1
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Sharma P, Shah J, Sokkary N. A case of image-guided hematometrocolpos drainage requiring tissue plasminogen activator in a pediatric patient. J Surg Case Rep 2024; 2024:rjae006. [PMID: 38379535 PMCID: PMC10877313 DOI: 10.1093/jscr/rjae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 02/22/2024] Open
Abstract
Hematometrocolpos (HMC) is a rare disorder that occurs when an anatomical anomaly like imperforate hymen causes menstrual blood to be retained in the uterus and vagina. There is no standard of care established for HMC beyond urgent vaginoplasty which requires a demanding post-operative course that may not be suited for all pediatric patients. This is a case report of successful use of image-guided percutaneous drainage of HMC with tissue plasminogen activator (TPA) followed by vaginoplasty in a 13-year-old female with lower vaginal atresia. Additionally, this case explores the role of menstrual suppression and the need for individualized guidelines. It emphasizes the potential of image-guided percutaneous drainage with TPA as a promising, less-invasive treatment option for pediatric HMC as well as the impact on follow-up surgery.
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Affiliation(s)
- Pareena Sharma
- Department of Medicine, Medical College of Georgia of Augusta University, 1120 15th St, Augusta, GA 30912, United States
| | - Jay Shah
- Department of Radiology, Emory School of Medicine/Children’s Healthcare of Atlanta, James B. Williams Medical Education Building 100 Woodruff Circle Atlanta, GA 30322, United States
| | - Nancy Sokkary
- Department of Obstetrics and Gynecology, Emory School of Medicine/Children’s Healthcare of Atlanta, James B. Williams Medical Education Building 100 Woodruff Circle Atlanta, GA 30322, United States
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2
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Notice B, Soffer E, Tickle K, Xiang Y, Gee BE, Sidonio RF, Sokkary N, Batsuli G. Assessment of menstrual health in adolescent and young adults with sickle cell disease. Pediatr Blood Cancer 2024; 71:e30727. [PMID: 37845801 DOI: 10.1002/pbc.30727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/19/2023] [Accepted: 10/07/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is associated with hypercoagulability, but adults with SCD also have an increased incidence of bleeding including heavy menstrual bleeding (HMB). HMB is common among adolescent females, but the impact of HMB in pediatric SCD is unclear. The objectives of this study were to examine menstrual health status, knowledge, and quality of life (QOL). METHODS We performed a single-institutional multi-clinic cross-sectional study comprised of a five-part survey in pediatric participants with SCD. The survey included the validated Menstrual Bleeding Questionnaire (MBQ) and Self-administered Bleeding Assessment Tool (Self-BAT). RESULTS Forty-eight participants with a median age of 16 years (range: 12-21 years) completed the study. The mean age at onset of menarche was 13 ± 1.3 years. On the MBQ, 29% reported heavy/very heavy menstrual flow, 61% reported moderate or severe dysmenorrhea, and 96% had menses lasting less than 1 week. The Self-BAT revealed that 42% of participants reported a history of HMB. Participants with severe dysmenorrhea or HMB had higher MBQ scores, corresponding to worse QOL. Despite this, less than 20% of participants had attempted any hormonal therapy for menstrual regulation. The odds of hormonal therapy utilization were comparable among participants on hydroxyurea versus not on hydroxyurea (odds ratio 1.58, 95% confidence interval [CI]: 0.33-7.56). CONCLUSIONS The prevalence of HMB and dysmenorrhea is high among adolescents and young women with SCD. Strategies that incorporate menstrual health assessment into routine medical care in this population would help address this important area of pediatric health.
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Affiliation(s)
- Brittany Notice
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth Soffer
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Kelly Tickle
- Aflac Cancer and Blood Disorder Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Nursing & Allied Health Research & Evidence-Based Practice Department, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Yijin Xiang
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Department of Pediatrics, Biostatistics Core, Emory School of Medicine, Atlanta, Georgia, USA
| | - Beatrice E Gee
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Morehouse School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorder Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Robert F Sidonio
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorder Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Nancy Sokkary
- Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia, USA
| | - Glaivy Batsuli
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorder Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Baldwin MK, Bannow BS, Rosovsky RP, Sokkary N, Srivaths LV. Individualized risk assessment for use of hormone therapy in people with sickle cell disease. Res Pract Thromb Haemost 2024; 8:102297. [PMID: 38249437 PMCID: PMC10797204 DOI: 10.1016/j.rpth.2023.102297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/20/2023] [Indexed: 01/23/2024] Open
Affiliation(s)
- Maureen K. Baldwin
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Oregon Health & Science University, Portland, Oregon, USA
| | - Bethany Samuelson Bannow
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Oregon Health & Science University, Portland, Oregon, USA
| | - Rachel P. Rosovsky
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Division of Hematology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Sokkary
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Department of Obstetrics and Gynecology, Children’s Healthcare of Atlanta/Emory School of Medicine, Atlanta, Georgia, USA
| | - Lakshmi V. Srivaths
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Department of Pediatrics, Gulf States Hemophilia and Thrombophilia Center, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
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Gold S, Huang C, Radi R, Gupta P, Felner EI, Haw JS, Childress K, Sokkary N, Tangpricha V, Goodman M, Yeung H. Dermatologic care of patients with differences of sex development. Int J Womens Dermatol 2023; 9:e106. [PMID: 37671254 PMCID: PMC10473340 DOI: 10.1097/jw9.0000000000000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 08/01/2023] [Indexed: 09/07/2023] Open
Abstract
Background Differences of sex development (DSD or disorders of sex development) are uncommon congenital conditions, characterized by atypical development of chromosomal, gonadal, or anatomic sex. Objective Dermatologic care is an important component of the multidisciplinary care needed for individuals with DSD. This article discusses the most common primary dermatologic manifestations of DSD in addition to the cutaneous manifestations of hormonal and surgical therapies in individuals with DSD. Data sources Published articles including case series and case reports on PubMed. Study selections Selection was conducted by examining existing literature with a team of multidisciplinary specialists. Methods Narrative review. Limitations This article was not conducted as a systematic review. Results In Klinefelter syndrome, refractory leg ulcers and incontinentia pigmenti have been described. Turner syndrome is associated with lymphatic malformations, halo nevi, dermatitis, and psoriasis. Virilization can be seen in some forms of congenital adrenal hyperplasia, where acne and hirsutism are common. Conclusion Dermatologists should consider teratogenic risk for treatments of skin conditions in DSD depending on pregnancy potential. Testosterone replacement, commonly used for Klinefelter syndrome, androgen insensitivity syndrome, 5-alpha reductase deficiency, gonadal dysgenesis, or ovotesticular DSD, may cause acne.
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Affiliation(s)
- Sarah Gold
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Christina Huang
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Rakan Radi
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Pranav Gupta
- Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Eric I. Felner
- Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jeehea Sonya Haw
- Division of Endocrinology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Krista Childress
- Pediatric and Adolescent Gynecology, University of Utah, Primary Children’s Hospital, Salt Lake City, Utah
| | - Nancy Sokkary
- Pediatric and Adolescent Gynecology, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Clinical Resource Hub, Veterans Administration Veterans Integrated Service Network 7 Southeast Network, Decatur, Georgia
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Garland K, Mullins E, Bercovitz RS, Rodriguez V, Connors J, Sokkary N. Hemostatic considerations for gender affirming care. Thromb Res 2023; 230:126-132. [PMID: 37717369 DOI: 10.1016/j.thromres.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 09/19/2023]
Abstract
Gender dysphoria or gender incongruence is defined as "persons that are not satisfied with their designated gender" [1]. The awareness and evidence-based treatment options available to this population have grown immensely over the last two decades. Protocols now include an Endocrine Society Clinical Practice Guideline [1] as well as the World Professional Association of Transgender Health Standards of Care (WPATH SOC) [2]. Hematologic manifestations, most notably thrombosis, are one of the most recognized adverse reactions to the hormones used for gender-affirming care. Therefore, hematologists are frequently consulted prior to initiation of hormonal therapy to help guide safe treatment. This review will focus on the scientific evidence related to hemostatic considerations for various gender-affirming therapies and serve as a resource to assist in medical decision-making among providers and patients.
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Affiliation(s)
- Kathleen Garland
- Children's Minnesota, Minneapolis, MN 55404, United States of America.
| | - Eric Mullins
- Cincinnati Children's Hospital Medical Center and University of Cincinnati-College of Medicine, Cincinnati, OH 45229, United States of America
| | - Rachel S Bercovitz
- Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States of America
| | - Vilmarie Rodriguez
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH 43205, United States of America
| | - Jean Connors
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA 02115, United States of America
| | - Nancy Sokkary
- Children's Healthcare of Atlanta, Atlanta, GA 30308, United States of America
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Baldwin MK, Samuelson Bannow B, Rosovsky RP, Sokkary N, Srivaths LV. Hormonal therapies in females with blood disorders: thrombophilia, thrombosis, hemoglobinopathies, and anemias. Res Pract Thromb Haemost 2023; 7:100161. [PMID: 37274174 PMCID: PMC10238261 DOI: 10.1016/j.rpth.2023.100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/08/2023] [Indexed: 06/06/2023] Open
Abstract
There is widespread use of gonadal steroid hormone therapy for a variety of indications throughout the reproductive and postreproductive lifespan. These therapies may have particular benefits and specific risk among those with blood disorders, including inherited or acquired bleeding disorders, thrombophilia, thrombosis, or anemia. This clinical review is intended to provide a guidance for counseling and management of adolescent and adult biologic females with thrombophilic risk factors and/or thrombosis who require hormonal therapy. In general, synthetic estrogens present in contraceptive products should be avoided in those with a personal or strong family history of thrombosis or thrombophilias. In contrast, natural estrogens present in formulations for climacteric symptom management do not need to be avoided, and vaginal or transdermal formulations are preferred. Likewise, transdermal estradiol is preferred for gender-affirming hormone therapy and requires individualized assessment in those at high risk of thrombosis. Progestogens (either synthetic progestins or naturally occurring progesterone) can be used safely in nearly all patients. There is minimal safety evidence among anticoagulated patients at risk for thrombosis, which requires a patient-specific approach when discussing hormone therapies.
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Affiliation(s)
- Maureen K. Baldwin
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Oregon Health & Science University, Portland, Oregon, USA
| | - Bethany Samuelson Bannow
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Oregon Health & Science University, Portland, Oregon, USA
| | - Rachel P. Rosovsky
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Department of Medicine, Division of Hematology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Sokkary
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Children’s Healthcare of Atlanta/Emory School of Medicine, Department of Obstetrics and Gynecology, Atlanta, Georgia, USA
| | - Lakshmi V. Srivaths
- Women and Girls with Blood Disorders Learning Action Network, Montclair, New Jersey, USA
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center, Gulf States Hemophilia and Thrombophilia Center, Houston, Texas, USA
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7
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Sokkary N, Awad H, Paulo D. Frequency of Sexual Orientation and Gender Identity Documentation After Electronic Medical Record Modification. J Pediatr Adolesc Gynecol 2021; 34:324-327. [PMID: 33333261 DOI: 10.1016/j.jpag.2020.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVE Documentation of sexual orientation (SO) and gender identity (GI) is crucial to identify lesbian, gay, bisexual, and transgender youth and perform meaningful research to improve health disparities in this community. As a result, some electronic medical records (EMRs) have incorporated SO and GI into part of the provider's workflow for documentation. We aimed to evaluate the effect this modification has had on the frequency of SO and GI documentation. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This was a retrospective chart review of patient encounters from an outpatient pediatric and adolescent gynecology clinical practice. The rate of documentation of SO and GI were compared between encounters that took place before the implementation of the EMR modification and those that took place after. Additionally, we examined rates of GI and SO documentation according to visit type and patient race. RESULTS A statistically significant increase in the frequency of SO and GI documentation after the EMR modification was detected. The documentation rate of SO increased from 10/73 (13.7%) to 32/73 (45.1%) (P < .01) and GI documentation rate went from 1.4% to 46.5% (P < .01) after the EMR changes were implemented. SO or GI was most commonly documented in social history (90%). There were no differences in documentation on the basis of race or type of encounter. CONCLUSION Including a specific tab for SO and GI in the EMR significantly increased the frequency of SO and GI documentation. Despite this increase, frequency of documentation remained at less than 50%, emphasizing the need for further improvement.
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Affiliation(s)
- Nancy Sokkary
- Navicent Health Medical Center, Department of Obstetrics and Gynecology, Macon, Georgia; Mercer University School of Medicine, Macon, Georgia
| | - Hamza Awad
- Mercer University School of Medicine, Macon, Georgia
| | - Dillon Paulo
- Mercer University School of Medicine, Macon, Georgia.
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8
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Jaramillo-Huff A, Bakkar R, McKee JQ, Sokkary N. Primary Primitive Neuroectodermal Tumor Arising from an Ovarian Mature Cystic Teratoma in a 12-Year-Old Girl: A Case Report. J Pediatr Adolesc Gynecol 2017; 30:511-512. [PMID: 27919713 DOI: 10.1016/j.jpag.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/08/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Ovarian mature cystic teratomas (MCTs) rarely transform to primary primitive neuroectodermal tumors. This case report offers evidence that MCTs might have undetected microfoci of malignant neural tumors. CASE We describe the case of a 12-year-old girl who presented with right-sided abdominal pain and distention. Intraoperative findings revealed a right ovarian MCT. However, pathology showed a 0.5-cm focus of malignant neural tumor within the 11-cm MCT. SUMMARY AND CONCLUSION This patient will need close follow-up with a multidisciplinary team because the clinical implications of this transformation has yet to be defined.
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Affiliation(s)
| | - Rania Bakkar
- Division of Pediatric and Adolescent Gynecology, Department of Pathology, University of New Mexico Health Science Center, Albuquerque, New Mexico
| | - Jason Q McKee
- Division of Pediatric and Adolescent Gynecology, Department of Pathology, University of New Mexico Health Science Center, Albuquerque, New Mexico
| | - Nancy Sokkary
- Division of Pediatric and Adolescent Gynecology, Department of Pediatric Surgery, University of New Mexico Health Science Center, Albuquerque, New Mexico
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Granada C, Sokkary N, Sangi-Haghpeykar H, Dietrich JE. Labial adhesions and outcomes of office management. J Pediatr Adolesc Gynecol 2015; 28:109-13. [PMID: 25850592 DOI: 10.1016/j.jpag.2014.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 05/10/2014] [Accepted: 06/17/2014] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To evaluate clinical outcomes of labial adhesions (LA) and to examine the association between LA, lichen sclerosus (LS), eczema (ECZ), or asthma. DESIGN Retrospective study. SETTING Single pediatric and adolescent gynecology clinic, Houston, Texas. PARTICIPANTS 50 girls diagnosed with LA from 2006-2011. INTERVENTIONS AND MAIN OUTCOME MEASURES Resolution, recurrence, single vs multiple treatments, need for surgery, and conditions such as LS, ECZ, and asthma were reviewed. RESULTS Mean age was 19.6 months (range 0-84 months), and 48% were Caucasian. Most patients were symptomatic (62%) and all 50 patients chose estrogen treatment. The majority (74%) required multiple treatments, as opposed to a single treatment (26%). Patients with multiple treatments were more likely to be severely agglutinated (P = .05) and to need manual separation after failed topical treatment (P = .08). The prevalence of asthma, LS, and ECZ was 9.8%, 7.8%, and 3.9% respectively. There was no association between LS, ECZ, or asthma, and number of treatments. Both asthma (N = 3; 8%), and LS (N = 2; 5%) were present among the severe agglutinated group; however, this difference was not statistically significant (P values .59 and .99). No association with ECZ was seen in either group. CONCLUSION Severe agglutination tends to be associated with need of multiple treatments and manual separation. A concurrent diagnosis of LS, ECZ, or asthma was not associated with number of treatments but there appears to be a trend towards severity of LA in patients with asthma and LS.
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Affiliation(s)
- Catalina Granada
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
| | - Nancy Sokkary
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, TX; Texas Children's Hospital, Houston, TX
| | | | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology and Pediatrics, Baylor College of Medicine, Houston, TX; Texas Children's Hospital, Houston, TX
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Knight S, Ogburn J, Sokkary N. Contraception and fertility preservation counseling in reproductive-aged women diagnosed with nongynecologic cancer. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sokkary N, Mansouri R, Yoost J, Focseneanu M, Dumont T, Nathwani M, Allen L, Hertweck SP, Dietrich JE. A multicenter survey of contraceptive knowledge among adolescents in North America. J Pediatr Adolesc Gynecol 2013; 26:274-6. [PMID: 23849092 DOI: 10.1016/j.jpag.2013.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 04/08/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To assess knowledge about contraceptive efficacy and side effects in an adolescent population seen in Pediatric and Adolescent Gynecology referral centers. DESIGN This is a multisite cross-sectional survey study. A 23-question survey assessing knowledge of contraception and demographic information was administered. Data analysis was performed using descriptive statistics, simple paired t tests, and chi-square analyses using SAS 9.3. SETTING Pediatric and Adolescent Gynecology clinics in 4 tertiary care centers. The study was conducted in 3 institutions in the United States and 1 institution in Canada. PARTICIPANTS A convenience sample of 354 female patients aged 10-24 y seeking reproductive healthcare at participating institutions. INTERVENTIONS None MAIN OUTCOME MEASURES The percentage of correct answers to questions assessing general knowledge about contraception, familiarity with different contraceptive methods, and comparison of results between study sites. RESULTS The mean percentage of correct answers among all participants was 55.8% ± 17%. Younger participants (age 10-13 years) scored significantly lower than their older counterparts (49%, 55%, and 60% respectively, P < .05). There was no correlation between score and ethnicity or location of the participating site. Subjects reporting the internet as a source of information, those who were sexually active, and those familiar with long acting reversible contraceptives scored significantly higher. Of all contraceptive methods, participants were least likely to have heard of etonogestrel implants (18%), rhythm method/natural family planning (28%), and IUDs (32%). CONCLUSION Adolescents and young adults performed poorly overall demonstrating both the lack of overall knowledge regarding methods of contraception and misinformation about side effects.
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Affiliation(s)
- Nancy Sokkary
- Baylor College of Medicine, Houston, TX; Texas Children's Hospital, Houston, TX.
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12
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Adeyemi O, Sokkary N, Dietrich J. Pubic osteomyelitis resulting in rectovaginal fistula in an adolescent female. J Pediatr Adolesc Gynecol 2013; 26:e9-e11. [PMID: 23332202 DOI: 10.1016/j.jpag.2012.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 09/20/2012] [Accepted: 09/27/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pelvic osteomyelitis is a rare but serious condition that has the potential for systemic and muscular complications if left untreated. The diagnosis is difficult due to the relative rarity of the disease, the difficulty of localizing the site of the infection, and the tendency for the presentation to mimic other disease processes. CASE A 13-year-old female who presented with complaint of severe right lower abdominal pain thought to be related to a hemorrhagic cyst but was found to have pubic osteomyelitis resulting in an abscess and vaginal fistula. CONCLUSION Although rare, pelvic osteomyelitis should be included in the differential diagnosis of pelvic pain.
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Affiliation(s)
- Oluyemisi Adeyemi
- Department of Pediatric and Adolescent Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
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Sokkary N, Granada C, Cunningham T, Dietrich JE. Use of microcatheter for intraabdominal survey. J Pediatr Surg 2012; 47:E25-7. [PMID: 22813827 DOI: 10.1016/j.jpedsurg.2012.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/13/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Laparoscopy is the most common procedure for minimally invasive intraabdominal surveys. Patients with pulmonary hypertension (PHTN) may need an alternate approach because the systemic absorption of carbon dioxide may lead to hypercapnia, acidemia, and increases in systemic and pulmonary pressures. We report a case of intraabdominal survey using a microcatheter trocar (Check-Flo Introducer) in a patient with a large adnexal mass and PHTN. CASE An adolescent girl with severe PHTN and multiple cardiac anomalies presented with oligomenorrhea. During the course of workup, an ultrasound revealed an 8-cm simple cyst in the right adnexa, which required removal. The decision was made to proceed with cystectomy. The patient was not a candidate for laparoscopy, and an alternative method was used. The Check-Flo Introducer, a microcatheter trocar; crystalloid fluid infusion; and a 3-mm laparoscopic camera were used to survey the abdominal cavity, revealing a 10-cm simple paratubal cyst that could be safely drained and removed via a minilaparotomy incision. CONCLUSION The microcatheter trocar is a useful and novel alternative in patients who cannot tolerate increases in intraabdominal pressure.
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Affiliation(s)
- Nancy Sokkary
- Section of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
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Abstract
OBJECTIVE To report our intrapartum experience with routine delivery at 38 weeks of gestation of A-2 diabetic pregnancies requiring primarily oral hypoglycemic therapy. METHODS This retrospective study consisted of 143 consecutive women with gestational diabetes not controlled with diet alone (A-2). Each underwent a routine trial of labor at 38 weeks of gestation. The preinduction condition of the cervix, need for oxytocin, and primary cesarean rates were primary endpoints. For comparison, a control group during that same period consisted of 137 consecutive diet-controlled diabetic (A-1) pregnancies with the same eligibility criteria who underwent expectant management at 38 weeks. RESULTS The study group was more likely to have an unfavorable cervix (75% versus 45%; p < 0.001) and to require oxytocin (76% versus 56%; p < 0.001). Early onset meconium was less common in the study group (3.5% versus 13.1%; p < 0.01). Primary cesarean rates were low and not different between the study and control groups (12.7% versus 11.7%; p < 0.8). The only stillbirth was in the control group and was associated with a tight double nuchal cord encirclement. Mean birth weights and the frequency of birth weights > 4000 g were not different between groups. Shoulder dystocia, low Apgar scores, and admissions to the special care nursery were infrequent in either group. No respiratory difficulties requiring resuscitation or prolonged nursery care were encountered. CONCLUSION Routine delivery at 38 weeks in an A-2 diabetic population is not associated with additional intrapartum morbidity or a greater need for cesarean delivery.
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Affiliation(s)
- William F Rayburn
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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