Study of Female Infertility

Introduction

Infertility is the inability of a couple to conceive within a normal period of one year (for a woman under 35) or half a year (for a woman over 35) regardless of satisfactory, standards (3-4 times each). week), unprotected sex. Infertility can also be referred to as the inability to carry a pregnancy to term. Infertility can be caused by the lady, the man, or both; necessary or optional. In essential infertility, couples have not always considered; while in involuntary infertility, after consideration (either carrying the pregnancy to term or an unnatural birth cycle), there is difficulty in imagining [1]. Optional infertility is absent if there has been a difference in accomplices within one year, which is associated with specific opportunities to be infertile. Cervical infertility (CI) involves the failure of sperm to enter the uterus due to damage to the cervix or cervical factors, such as cervical stenosis; anti-sperm antibodies; insufficient, hostile, or unresponsive cervical body fluid and cervical contamination from physically transmitted diseases (chlamydia, gonorrhea, trichinellosis, cytoplasmic hominins, and ureaplasma urealyticum).

Risk Factors and Causes

Infertility might be brought about by an elementary ailment that may harm the fallopian tubes, meddle with ovulation, or cause hormonal intricacies [2]. These ailments incorporate pelvic fiery illness, endometriosis, polycystic ovarian condition, untimely ovarian distress, uterine fibroid tumor, and natural components. Different reasons for infertility in females incorporate ovulation issues, tubal blockage, age-related elements, uterine issues, past tubal ligation, and chemical awkwardness while the fundamental teamster of male infertility is helpless spermatozoa quality.

Environmental Factor and Infertility

It was focused on the etiological significance of environmental variables in infertility. Toxins such as pastes, unstable natural solvents or silicones, real specialists, synthetic cleaning products, and pesticides are involved in infertility [3]. In addition, other harmful ecological manifestations associated with words such as chlorinated hydrocarbons and femicides are related to the widespread association of an unrestricted unnatural birth cycle in women. As of now, people who are in direct contact with or open to such synthetic compounds have a high probability of having essential or elective infertility. Estrogen-like chemical-disrupting synthetic compounds such as phthalates are of particular concern for effects on women’s children.

Age and Infertility

Ripeness decays with age. Female fruitfulness is at its top between the ages of 18 and 24 years, while, it starts to decay after age 27 and drops at a fairly more noteworthy rate after age 35. As far as ovarian hold, a normal lady has 12% of her savings at age 30 and just 3% at age 40. 81% of the variety in the ovarian hold is because old enough alone, making age the main factor in female infertility. Ovulatory brokenness is more normal in more youthful than in old couples [4].

Weight Changes and Infertility

Ovarian brokenness could be brought about by weight reduction and unnecessary weight acquired with weight file (BMI) more noteworthy than 27 kg/m². Abundance weight has additionally been found to have an impact on treatment viability and results of helped regenerative strategy. Estrogen is created by the fat cells and essential sex organs and along these lines, the condition of high muscle versus fat or stoutness causes expansion in estrogen creation which the body deciphers as contraception, restricting the odds of getting pregnant. Likewise, too little muscle-to-fat ratio causes a lack of estrogen creation and hence feminine anomalies with an anovulatory cycle. Legitimate nourishment in early life had been connected to being a central point for later ripeness [5].

Hormonal Imbalance and Infertility

The nerve center, through the arrival of gonadotropic hormone-delivering chemicals, controls the pituitary organ which straightforwardly or by consequence controls most other hormonal organs in the human body [6]. Subsequently, changes in the element signals from the nerve center can influence the pituitary organ, ovaries, thyroid, and mammary organ and consequently, hormonal irregularities. Hormonal abnormalities that influence ovulation incorporate hyperthyroidism, hypothyroidism, polycystic ovary condition (otherwise called Stein-Leventhal disorder), and hyperprolactinemia. Hormonal irregularity is a significant reason for anovulation. Ladies with hormonal lopsidedness won’t create enough follicles to guarantee the improvement of an ovule. Changes in the hormonal equilibrium of the Hypothalamic-Pituitary-Adrenal Hub (HPA-hub) could be brought about by stress.

Thyroid Disease and Infertility

A thyroid infection is associated with an increased risk of a rash or stillbirth. The prevalence of hypothyroidism in women of childbearing age (20-40 years) is between 2% and 4%. In essential hypothyroidism, the serum thyroxine (T4) level is low and the negative input to the hypothalamic-pituitary pivot is reduced. Subsequently, the expanded emission of thyrotropin-releasing chemical (TRH) stimulates thyrotropin and lactotrophs, consequently expanding the degrees of both thyroid-stimulating chemical (TSH) and prolactin and, in this sense, ovulatory disorders due to hyperprolactinemia. Prolactin production can also be stimulated by vasoactive intestinal peptide (VIP), epidermal growth factor, and dopamine receptor agonists. Hyperthyroidism is then again shown by suppressed serum TSH and expanded thyroxine (T4), triiodothyronine (T3), or both [7]. Hyperthyroidism in women of childbearing age is caused by Graves’ disease, toxic goiter, and thyroiditis. In Krassas et al, a higher rate of hyperthyroidism was associated with a sporadic monthly cycle ranging from hypomenorrhea, polymenorrhea, and oligomenorrhea to hypermenorrhea.

Diagnosis and Infertility

In any infertility struggle, both co-conspirators and co-conspirators are considered significant benefactors and are thus investigated especially if the woman is over 35 or if any of the co-conspirators have realized risk factors for infertility [8]. The male components must be removed before subjecting the female accomplice to any costly but disruptive testing.

Diagnostic and Imaging Test

1. Imaging tests to look at the uterus and fallopian tubes include ultrasound (especially sonohysterography with saline implantation), hysterosalpingography, hysteroscopy, fertiloscopy, and laparoscopy [9]. An endometrial biopsy is done to confirm ovulation and a Pap smear is done to see the pelvic organs and check for signs of disease. Magnetic resonance imaging (MRI) is the imaging test of choice because it can identify adenomas that are only about 3-5 mm. Mixtures of these imaging methods can be used to confirm the analysis [10,11].

2. The estimation of blood urea nitrogen and creatinine is significant in recognizing persistent renal failure as the reason.

3. Pregnancy tests are required except when the patient is postmenopausal or has had a hysterectomy.

4. Estimation of insulin-Like Growth Factor-1 (IGF-1) level is performed in acromegaly. 5. Hormonal measures include the determination of plasma levels of chemicals such as Luteinizing Chemical (LH) to determine ovulation in women and detect pituitary problems, Follicle-Stimulating Chemical (FSH) to determine ovarian retention, prolactin level to confirm an anovulatory cycle, and Thyroid -Stimulating Chemicals (TSH) to control thyroid organ problems. A Thyroid-Stimulating Chemical (TSH) level somewhere between 1 and 2 is considered ideal for conception. Progesterone estimates in the second 50% of the cycle help confirm ovulation.

5. Immunological tests are performed to determine anti-sperm antibodies in blood and vaginal fluids. Infertility immunizer blood tests are conducted to detect antibodies that destroy sperm.

6. A post-coital test can be performed shortly after intercourse to check for problems with sperm penetration into the cervical mucosa.

Prevention of Infertility

Some cases of infertility could be prevented by strong intercessions:

• Maintaining a healthy lifestyle: Excessive exercise, use of caffeine and alcohol, and smoking (tobacco and weed) are associated with reduced maturity, which should subsequently be avoided. A fair and nutritious diet, products of the soil (lots of folate), and maintaining a normal body weight are associated with better chances of wealth.

• Prevention or treatment of existing diseases: Identifying and controlling persistent diseases such as diabetes, hyperthyroidism, and hypothyroidism creates opportunities for maturity. Routine current evaluations (counting Pap spreads) help recognize early signs of contamination or abnormalities.

• STDs can be prevented by limiting sex or practicing “safer sex” techniques among individuals with multiple sexual partners, including regular monogamy, non-penetrative sex, and the proper and predictable use of boundary prophylactic strategies, especially latex. male condoms and polyurethane vaginal sheath (female condom).

• Rapid treatment of sexually transmitted

• Not delaying parenthood: Fertility begins to decline after age 27 and declines much more significantly after 35. don’t delay parenthood.

Treatment

Treatment of female infertility can be done in different ways which are as follows:

1. Weight loss drugs: In corpulent anovulatory infertile women, a 5-10% loss of body weight was enough to restore regenerative abilities in 55-100% of women within half a year.

2. Reception of ovulation using gonadotropins, Human Menopausal Gonadotropin (HMG).

3. Bromocriptine in hyperprolactinaemic

4. A mixture of clomiphene citrate and human menopausal gonadotropin (CC-HMG).

5. Chemical treatment (e.g. Perganol).

6. Careful intercession.

7. Directed Impregnation (AI): AI can be performed by intracervical or intrauterine insemination. It works in an ovulating lady with patent cylinders.

8. In Vitro Fertilization (IVF): IVF can be used to treat women with damaged fallopian tubes and endometriosis or in cases of unexplained infertility. Standard IVF requires the presence of a functional fallopian tube and the methodology includes gamete intrafallopian movement (GIFT), zygote intrafallopian movement (ZIFT), or GIFT-ET, which is a combination of GIFT and IVF.

For More Articles: Biomedical Journal Impact Factor: https://biomedres.us

Comparison of a Novel Incubator with Standard Incubator Care: A Randomised Multi-Centre, Cross-Over Study

Introduction

The use of incubators to maintain normothermia is a cornerstone of neonatal care [1]. Hypothermia in the premature infant can result in poor weight gain and metabolic stress [2,3]. Babies maintain normothermia via hypothalamic control mechanisms, creating warmth through shivering and non-shivering mechanisms [4]. In the preterm or growth restricted infant, these mechanisms are immature, placing them at additional risk. In lower-resource settings, hypothermia is associated with significant mortality especially in these higher risk patients [5]. The World Health Organisation (WHO) recommends that stable babies ≤2kg should receive external warming (radiant or incubator) if they cannot be given skin-to-skin care [6]. The mOm Essential Incubator, [Mom Incubators Ltd, Nottingham, UK] (Figure 1) meets international safety and performance standards for conventional incubators, is CE marked under the medical device regulations (MDR2017/745), and is suitable, by design, for use in both high- and lower-resource settings. This study evaluated the thermal performance of this novel incubator against standard incubators used on neonatal units, and to investigate usability aspects from staff perspectives.

Figure 1

Methods

Patient Population

Eligible infants were at least 30 weeks corrected gestational age (GA) at birth, and ≤6kg at inclusion to the study. They were clinically stable, not needing endotracheal ventilation, had already spent at least 24 hours receiving standard incubator care, and were expected to require at least 48 hours of non-humidified incubator care at ≥30°C at the time of study inclusion. Written consent was obtained from the parent(s) or legal guardian(s) aged 16 years or above and not considered to be in a vulnerable group. Infants with major congenital abnormalities or suspected infection were excluded. The clinical team-maintained responsibility for each infant’s care, with the ability, along with the initial consent giver, to withdraw the infant from the study at any time for any reason.

Study Design and Setting

This was a prospective, multi-centre, randomised controlled, cross-over design pilot study, conducted in three hospital Neonatal Intensive Care Units within the United Kingdom: St Peter’s Hospital (Ashford and St Peters NHS Foundation Trust, Chertsey), Royal Hospital for Children (Queen Elizabeth University hospital, Glasgow) and the Norfolk & Norwich University Hospital, Norwich. The primary objective of this study was to compare the maintenance of normothermia within each incubator group (mOm or standard) by measurement of each infant’s truncal skin temperature, or core temperature. This is expected to fluctuate but remain within normal temperature limits (36.5 to 37.5°C). Variations from this endpoint were analysed and compared statistically between the two incubator groups. Thirty-six completed datasets were required for the analysis to be valid. A complete subject dataset was deemed acceptable if 19 of the 24, once-hourly temperature observations were recorded for each incubator type (i.e. 79% compliance). This degree of compliance was considered acceptable for analysis because it is still greater than the routine standard for this type of incubator care for clinically stable infants of ≥30 weeks GA, which is often every three hours. The overall mean temperature variance per incubator group (mOm or standard) was compared. Where temperature data from skin probes attached to the incubators, was not available for any technical reason, axillary temperature readings were used instead to maintain dataset integrity. If infants were removed from incubators, (e.g. for skin-to-skin care), the nature and duration of the event was recorded.

A 95% confidence interval was calculated around the mean of these fluctuations within each baby for each incubator group. Data from 36 babies would allow such a confidence interval to be calculated to within ±0.33°C if the actual mean fluctuations are around one degree (i.e. as normally expected) and assuming a two-sided confidence interval. A paired t-test was used to compare values, and p-values were calculated. Each patient served as their own control. The order of incubator type used for each of the two consecutive 24-hour periods of incubator care, was assigned randomly. A Microsoft Excel random number generation system was used to generate random numbers used to assign the arm of the study the infant was assigned (i.e. which incubator type the infant went into for the first 24h before cross-over). Each assignment was placed in an envelope attached to case report form folders already numbered with a continuous series subject number. As secondary endpoints, baseline demographics, then vital signs (i.e. pulse rate, breathing rate and O2% saturation) of the infant, plus set and actual temperature of the incubator were recorded every hour; blood pressure was recorded daily. The type and duration of care activities, duration the portholes or door was open and any adverse events were recorded throughout the 48h each infant spent in the study. Further to these, the time taken to clean each incubator between use was recorded and users were given a questionnaire to complete, regards the usability of the mOm compared to standard incubators. No formal survey was provided to parents, although any comments given were recorded in their infants’ case report form.All data were collected, 100% verified by the Sponsor’s monitors, and stored in compliance with Good Clinical Practice (GCP) and Data Protection legislation. The CONSORT reporting guidelines were used to provide reporting guidance [7].

Ethics and Regulatory Approvals

This study was initially approved by the London – Harrow Research Ethics Committee (REC), 19 November 2018 (ref: 18/LO/1757). After a delayed start due to the Covid pandemic, MHRA no objection was gained on 22nd October 2021 (ref: CI/2021/0050/GB), Health Research Authority approval on 27th October 2021 and adoption onto the National Institute for Health Research Clinical Research Network portfolio (CPMS ID 38607). The study was conducted in accordance with ISO 14155, Good Clinical Practice and the Declaration of Helsinki for Human Rights.

Results

One hundred patients were screened and identified as eligible for participation in this study over a period from November 2021 until August 2022 at the three study sites. Forty-three infants were enrolled of which three infants were withdrawn, one prior to commencement (moved to a different hospital) and two during the study by neonatal staff (one due nurse wanting to cool infant rapidly after overheating due to too much clothing, one due to staff concern with incubator temperature dropping when alarm not cleared); in both cases the incubator performed correctly. Three infants had no primary endpoint data collected whilst the infants were in the standard incubator so no comparative analysis could be performed; these were excluded from the results reported in this paper. However, the data collection target was reached (i.e. 36 evaluable data sets) with 37 evaluable datasets being available for inclusion in the analyses (Figure 2); see Table 1 for their demographic data. Of the 37 evaluable datasets, 18 (49%) infants were randomised to a mOm incubator -first 24h, then a standard incubator – second 24h, and 19 (51%) infants were randomised to standard – first 24h, then mOm incubator – second 24h (Table 1).

Table 1: Summary of demographics at study inclusion.

Figure 2

Efficacy Outcome

No significant differences were found in the primary endpoint for maintenance of normothermia in infants cared for in either the mOm incubator or the standard incubators. Fluctuations in temperature beyond the normal range were noted and the mean variance compared (Table 2). Figure 3 shows the mean temperatures of the infants recorded in each incubator over the 24-hour period.

Table 2: Analysis of paired data for mean fluctuations from normothermia (°C).

Figure 3

Secondary Endpoints

Clinical Stability: There were no statistical differences in heart rate, respiratory rate, oxygen saturations, or blood pressure between mOm and standard incubator groups (Table 3).

Table 3: Vital signs

Incubator Performance: Standard incubators used in the study included a variety of Draeger (Lubeck, Germany) models (90.2%) and GE (Chicago, IL) Giraffes (7.3%). Both incubator groups demonstrated temperature differences between set and actual temperature (as displayed on the incubators interfaces) which were within the permitted limits of the BS EN 60601-2-19 Standard [7]. Both had the same median difference of 0.03°C. The overall mean (standard deviation; SD) difference was 0.04°C (±06°C) for the mOm, compared to 0.03°C (±0.03°C) for the standard incubator group. The mean length of time the infants underwent care activities with the portholes and/or door open was similar in both incubator groups with no significant difference (Table 4). Both incubator groups had a median of 10 minutes for care activities with similar interquartile ranges (IQR) of 5.5-20 minutes for the mOm group and 7.0-20 minutes for the standard incubator group.

Cleaning of Incubators (Table 4): Cleaning times were recorded on 44 (69%) occasions for the mOm incubator compared to 20 (31%) occasions for the standard incubators. Median (IQR) cleaning time was significantly shorter for the mOm incubator compared to the standard incubator; 25 (15-30) vs. 45 (30-45), p <0.001) (Table 4).

Table 4: Activities and Incubator Cleaning Times.

Adverse Events (AEs): Seven AEs were reported (3 hyperthermia, 1 hypothermia, 1 skin irritation, and 2 oxygen desaturations) of which none were considered causally related to either type of incubator. No serious AEs or device-related AEs were reported.

Usability: Thirty-two clinical staff, of whom the majority 27(84%) were nursing staff and the rest consultants, and 10 non-clinical staff (healthcare support workers), completed responses. 85% found the device intuitive to use and all respondents said they would be happy to allow their own baby to be managed in the mOm incubator. The majority of clinical staff felt the incubator may be useful for interdepartmental transfers (78%), home use (66%), ward use (e.g. transitional care, postnatal wards (63%)), delivery suite (56%) or for low infrastructure countries. There were positive comments about the size and cleanability of the mOm (“less invasive looking for parents”, “easy to transfer” [referring to interdepartmental transfer]). Eight (80%) of the non-clinical respondents who commented, thought that the cleaning, disassembling, and setting up the mOm incubator was ‘Easier’ or of ‘Similar Difficulty’, when compared to a standard incubator. Negative comments included the self-closing porthole doors (feature now removed), and about accessibility for complex babies with multiple intravenous (IV) lines (four IV ports currently provided), or during an emergency. Suggestions included additional portholes for access. Clinical staff also did not like the lack of a height adjustable trolley (now available).

Parents: Parents commented that they liked the compact size of the mOm incubator, as it seemed “right sized” for their baby. Parents said it was easier to see the baby and that the “baby looked perfect size in [mOm] incubator”. Parents also said they liked the display of their baby’s temperature. No comments were recorded for the standard incubators.

Discussion

There were no significant differences in the maintenance of normothermia between infants cared for in the mOm and the standard incubators. Similarly, there were no differences in recorded physiological measurements. The performance of the incubator was within expected values; the differences noted between set and actual values are within the permissible safety and performance criteria of the BS EN 60601-2-19 Standard [8]. There were no device-related adverse incidents. The mOm incubator was designed by James Roberts, at the time a Design Engineering student at Loughborough University, winning the Sir James Dyson Global Prize for Innovation in 2014. Originally known as an “inflatable incubator”, it has been refined and re-designed, whilst maintaining the original aims of being portable and space-saving, able to operate from a variety of power sources and to be more cost-effective than standard incubators. This study is the first report of its clinical use, paving the way for further evaluations in different settings. The aim for medical equipment to be cost-effective, or designed for lower resource settings, does not mean that functionality, safety or usability should not be evaluated and meet the standards required in higher-resource environments.

A recent review examined currently available warming devices suitable for low-resource settings [9]. These included radiant warmers, incubators, warming mattresses and phase-change materials. Devices were generally effective although it was noted that radiant warmers increased insensible water losses. Some require consumables which may add additional costs, and phase-change materials have a relatively short duration of action before replacement is needed. Considerations such as servicing, parts and power availability, and means of disposal, should also be considered. A randomised controlled study of a prototype cardboard incubator [10] demonstrated non-inferiority in a low-resource setting with high ambient temperatures (25°C) and humidity (50%); 1:1 nursing was provided for the study duration (48h).

During our study trial period, 60% of babies with parental consent did not participate in the study, and trial recruitment was slower than anticipated. The overwhelming reason for this was due to a requirement for a lower incubator temperature than the mOm incubator could provide. Stable neonatal patients often require a set incubator temperature of 28-29°C. The standard incubators could provide this, however, the operating range of the mOm incubator used in the study was 30-37°C. The mOm incubator has since been adjusted to provide a wider range of 28-37°C, demonstrating the value of clinical evaluation. The mOm incubator was designed for use in a broad range of settings, including emergency ones where environments would be expected to be less favourable and staff less experienced. Assessment of usability was important in order to understand the attitudes of staff to a medical device which does not have the features associated with more expensive, conventional devices. The positive feedback from users was reassuring that use in a busy high resource setting was acceptable, with all respondent clinical staff (consultants and nurses) and non-clinical staff (healthcare support workers) saying they would allow their own baby to be cared for in a mOm Essential incubator.

Study Limitations

This was a small-scale pilot study, which although demonstrating compliance to the safety and performance incubator standards [8], was not powered to show non-inferiority against one particular standard incubator, instead hospitals used standard practice which included the use of a range of different ‘standard’ incubators.

Conclusion

In this pilot study, performance of the mOm Essential Incubator showed no significant differences in maintaining thermal stability compared with the standard incubators in infants ≤6Kg, who did not require humidification, and no incubator-related adverse events were observed. In a busy high resource setting, the mOm incubator matches the performance of standard incubators in the maintenance of temperature and may provide the additional benefit of shorter cleaning time.

For More Articles: Biomedical Journal Impact Factor: https://biomedres.us

Renal Cell Carcinoma: A Review on Patients’ Quality of Life

Introduction

Kidney cancer occurs due to the abnormal growth and division of cells. This phenomenon occurs when an injured cell grows and multiplies, giving rise to several abnormal cells forming a tumor (Alberts, et al. [1]). Renal carcinoma originates in the kidneys, essential organs for normal and healthy functioning. The kidneys belong to the urinary system and have several functions, including the excretory function, responsible for filtering the blood and producing urine, which expels substances that in large quantities would be harmful to the body; the regulatory function of internal volume and acid-base balance, responsible for internal homeostasis through the excretion of water and electrolytes; the hormonal function, which plays a role in the internal secretion of hormones that regulate various processes related to the organ and the catabolic function, which ensures that no essential substances are lost. Kidney cancer represents 2-3% of all malignant tumors in adults, with an increase in incidence in recent decades (Karki, et al. [2]), and is one of the most common cancers of the urinary system (Liu, et al. [3]). This diagnosis has a higher incidence in males, and it has been shown that they have worse initial tumor characteristics and worse mortality specific to this cancer (Ajaj, et al. [4]). It is estimated that 90% of kidney cancers are represented by Renal Cell Carcinoma (RCC), and this is divided into three types: clear cell RCC, which represents 70% to 85% of cases; papillary RCC, which represents 10 to 15% of cases and chromophobe RCC, which represents less than 5% of cases (Motzer, et al. [5]).

A set of risk factors is associated with kidney cancer, meaning that a risk factor implies any aspect that interferes with the probability of having a specific disease but does not incorporate a direct causal relationship in cancer development (Hancock & Georgiades [6]). Firstly, we have smoking as one of the main risk factors associated with renal carcinoma. The risk increases proportionally to the number of cigarettes smoked; however, if the individual stops smoking, the risk decreases. The incidence in males can be explained by the fact that, in the past, men were the biggest tobacco consumers (Lopaz-Beltran, et al. [7]). Additionally, obesity also incorporates a considerable risk factor, with the risk increasing exponentially with excess weight. It may be due to the hormonal changes characteristic of excess weight, which can lead to hormonal imbalance (Lopaz-Beltran, et al. [7]). Professional exposure to certain chemicals has also been shown to be a risk factor, specifically trichloroethylene, as well as prolonged exposure to cadmium, benzene, herbicides, and vinyl chloride, among others (Lopaz-Beltran, et al. [7]). CRC does not have a constellation of defined symptoms and is usually asymptomatic in its earliest stages, often discovered at a late stage of the disease, affecting the individual’s prognosis and chance of survival (Hancock & Georgiades [6]). Patients with metastatic CRC have a more unfavorable prognosis, with a survival rate that varies between 2 and 3 years. However, there is a constant attempt and effort to develop ways to regularly track and effectively manage distress, as an essential component of patient care, to help improve patients’ quality of life (Bergerot, et al. [8]).

Method

A systematic review of the literature published between 2003 and 2023 was carried out in the B-on database to find out what the literature says about the quality of life in patients with CRC. The research protocol used was: (“kidney cancer” OR “renal cell carcinoma”) AND (“intervention plan” OR “therapy” OR “psychology” OR “psychoeducation”) AND (“adults” OR “elderly people”) AND (“anxiety” AND “trauma” OR “distress” AND “depression” OR “coping” OR “death anxiety” AND “future planning” AND “quality of life”). The Boolean Operators “AND” were used to ensure that the topics were all included in the search, and the “OR” was used to increase the possibility of obtaining more results within the same topics. The inclusion criteria are studies

(a) Academic articles,

(b) Published between 2003 and 2023,

(c) In English,

(d) That mentioned the quality of life,

(e) That focused on the psychological perspective of cancer, and

(f) That focused on kidney cancer.

The exclusion criteria are articles that

(a) Did not mention psychology,

(b) Were unavailable for consultation,

(c) Did not address kidney cancer,

(d) Were more focused on the medical perspective, and

(e) Focused on testing for cancer symptoms.

First, 50 articles were collected, and, considering the exclusion criteria, 36 articles were removed, leaving 14 articles to be used in this review (Figure 1).

Figure 1

Results

Firstly, after applying the research protocol, 50 articles were collected, but only 14 articles were considered eligible for the systematic review after applying the exclusion and inclusion criteria mentioned above. Although the number is small, this fact only highlights the importance of more research in psycho-oncology and kidney cancer, specifically on the topic of quality of life, which is the central theme of this systematic review. All articles used in this systematic review are included in Annex 1. Additionally, all literature used in this systematic review included a psychological perspective on the quality of life in the context of kidney cancer, including topics such as resilience, self-efficacy, self-management, hope, the consequences of treatments and experiencing cancer, physical activity, psychopathologies, psychological suffering, and positive affect.

Discussion

Quality of Life of Patients with CRC

For cancer patients, quality of life (QoL) is an essential factor, and the literature shows that there is a correlation between a high symptom burden and poor QoL. There is a constellation of symptoms associated with cancer; however, among individuals with cancer, fatigue, pain, and depression are the three most frequently reported symptoms related to the disease and subsequent treatment. This phenomenon, together with the fact that 50% of patients who suffer psychosocial impacts do not disclose them to their healthcare team, can immensely affect their QoL. Therefore, the emotional and psychological impact of cancer on patients is likely not well understood (Carlos, et al. [9]). QoL is a subjective perception at various levels that changes over time as it reflects an individual’s current situation. Deterioration in QoL is associated with an increased risk of suicide and depression. In particular, the QoL of patients with metastatic kidney cancer deteriorates significantly as a result of treatment due to the stress imposed on their body and mind (Liu, et al. [3]). More specifically, kidney cancer patients are faced with multiple stressors, including pain, fatigue, significant bodily changes, and changes in sexual/urinary function (Yang et al., 2016). Furthermore, due to the adverse effects of altered self-image/body image and altered sexual/urinary function, individuals may withdraw from friends and other people because they are afraid of losing people due to their condition and do not know how to ask for help due to their embarrassment, which may lead to them receiving insufficient support from their loved ones and friends (Yang et al., 2016).

Furthermore, intense physiological, psychological, and interpersonal challenges may arise in the first year after diagnosis, which may decrease QoL and increase the likelihood of developing psychopathologies such as anxiety, depression, or posttraumatic stress disorder (PTSD) (Moretto et al.) (Thekdi, et al. [10]). In kidney cancer patients, the prevalence of depression, anxiety, and PTSD is 77.5%, 69.3%, and 25.2%, respectively (Yang et al., 2016). Psychopathologies can affect the patient’s judgment and decision-making capacity, which is crucial in their treatment (Karki, et al. [2]). Indeed, concerns about the recurrence of cancer or the possibility of never being able to overcome it can worsen these psychopathologies if they are not correctly regulated (Liu, et al. [11]). Furthermore, these psychological disorders can lead to a decrease in the immune response, prolonged recovery times, difficulties in controlling symptoms, poor adherence to treatment and, possibly, a reduction in survival time. Therefore, regular screening and adequate management of these psychological disorders are an essential aspect of psycho-oncology, as they not only affect the patient’s psychological aspect but can also reduce their survival rate and the success of their treatment (Yang et al., 2016). Although currently available drug treatments (sunitinib, interleukin-2, interferon-α, among others) can improve overall survival and alleviate some of the symptoms to a certain extent, at the same time, they also produce toxic side effects, which can also affect their QoL (Liu, et al. [11]).

Additionally, in patients with advanced cancer, fatigue is often a priority symptom. It can hurt QoL because it affects physical and social functioning, activity level and emotional well-being. Fatigue is also a joint adverse event (AE) associated with advanced cancer treatments, including targeted therapies (such as those approved for advanced RCC). It is reported as an AE in approximately 40% to 70% of patients with advanced RCC. (Cella, et al. [12]). In fact, due to physical exhaustion and restrictions imposed on activities, these patients have difficulty performing activities they previously enjoyed, which can worsen their psychological suffering (Liu, et al. [3]). Psychological distress refers to non-specific symptoms that include stress, anxiety and depression. Increased levels of psychological suffering may indicate the beginning of diagnostic severe conditions, such as the psychological disorders already mentioned above. In practice, it is often found that many patients deny any symptoms of psychological distress and often self-medicate with ethanol and recreational drugs. It is assumed that the impact of psychological distress on therapeutic adherence and long-term well-being is significant. However, this field is poorly explored (Bartolomei et al., 2022). Additionally, it has been shown that female cancer patients suffer more from psychological distress. In contrast, men suffer more from symptoms of physical distress, and it has also been shown that younger people are more susceptible to experiencing psychological distress (Ajaj, et al. [4]).

While QoL deteriorates through treatments and the various difficulties a patient faces, optimism and resilience work as protective factors for their QoL. Resilience is the ability to restore one’s original state when faced with an essential stressful event and can be a process or a result of coping. Characteristics of resilience include resilience, flexibility, self-determination, self-esteem/self-efficacy, a sense of humor, and the ability to maintain positive relationships (Liu, et al. [3]); Yang et al., 2016). In the conceptual framework for recovering the health and well-being of cancer survivors, cancer-related self-efficacy refers to the degree of self-confidence of survivors about self-management of problems caused by cancer or treatment after completion. of primary treatment; that is, these patients are confident in their ability to avoid symptoms or health problems that interfere with what they want to do, believe that performing their self-care activities would reduce their need to see a doctor and can improve psychological distress caused by treatment (Liu, et al. [3]). This self-efficacy mediates the relationship between negative emotional states and resilience; the fewer negative states, the greater self-efficacy and, consequently, the better resilience (Liu, et al. [3]). Additionally, a high level of self-confidence is beneficial so that individuals can adopt self-management behaviors to improve their symptoms or health problems and reestablish their health and well-being. Thus, the emotional state of cancer patients affects their self-efficacy about cancer, which, in turn, affects their resilience and QoL.

A negative emotional state may lead to low self-efficacy, while a positive one will have the opposite effect. Resilience plays a crucial role in this process, as it can help resist the influence of a hostile state on QoL, thus implying that patients with better resilience have better QoL (Liu, et al. [3]). As a product of resilience, coping appears, defined as continuous cognitive and behavioral efforts to manage specific external and internal demands that overload or exceed the individual’s resources (Lazarus [13]). Coping helps patients live with the demands placed on them by the disease and experience a general sense of well-being. The main coping styles identified are problem-focused, emotion-focused and avoidance-focused. These mechanisms can be great protectors of QoL, as they increase the individual’s resilience if used correctly. However, avoidance-focused coping may have a negative association with QoL, so not all coping styles will benefit all patients (Beisland, et al. [14]). Another concept associated with QoL is hope; a high level of hope in a cancer patient can increase their ability to find solutions to the problems caused by cancer and feel confident that they can use ways to solve or deal with these problems. Problems. Additionally, hope showed a negative association with PTSD, which may provide valuable information for the development of targeted psychotherapy for PTSD in cancer patients (Yang et al. 2016).

Furthermore, the psychological impact of cancer not only increases levels of negative emotions but also reduces the positive affective experience; that is, patients may not necessarily have an abundance of negative emotions, but rather a lack of positive emotions. Positive and negative affect mechanisms contribute differently to biological and psychological processes, such as blood pressure, heart rate, creativity and stress perception (Prinsloo, et al. [15]). Positive affect was also associated with a 10% reduction in mortality; survival outcomes were substantially better for patients who simultaneously reported high positive affect and low depressive symptoms, thus affecting QoL (Prinsloo, et al. [15]). Finally, physical activity (PA) and sleep have been associated with better health and QoL outcomes in many cancer groups (Tabaczynski, et al. [16]). Light-intensity PA has also been associated with positive health outcomes for cancer survivors, as it can be performed in many domains as part of daily living activities. Additionally, kidney cancer survivors spend a lot of time sedentary, which is defined as any behavior, including sitting, reclining, or lying down, performed during waking hours. Sedentary behavior is linked to adverse health outcomes for kidney cancer survivors, including decreased physical functioning, increased pain and fatigue, decreased well-being, and reduced QoL (Tabaczynski, et al. [16]) Furthermore, sleep disturbances are also one of the symptoms most cited by cancer patients during and after treatment [17,18].

Therefore, better sleep quality and longer sleep duration are associated with positive health and well-being and are fundamental to maintaining QoL during the process. Reorienting sedentary time to PA of any intensity or sleep can lead to successful symptom management in kidney cancer patients, increasing QoL (Tabaczynski, et al. [16]).

Conclusion

After the systematic review of the literature, we can note that this subject has not yet been explored much, as most articles mentioned the quality of life of cancer patients in general, and few delved into the experience of patients with CRC. However, it cannot be said that the experience of an individual with cancer is not the same as that of an individual with CRC, as the processes are similar. One of the limitations of this study is the number of keywords used in the research protocol; in a future review, it would be relevant to try to reduce some keywords. Finally, resilience and self-efficacy play an essential role in maintaining and protecting the quality of life of patients with CRC.

For More Articles: Biomedical Journal Impact Factor: https://biomedres.us

Semicircular Lipoatrophy of Occupational Origin (SLOO): Proposal of a Clinical History Sheet for Data Collection and Implementation of Corrective Factors

Introduction

Definition

Semicircular lipoatrophy (SL) is defined as a benign disorder of the subcutaneous tissue that manifests as atrophy of the adipose tissue and is characterised by semicircular banded depressions affecting mainly the thighs on the anterolateral aspect and, to a lesser extent, the forearms and abdomen uni or bilaterally [1,2], with asymptomatic lesions, and with intact skin and muscle (Figure 1). Where an occupational cause is demonstrated, it most commonly affects females in a 6:1 ratio and in an age range of 30 40 years and in office workers [3]. The course is reversible, be nign and without sequelae, remitting within months or years after

cessation of exposure to risk factors. This rare disorder has been linked to the workplace since 1974, when cases of LS were reported in workers in certain buildings in Germany, and since 1 995, when new cases have been published in France, Italy, the United Kingdom and the Netherlands, including the appearance of 900 cases in a bank in Brussels [2]. In Spain, the first cases appeared in 2007, causing a health scare with great media coverage among the working population in Catalonia, and cases were subsequently reported in other autonomous communities [4]. Although there is insufficient scientific evidence on the causes, in the studies reviewed, it is associated with repeated microtrauma due to repeated pressure from office furniture, tight clothing, electromagnetic fields and static electricity (work environment factors such as low relative humidity and the influence of computer equipment and wiring) [5].

Figure 1

Common characteristics and a Etiology

Most of the cases described have the following common features:

• The incidence is not universal. Not all workers in the same building are affected, but it is common to find several cases in the same group.
• It is usually associated with office work with computer equipment, although not always administrative (also cleaning and maintenance).
• Most cases have occurred in modern buildings Most cases have occurred in modern buildings — smart, airtight, lacking natural ventilation, or smart, airtight, lacking natural ventilation, or following changes or moves to new buildings equipped with new furniture and/or renewal of IT following changes or moves to new buildings equipped with new furniture and/or renewal of IT equipment.
• In most cases, a significant reduction in the relative humidity of the environment has been observed, and it is common for affected workers to report frequent episodes of electrostatic discharges in their work area.
• Once the environmental conditions or factors have been corrected, the clinical signs of lipoatrophy progressively disappear between 9 months and 4 years.
• It is predominantly observed in women, who are more susceptible to accumulate electrostatic charges, possibly due to a laxer structure of the superficial adipose tissue.
• Affected workers do not present other general alterations. • There is no current scientific evidence of specific effects on the embryo or foetus in case of pregnancy.

Causal Hypothesis

There is insufficient scientific evidence on the causes of LSOL. However, the main risk factors identified, and which should be prevented from the design of workstations are: microtrauma due to repeated pressure on the affected area, low relative humidity and electromagnetic fields [6-8]:

1. Low relative humidity below 45% (objectively measurable).
2. Presence of electrostatic charge higher than 2 KV (objectifiable)
3. Electromagnetic fields of weighted values with respect to the limit curve of the ICNIRP98 (International Commission on Non-Ionizing Radiation Protection) limit curve for the public > 100% (objectifiable)
4. Pressure, compression in injury areas (subjective objective) The current hypothesis on the causes of LSOL is based on the induction of lipolysis by electric and magnetic fields generated by computer equipment and its cabling. The greater or lesser presence of lipoatrophy in other areas would be due to the different bioelectrical properties of the skin, depending on the region. Is possible that electrical stimulation of macrophages causes a release of tumour necrosis factor (TNF α) that would damage adipocytes and facilitate lipid phagocytosis.

Diagnosis

SLOO is currently considered to be primarily diagnosed clinically (visual inspection and palpation of the skin lesion) and has no evaluated complementary diagnostic test that would substantially improve the diagnosis. In cases of suspected SLOO, when visual inspection and palpation are doubtful, a new examination should be performed a few weeks after the first visit to confirm or rule out the diagnosis.

Treatment

There is no specific treatment. The lesions reverse after elimination of the triggering factors [5,8-12]:

Ensure a relative humidity level of not less than 50% throughout the working day.

• Avoid contact with the edges of worktable tops by re viewing the design and work procedures. Adjust the height of the chair to avoid contact of the thighs with the tables, by resting the feet on the floor or footrest. Do not rest your feet on the legs of the chair.
• Avoid materials that generate or accumulate static electricity. Antistatic products can also be applied to surfaces susceptible to retaining electrostatic electricity (chairs, tables, etc.) in the form of a spray or varnish.
• Improve the electrical insulation of the wiring with respect to the metal structures of the furniture. Collect all electrical cables that may be under the tables and remove any cables that may be in contact with the tables.
• Replace thin edges with rounded edges. This would increase the contact surface. This would increase the contact surface and reduce the intensity of the shock.
• Get up from the chair and walk around at least every hour.
• Maintain good, seated ergonomics.

Do not wear fabrics with artificial fibres (acrylic) when the accumulation of static electricity is important and avoid tight fitting clothing as far as possible.
• Maintain good hydration with water.
Most cases show progressive resolution over a period ranging from 3 months to 4 years.

Material and Method

Proposed Assessment and Anamnesis

Take a medical history with assessment of pathological antecedents in order to determine other pathologies that may be related to semicircular lipoatrophy, such as systemic panniculitis, scleroderma, lipoatrophy caused by antiretrovirals, or by injection of insulin or corticoids; the latter are compatible with linear skin atrophy and hypopigmentation due to this intra articular injection given the antiproliferative effect that alters the metabolism of the proteins of the extracellular matrix (3,4). There is no evidence of personal history that could be relevant. However, some studies link a congenital defect of the lateral femoral circumflex artery as a predisposing factor. It is important to detail the characteristics of the onset of the lesions, time of onset, coexistence with other symptoms and whether similar lesions were previously present and their evolution, as well as the involvement of other coworkers. If a case of lipoatrophy is detected, information should be sought on the areas frequented by the affected person affected person [4,8,11,13]

• Air conditioning, ventilation, and humidification system.
• Electrical installation around the table where the case occurred. In this case
• The installation is understood to include the wiring of any consumer appliances that may be present.
• Type of flooring and treatments carried out.
• The presence of telecommunications signal amplifiers or possible emitters of electromagnetic fields.
• Electromagnetic fields.
• Shape of the furniture with which it is in contact. Observing the edges and checking for the presence of wiring inside.
• Check that chairs have antistatic treatment.
• Checking that work equipment is in good condition (operation, earthing, appearance, etc.).
• Check that work equipment is in good condition (operation, earthing, appearance, etc.).
• Check that the relative humidity of the air is at least 50%.
• When it is considered that the values of electromagnetic fields may be higher than those of the European regulations, it will be necessary to measure in the spaces closest to the person affected.
• Electrostatic charges should be measured when occupants report electrostatic discharges. The aim is to ensure that the person concerned does not become electrostatically charged or frequently discharged.
• The conductivity of materials in space should be checked to ensure that they assist in dissipating electrostatic charges [14,15].

Results

After the collection of data based on health risk factors such as physical, chemical, biological factors or due to situations in the building or construction and the environment and workplace and their influence on the clinical variables and the occurrence of injuries, the following proposal for a clinica l data collection form has been detailed (Table 1).

Table 1:

Conclusion

When dealing with semicircular lipoatrophy of occupational origin, it is important to consider the health risk factors that may have led to its development and its consequences, which can be found in documentation produced by official bodies (WHO, State Public Health Agencies, etc.). These factors are sometimes intangible to the naked eye, but they affect our health, their effects are rarely immediate, and it is difficult to associate them with any symptomatology. Based on the exposure risk factors and the results of the checks and data collected, technical proposals for correction can be established to be taken into account in the development of the work activity in the work environment and workplace.

For More Articles: Biomedical Journal Impact Factor: https://biomedres.us