and tenth codes for gender dysphoria from the Veteran Health Affairs national data, we identified 284 transfeminine (TF) and 79 transmasculine (TM) patients with documentedreceived GAHT initiation date(index date=ID) and MetS components data. GAHT consists of estradiol in TF and testosterone in TM individuals.TG individuals were matched to 252 cis-male (CM) and 111 cis-female (CF) referents. MetS z-scores were calculated as: where . In the longitudinal analyses, time (years) was computed from the ID (“Time 0”) with negative and positive values indicating pre- and post ID period, respectively. The mean MetS z-scores were compared among TG and cis-gender groups over time using a repeated measures analysis of variance model.Results:The mean age of cohort was 41, 84% non-Hispanic White and 9% non-Hispanic Black.Table 1 shows MetS z-score significantly changed overtime (p

Circulation, Volume 148, Issue Suppl_1, Page A18683-A18683, November 6, 2023. Introduction:Although obesity and its impact on major adverse cardiac and cerebrovascular events (MACCE) and pulmonary embolism(PE) have been extensively studied, little is known about obesity’s impact on MACCE and PE in the transgender population. Through this study, we sought to establish the prevalence of obesity and its impact on MACCE outcomes and PE in this population subset.Methods:Using the National Inpatient Sample 2020 database, we identified admissions of transgender patients or patients with prior sex reassignment surgery using ICD-10 CM Codes. Later, all these patients were divided into obesity and non-obesity cohorts. Multivariate regression analysis was then performed for in-hospital MACCE and PE to calculate the odds ratio (OR). Predictors for MACCE were also identified in transgender patients with obesity.Results:In 2020, 19,345 transgender patients or patients who had sex reassignment surgery were admitted to the hospital; 16,390 (84.7%) had no obesity, and 2,955 (15.3%) had obesity. In the obesity cohort, 64.5% of patients had a mean age between 18-44 years, 66.5% were white, 47.9% were transgender males, and 52.1% were transgender females. The most common comorbidities include hypertension (43.5%), diabetes (32.5%), and chronic pulmonary disease. (27.7%). Among the transgender patients with obesity, 5.4% had MACCE events, and 1.2% had cardiac arrest. A statistically significant association was observed in MACCE [OR 2.1, 95% confidence interval (CI) 1.24-3.55, p=0.006] and cardiac arrest (OR 3.92, 95% CI 1.11-12.63, p=0.022 among obesity cohort, with age being the important predictor of MACCE. However, no statistically significant association was observed in acute myocardial infarction (OR 1.82, 95% CI 0.8503.93, p=0.125), acute ischemic stroke (1.34, 95% CI 0.39-4.62, p=0.638) and PE (2.18, 95% CI 0.83-5.72, p=0.113).Conclusion:We observed increased odds of MACCE and cardiac arrest in transgender patients with obesity in our large population-based analysis. This observation could be a result of hormonal treatment that transgender adults receive or associated disparities with transgender care. Further large-scale studies are needed to understand the impact of obesity and MACCE events, and PE in this population.

Circulation, Volume 148, Issue Suppl_1, Page A14018-A14018, November 6, 2023. Background:Sex differences in cardiac arrhythmias are well-established and partly attributed to sex hormones.Aim:We aimed to explore the prevalence of arrhythmias in transgender and nonbinary (TGNB) adults.Methods:This cross-sectional study utilized patient electronic medical records from a single community healthcare center specializing in TGNB care. Adults aged ≥18 years with ≥2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups as TGNB (transgender man[TGM], transgender woman[TGW], nonbinary-assigned male at birth, nonbinary-assigned female at birth) and cisgender (cisgender man[CisM] or cisgender woman[CisW]). We categorized arrhythmias as atrial, ventricular, or other. Descriptive statistics characterized the prevalence of arrhythmias by gender group. Age- and race-adjusted Firth-type logistic regression models compared TGNB patients to CisM and CisW. The prevalence of arrhythmias was also descriptively explored in nonbinary people and in TGNB people with a gender-affirming hormone therapy (GAHT) prescription.Results:Among 49,862 adults, 7121 (14%) identified as TGNB persons. Participants were young (median age 28 years-old) and prevalence of arrhythmias was low (0.7-1.4% in nonbinary persons, 1.4-1.5% in transgender persons). Adjusting for age and race, TGM and TGW had a similar risk of arrhythmias compared to CisM (TGW: OR=0.89 (0.63-1.24), p=0.52; TGM: OR=1.17 (0.82-1.62), p=0.37), but statistically significantly higher odds of arrhythmias compared to CisW (TGW: OR=1.65 (1.13-2.34), p=0.01; TGM: OR=2.15 (1.48-3.04), p

Circulation, Volume 148, Issue Suppl_1, Page A18471-A18471, November 6, 2023. Introduction:Previous findings suggest that transgender (TGD) populations have disproportionately higher cardiovascular (CV) risks. We aimed to evaluate the prevalence and odds of CV risk factors in the TGD population in rural Appalachia.Methods:Our case-control study enrolled 92 self-identified TGD people and 73 randomly selected cisgender people. The average age for the TGD and cisgender groups were 29.2 and 29.9, respectively. CV risks of interest examined in both groups were tobacco use, hypertension (HTN), prediabetes/diabetes mellitus (DM), obesity, and hyperlipidemia (HLD). Univariate analysis was used to generate the prevalence of risk factors. Multivariable logistic regressions, adjusted for age and family history of ASCVD, were used to estimate the odds ratio and 95% confidence Interval of having risks of interest.Results:This analysis included 89 and 69 TGD and cisgender individuals, respectively. There was a >6-fold increase in tobacco use (adjusted OR 6.64 [2.59-17.01]) and 4-fold increase in prediabetes/DM (adjusted OR 3.98 [1.05-15.15]) among the TGD population. Among the TGD population, there were increased odds of obesity (OR 13.39 [3.30-54.30] and HLD (OR 3.46 [1.03-11.59]) in the trans-male group compared to the trans-female group. Also, surgical and/or hormonal treatments were significantly associated with higher odds of tobacco use (OR 6.67 [2.80-15.98]), and statin need (OR 3.97 [1.14-13.81] in the TGD group.ConclusionThe TGD population have disproportionately higher odds of CV risks in rural Appalachia, worse among trans-male and individuals who received hormonal and/or surgical treatment. This study is limited by sample size.

Introduction
Chemsex is defined as drug use to enhance sexual pleasure. Global literature illustrated the pervasiveness of chemsex among men who have sex with men (MSM) and transgender women (hijra) for prolonging anal intercourse, reducing pain and intensifying pleasure, oftentimes without condoms. Global literature highlighted the association between chemsex and unsafe sexual behaviours. These circumstances warrant targeted chemsex research to explore the chemsex situation. The study aims to explore the overall dynamics of chemsex among MSM, male sex workers (MSW) and hijra in Dhaka, Bangladesh and formulate culturally relevant, context-specific, gender-sensitive and evidence-based recommendations for chemsex interventions.

Methods and analysis
This will be a sequential, exploratory, mixed-methods study. Data will be collected at four drop-in centres in Dhaka in three phases. To explore issues related to chemsex, the formative phase (phase 1) will generate evidence on the overall dynamics of chemsex through a literature review and qualitative interviews. Qualitative data will be manually analysed using thematic analysis. In phase 2, a cross-sectional survey will be conducted among 458 MSM, male sex workers and hijra to measure the prevalence, reasons and sexual risk behaviour associated with chemsex. In phase 3, qualitative interviews will be conducted with the participants involved in chemsex, service providers and relevant stakeholders to add qualitative depth to survey responses. In this phase, service provision will also be investigated for people engaging in chemsex. Moreover, based on the findings of phases 1 and 2, and qualitative interviews of phase 3, a preliminary chemsex intervention model will be developed through a series of intervention design workshops.

Ethics and dissemination
Ethical approval has been attained from the Ethical Review Committee of icddr,b. Informed consent will be obtained from the participants, and confidentiality will be maintained during data collection and storage. Findings will be disseminated via several platforms including dissemination seminars, scientific articles and study report.

Permette di avere vaccini più mirati e diete meno restrittive

Permette di avere vaccini più mirati e diete meno restrittive

To the Editor A recent Research Letter highlighted the lack of data regarding pregnancy outcomes among transgender individuals and provided insights regarding their prenatal and perinatal care needs.

In Reply We thank Ms Chiu for the comments about our Research Letter. We wholeheartedly agree that transgender people face substantial health disparities that may affect birth outcomes. We acknowledge the limitations of using claims data for identification of transgender individuals, as well as for identification of relatively rare outcomes such as severe parental morbidity or death. Chiu cites an article that showed increased mortality in the gender-diverse population. While these findings may imply poor pregnancy outcomes, this study also relied on secondary data and patient disclosure of their gender identity.