To investigate the extent to which seizure control and the occurrence of fetal malformation in an initial pregnancy can serve to anticipate the outcome in the next pregnancy. We analyzed the records of the Raoul Wallenberg Australian Register of Antiepileptic Drugs in Pregnancy for seizure control and fetal malformation data for women with epilepsy taking antiseizure medication in consecutive pregnancies. Seizure freedom rates throughout pregnancy were higher in the subsequent pregnancy than in the initial one (60.8% vs. 52.9%; RR 1.15, 95% CI 1.03, 1.28), particularly when the nature of antiseizure therapy was unchanged between pregnancies. Fetal malformation occurrence rates (5.9% and 6.2%, respectively) were similar, but tended to be higher in women with generalized rather than focal epilepsies (7.9% vs. 4.28%; RR 1.84, 95% CI 0.89, 3.81). If a small cohort with fetal malformations in both the initial and subsequent pregnancies (7 women, 8 pairs of pregnancies) was excluded, the RR value was smaller (1.24). All but one woman in this cohort had generalized epilepsies. The birth of a malformed baby tended to occur more frequently in the next pregnancy for women with generalized epilepsy and a malformed baby in the previous pregnancy than in similar women with focal epilepsies (50% vs. 7.7%; RR 6.5, 95% CI 0.92, 45.1). Compared with women with focal epilepsies, antiseizure medication-treated women with generalized epilepsy who give birth to a malformed baby appear to have a substantially greater risk of another malformed baby in their next pregnancy. Overall, seizure freedom rates were higher in subsequent pregnancies than in initial ones.
Ribociclib, a CDK4/6 inhibitor, is vital in the management of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer. However, drug-induced pneumonitis is a rare but serious adverse effect that requires timely identification and intervention. Our case presents a 66-year-old woman with stage IV metastatic breast cancer on ribociclib presenting with a two-month history of worsening dry cough and progressive dyspnea. Computed tomography of the chest revealed bilateral interstitial lung changes. Bronchoalveolar lavage ruled out infectious causes, and pulmonary function tests indicated a restrictive pattern, all supporting the diagnosis of drug-induced pneumonitis. Discontinuation of ribociclib and initiation of corticosteroid therapy rapidly improved the patient's symptoms, and by the time of her discharge, her oxygen saturation was stable. This case emphasizes the importance of early recognition of pneumonitis in patients on CDK4/6 inhibitors. Clinicians should maintain vigilance for pulmonary symptoms and consider rapid intervention to prevent severe outcomes.
Colonoscopy is a key diagnostic and therapeutic procedure in gastrointestinal practice, although rare complications such as post-colonoscopy appendicitis (PCA) may occur. We report the case of a 61-year-old woman who presented 24 hours after a screening colonoscopy with severe diffuse abdominal pain, fever, nausea, vomiting, and watery diarrhea. The procedure had been complicated by poor bowel preparation, with a Boston Bowel Preparation Score of 1-2-1 (right colon, transverse colon, and left colon, respectively; scores range from 0 to 3 per segment, with 0 indicating an unprepared colon and 3 indicating perfectly clean mucosa). Abdominal computed tomography (CT) revealed phlegmonous acute appendicitis with abscess formation and a calcified fecalith, in a pelvis-projecting appendix with a medial cecal position. An open appendectomy was performed, given the complex intraoperative findings and unfavorable anatomy for laparoscopic access. The patient recovered uneventfully and was discharged the following day. This case highlights the convergence of poor bowel preparation, fecalith impaction, and complicated appendicitis as a mechanistically informative triad and underscores the importance of maintaining a low threshold for CT imaging in patients with new abdominal symptoms following colonoscopy.
Endoscopically assisted surgery for parathyroid tumors has provided excellent cosmetic results and has been covered by Japan's national insurance system since 2016. However, careful handling is essential because parathyroid tumor cells can easily disseminate. We herein report the case of a 34-year-old woman who developed widespread dissemination of parathyroid carcinoma after endoscopic resection. She initially underwent endoscopically assisted left thyroid lobectomy for an intrathyroidal parathyroid tumor, which was later diagnosed as a carcinoma. Four years later, multiple cervical recurrences and pulmonary metastases were observed. Extensive cervical tumor resection was performed, including en bloc removal of the invaded structures, followed by resection of lung metastases. Despite temporary improvement, the disease progressed. Genomic profiling revealed a CDC73 mutation and high tumor mutation burden. Pembrolizumab therapy achieved temporary stabilization but was eventually ineffective. The patient died during palliative care. This case highlights the risk of tumor cell dissemination in parathyroid surgery when capsular integrity is compromised. While this risk exists regardless of the surgical approach, certain technical factors associated with endoscopically assisted procedures may increase the likelihood of inadvertent capsular injury. Complete en bloc resection during the initial operation is essential for parathyroid carcinoma, because incomplete resection leads to poor prognosis. When carcinoma is suspected intraoperatively, surgeons should consider open surgery. Comprehensive genomic profiling may provide therapeutic options such as immune checkpoint inhibitors for recurrent or metastatic cases.
Dyspeptic symptoms associated with chronic belching may substantially affect quality of life and can be challenging to manage in clinical practice. We report the case of a 40-year-old nulligravid woman with depressive disorder, bilateral cochlear implants due to deafness, a hiatal hernia, and a previous pulmonary embolism. Her medications included desvenlafaxine, multiple benzodiazepines, mirtazapine, trazodone, and apixaban. She presented with an 18-month history of persistent belching, heartburn, early satiety, and intermittent dry cough, severely impairing her quality of life and leading to social isolation. Additionally, her symptoms intensified during anxiety and depressive episodes. Physical examination was unremarkable, and upper gastrointestinal endoscopy revealed only a small hiatal hernia and mild gastropathy, with no evidence of Helicobacter pylori infection. Despite repeated medical evaluations and multiple therapeutic approaches, including proton pump inhibitors, sucralfate, domperidone, simethicone, and bilastine, symptoms persisted without significant improvement. Functional dyspepsia was therefore suspected, and treatment with baclofen 10 mg twice daily was initiated, resulting in significant clinical improvement and enhanced quality of life. This report highlights the potential benefit of baclofen in patients with persistent belching and dyspeptic symptoms refractory to conventional therapy, particularly in the context of psychiatric comorbidity.
Mediastinal displacement toward the side of lung volume loss is a well-recognized radiographic feature of atelectasis. Significant mediastinal shift most commonly occurs when larger lung segments, such as the right upper or lower lobes, collapse. Because the right middle lobe (RML) contributes a relatively small proportion of total lung volume, isolated RML collapse typically produces minimal mediastinal deviation. The case in this report is of an 83-year-old woman with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF), who presented with progressive dyspnea and increased oxygen requirements. Chest radiography demonstrated opacification of the right middle lobe with marked rightward displacement of the cardiac silhouette. Computed tomography (CT) of the chest confirmed isolated collapse of the right middle lobe with rightward mediastinal and cardiac displacement, without involvement of the right upper or lower lobes. Bronchoscopy revealed narrowing of the right middle lobe bronchus due to floppy cartilage consistent with bronchomalacia and no evidence of endobronchial mass or malignancy. The patient improved with conservative medical management, including diuresis, bronchodilators, and pulmonary hygiene. This case demonstrates that isolated RML collapse can produce significant mediastinal and cardiac displacement. Clinicians should recognize that even the collapse of relatively small lung segments may generate substantial radiographic shift, particularly in patients with underlying airway structural abnormalities or pulmonary hyperinflation.
Uterine leiomyomas are the most common benign neoplasms in women, typically driven by mutations in MED12. We report the case of a 68-year-old woman with a history of uterine fibroids who underwent a total laparoscopic hysterectomy. Microscopically, the tumor was a benign-appearing spindle cell neoplasm with focal edema, hyaline plaques, and hemorrhage, but lacking high-grade atypia, tumor cell necrosis, or significant mitotic activity. Immunohistochemistry was consistent with a smooth muscle origin (positive for desmin and smooth muscle actin (SMA), negative for CD10). Due to its unusual features on imaging, next-generation RNA sequencing was performed, which identified a novel BRAF::ABCB1 fusion secondary to t(7;7)(q34;q21.12). This case describes a new, potentially targetable molecular alteration in a uterine leiomyoma, distinct from the common MED12-mutated pathway, highlighting the underlying molecular heterogeneity of these common tumors.
Cytomegalovirus (CMV) infection is a leading cause of congenital infection and neonatal morbidity. Conventional diagnostic methods, such as polymerase chain reaction (PCR) and amniocentesis, remain important in the diagnosis of congenital CMV infection, although each method has its own limitations in clinical practice. A 31-year-old woman, gravida 3 para 1, presented for routine prenatal evaluation. At 18 weeks of gestation, ultrasound revealed echogenic bowel and fetal ascites. Amniocentesis at 19 weeks showed normal chromosomal results, but targeted next-generation sequencing (tNGS) detected CMV DNA with a high viral load, confirming intrauterine infection. Despite counseling regarding poor fetal prognosis, the patient chose to continue the pregnancy under close ultrasound surveillance. Progressive hydrops fetalis was observed at 23 weeks, and the pregnancy was terminated at 24 weeks. This case suggests that combining tNGS with ultrasound may provide complementary diagnostic information in selected cases of suspected fetal infection. In this patient, tNGS supported the identification of CMV in amniotic fluid when conventional genetic testing was unremarkable. However, as this is a single-case report, the broader diagnostic performance and clinical utility of tNGS require further validation in larger studies.
A 63-year-old woman presented with acute quadriparesis and severe hypokalemia (2.07 meq/L) secondary to distal renal tubular acidosis (dRTA), which was later attributed to primary Sjögren's syndrome (SS). Brain MRI revealed a characteristic trident-shaped hyperintense lesion in the central pons on T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, consistent with central pontine myelinolysis (CPM). The patient had no history of rapid sodium correction, suggesting hypokalemia as the primary trigger for CPM. She was treated with intravenous potassium replacement and intravenous methylprednisolone, followed by oral steroids and hydroxychloroquine. Her neurological symptoms resolved completely within one month, and follow-up MRI showed only residual gliosis. This case highlights two rare neurological manifestations of SS - hypokalemic paralysis and CPM - both resulting from electrolyte disturbances rather than direct autoimmune-mediated nerve damage. While peripheral neuropathy is the most common neurological complication of SS, central nervous system involvement, particularly CPM, is exceedingly rare. This report emphasizes the importance of considering SS in patients with unexplained hypokalemia and acute neurological deficits, as timely diagnosis and treatment can lead to favorable outcomes.
Euglycemic diabetic ketoacidosis (EDKA) is an uncommon but serious metabolic complication in pregnancy, where physiologic changes promote ketone production even without marked hyperglycemia. We report the case of an 18-year-old woman at 35 weeks and 4 days of gestation with type 1 diabetes mellitus and severe preeclampsia who developed intraoperative cardiac arrest during an emergent cesarean delivery. She had been nonadherent with insulin therapy for more than seven days before admission. Initial laboratory evaluation demonstrated metabolic abnormalities despite normoglycemia. During cesarean delivery, inadequate epidural anesthesia required rapid sequence intubation. Following delivery and administration of tranexamic acid for hemorrhage control, the patient developed progressive bradycardia, hypotension, and pulselessness. Cardiopulmonary resuscitation was initiated, and return of spontaneous circulation occurred within one minute. Post-arrest laboratory studies revealed severe metabolic acidosis, markedly low bicarbonate, elevated anion gap, and ketonuria consistent with EDKA. Magnesium levels were elevated but below thresholds typically associated with severe toxicity. This case highlights how overlapping obstetric, anesthetic, and metabolic stressors can obscure the diagnosis of EDKA and precipitate acute cardiovascular instability. Early recognition of acid-base disturbances and prompt multidisciplinary management are essential in high-risk obstetric patients, particularly when insulin omission and advanced gestation increase susceptibility to ketosis.
Polycystic ovary syndrome (PCOS) is one of the main causes of anovulatory infertility in women of reproductive age. The main ovulation induction protocols currently used in clinical practice primarily include letrozole, clomiphene, and gonadotropins. However, some patients may exhibit drug resistance or experience ovarian hyperstimulation syndrome (OHSS). In this article, we report a case of a 28-year-old patient with PCOS who had a normal body mass index (BMI) and normal level of luteinizing hormone (LH), failed to conceive with letrozole combined with human menopausal gonadotropin (HMG) but achieved successful ovulation and pregnancy with pulsatile gonadotropin-releasing hormone (GnRH) pump therapy, without OHSS or other adverse effects. This case demonstrates the potential efficacy of pulsatile GnRH pump therapy in PCOS patients who have failed to conceive with conventional ovulation induction, suggesting its potential as a promising alternative in clinical management.
Somalia continues to face an exceptionally high burden of maternal mortality within a fragile health system shaped by prolonged conflict, infrastructure constraints, workforce shortages, and uneven access to emergency obstetric services. Safe obstetric and emergency anesthesia is a critical but often underexamined component of this challenge. This article is an evidence informed commentary based on published literature, organizational reports, and contextual clinical experience in anesthesia practice in Somalia. Key concerns include shortages of trained anesthesia personnel, inconsistent access to oxygen, monitoring, blood products, drugs, and postoperative critical care, as well as weak governance and limited standardization of practice. In obstetric emergencies, these gaps may amplify the risks associated with difficult airway management, aspiration, spinal hypotension, delayed transfusion, hemorrhagic shock, and perioperative deterioration. This commentary argues that anesthesia safety should be treated as an essential component of maternal and emergency care quality in fragile settings. Practical priorities include strengthening nonphysician anesthesia training with supervision, continuing professional development, expanding access to minimum monitoring and oxygen systems, improving preparedness for airway and hemorrhage emergencies, and embedding anesthesia within national surgical and maternal health planning. Nationally compiled Somalia-specific data remain limited in the accessible published literature, but the available evidence is sufficient to support urgent, evidence-informed action.
A body of literature consistently highlights that women from minority cultures have been an underserved group in cervical screening. We aimed to report the development and psychometric assessment of the Cervical Cancer Screening Beliefs Questionnaire (CCSBQ), a culturally sensitive questionnaire for measuring immigrant women's beliefs, knowledge, and attitudes towards cervical cancer and its screening. A convenience sample of 871 women, recruited from various ethnic organizations for this study, was split into 2 sets for development and validation of the CCSBQ. Items for the questionnaire were drawn from a literature review and a preliminary study conducted by the team. A panel of professional experts and lay women evaluated face and content validity. Multi-trait analysis and Cronbach's alpha were used to assess its factor structure, convergent-divergent validity, internal consistency and construct validity. A17-item, 3-subscale version of the CCSBQ was formed. Psychometric examination confirmed its 3-factor structure. All items showed a correlation coefficient ≥0.39 with its subscale score. Cronbach's alpha of the 3 subscales ranged from 0.71 to 0.88. Women, who had ever heard of cervical cancer and cervical screening, and screening participation, including ever attended, attended in the last 5 years as recommended and having intention to attend in the near future, had more proactive attitudes to health check-ups, better knowledge about cervical cancer and its screening, and perceived fewer barriers to cervical screening. The CCSBQ is culturally appropriate, valid and reliable for measuring immigrant women's attitudes, beliefs, and knowledge about cervical cancer and its screening practice.
Mammary duct ectasia is a benign breast condition that can mimic malignancy on MRI. We describe a woman with a pathogenic RAD51C variant who entered high-risk MRI surveillance at age 53 and was found to have segmental non-mass enhancement in the central left breast. MRI-guided core biopsy demonstrated duct ectasia with inspissated eosinophilic secretions, dense periductal lymphoplasmacytic inflammation with concentric fibrosis, and coarse microcalcifications without epithelial atypia or carcinoma. Her history included hyperprolactinemia from a growth hormone- and prolactin-positive pituitary adenoma diagnosed at age 41 and treated surgically, raising the possibility of an endocrine contribution to ductal dilatation and secretory stasis. This case emphasizes the importance of radiologic-pathologic correlation to avoid overdiagnosis while highlighting a potential link between long-standing hyperprolactinemia and mammary duct ectasia in susceptible patients.
High-porosity nanoporous separators exhibit fast ion conduction and homogeneous Li+ ion distribution, which are advantageous for effective dendrite suppression in Li-metal batteries. However, their controlled fabrication of highly porous nanostructures in thin film form remains challenging. Hence, the present study reports on the phase-separation-induced self-assembly of highly porous 3D aramid nanofiber (ANF) separators decorated with gelatin nanospheres (GNFs) for use in Li-metal batteries. During this process, the gelatin nanospheres are spontaneously self-assembled onto the ultraporous ANF matrix in order to minimize interfacial energy. The resulting nanoporous GNF separator exhibits high porosity (> 60%) along with preferential affinity toward PF6 - anions, thereby achieving a high Li+ cation conductivity (σ+) of 0.69 mS/cm. Notably, this conductivity is 4 times greater than that of commercial Celgard and 28 times greater than that of the gelatin-free ANF sample. The enhanced ionic conductivity and homogeneous ion distribution promote effective dendrite suppression for Li-metal anodes by the formation of stable solid electrolyte interphase layers. Resultantly, Li half cells with GNF separators show improved cycling stability, low overpotentials, and high coulombic efficiency. The Li/LiNi0.8Co0.1Mn0.1O2 full cell exhibits enhanced cycle performance even at 4.5 V, further enabled by the transition-metal ion capture capability from the gelatin nanospheres.
The utilization of the intrauterine device (IUD) in Indonesia remains low at 3.9%, despite its high effectiveness (99.4%) and designation as a national family planning priority, suggesting the presence of psychosocial barriers influencing contraceptive behavior among women of reproductive age. This study aimed to analyze psychosocial factors influencing IUD use behavior based on the theory of planned behavior, including attitudes, subjective norms, perceived behavioral control, actual behavioral control, and intention, in Banda Aceh-the only province in Indonesia implementing holistic Sharia law. A quantitative cross-sectional study was conducted among women of reproductive age from six urban public health centers using cluster random sampling. Data were collected through face-to-face interviews using a structured TPB-based questionnaire validated for reliability. Statistical analyses included linear regression and binary logistic regression with a significance level set at p < 0.05. A total of 442 women were included in the final analysis. Attitude toward IUD use, subjective norms, and perceived behavioral control were all significantly associated with intention to use an IUD; all had p < 0.001. Attitudes toward IUD use (B = 0.410; p < 0.001; R2 = 0.213), subjective norms (B = 0.552; p < 0.001; R2 = 0.413), perceived behavioral control (B = 0.273; p < 0.001; R2 = 0.255), and actual behavioral control (B = 0.273; p < 0.001; R2 = 0.255) were all significantly associated with IUD use behavior. Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B = 0.780; p < 0.001; R2 = 0.566). Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B = 0.78; p < 0.001; R2 = 0.56). This study highlights that all intentions were shaped by positive attitudes, strong subjective norms, and a high level of behavioral control. Efforts to increase IUD use should therefore focus on educational interventions, strengthening partner and social support, and improving the accessibility and quality of long-acting contraceptive services.
Pelvic organ prolapse (POP) is a common pelvic floor disorder in postmenopausal women, yet no biomarkers currently exist to predict its development. This study aimed to investigate the relationship between sex hormone levels, particularly androgens, and the severity of POP in postmenopausal women. We conducted a prospective observational study including 109 postmenopausal women with POP and 66 age-matched women without POP (control group) at Saga University Hospital. POP severity was classified using the Pelvic Organ Prolapse Quantification (POP-Q) system. Salivary free testosterone and 17β-estradiol were measured, along with serum dehydroepiandrosterone sulfate (DHEA-S), using enzyme-linked immunosorbent assays. Clinical characteristics and lower urinary tract symptoms were also assessed. Statistical comparisons were performed using t-tests, Chi-square tests, and Pearson correlation analysis. The POP group had significantly higher BMI and parity and reported more severe lower urinary tract symptoms than the control group. Salivary free testosterone levels were significantly decreased, and serum DHEA-S levels were significantly increased in the POP group (p = 0.0157 and p = 0.0082, respectively), while estradiol levels showed no significant difference. Advanced POP (stages III-IV) was associated with further reductions in free testosterone. DHEA-S levels were unexpectedly higher in POP stages II and III compared to controls. Reduced levels of circulating androgens, particularly Salivary free testosterone, may be associated with POP development and severity. Salivary free testosterone could serve as a non-invasive biomarker for POP risk stratification. Further longitudinal and multi-institutional studies are needed to clarify the role of androgens in POP pathophysiology.
Recurrent cystitis is a common problem in women that substantially impairs quality of life and contributes to increasing healthcare costs. Traditionally regarded as an ascending infection originating from the gut, recurrent cystitis is now increasingly understood as a disorder rooted in vaginal dysbiosis, with the vagina acting as a key reservoir for uropathogenic Escherichia coli. Loss of a Lactobacillus-dominant vaginal microbiota and overgrowth of enteric and anaerobic bacteria are strongly associated with recurrent cystitis, particularly in postmenopausal women. Lactobacillus species promote vaginal health by producing lactic acid, maintaining a low pH, generating antimicrobial compounds, inhibiting pathogen adhesion, and modulating mucosal immune responses. At the same time, long-term antimicrobial prophylaxis, although effective in reducing recurrences, is limited by adverse effects and the promotion of antimicrobial resistance. These concerns have driven interest in strategies that restore the protective vaginal ecosystem rather than relying on repeated antimicrobial exposure. This narrative review summarizes current concepts linking vaginal dysbiosis to recurrent cystitis, highlights the protective role of Lactobacillus, and synthesizes clinical data on Lactobacillus vaginal suppositories, particularly Lactobacillus crispatus (L. crispatus)-based preparations, as a targeted, non-antimicrobial prophylactic option. Across pilot, phase II, and randomized trials, Lactobacillus vaginal therapy has demonstrated a generally favorable safety and tolerability profile, with preliminary evidence suggesting a potential to reduce recurrent cystitis episodes while restoring a Lactobacillus-dominant vaginal microbiota. However, larger, standardized studies are still needed. Collectively, these findings provide a rationale for investigating Lactobacillus vaginal suppositories as a microbiome-informed, non-antimicrobial strategy for the long-term prevention of recurrent cystitis, particularly in postmenopausal and other high-risk women, and highlight the importance of further research to define the role of vaginal microbiota-directed therapies in future recurrent cystitis management. How vaginal bacteria may contribute to repeated bladder infections: a review of Lactobacillus vaginal suppositories to help prevent recurrence What is this review about? This review examines how changes in vaginal bacteria may contribute to recurrent cystitis (repeated bladder infections) and whether Lactobacillus vaginal suppositories could help prevent infections from returning. Why does the vagina matter? Long-term antibiotics may cause side effects and contribute to antibiotic resistance, so non-antibiotic options are being explored. Increasing evidence suggests the vagina can act as a reservoir for bacteria such as Escherichia coli. When vaginal balance is disrupted ("vaginal dysbiosis"), protective Lactobacillus bacteria may decrease, allowing harmful bacteria to persist and ascend to the bladder. What did we do and find? We summarized studies linking vaginal microbiota patterns to recurrent cystitis and reviewed clinical research on Lactobacillus vaginal products, including Lactobacillus crispatus. The available trials are still limited in number and vary in design and population, but they suggest a generally favorable safety and tolerability profile for these suppositories, with preliminary evidence of a potential to reduce recurrences and help restore Lactobacillus-dominant vaginal communities. The overall evidence base, however, remains limited by small sample sizes and differences between studies. What do these findings mean? These findings provide a rationale for further investigation of Lactobacillus vaginal suppositories as a microbiome-informed, non-antibiotic strategy for preventing recurrent cystitis. Larger, well-standardized clinical trials are needed to confirm their benefit and determine optimal dosing and duration.
Endometriosis affects approximately 10-15% of reproductive-age women and up to 70% of those with chronic pelvic pain, with diagnosis typically relying on invasive laparoscopy with histopathological confirmation. Cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) are central mediators of the inflammatory and angiogenic pathways underpinning endometriosis pathogenesis, making them promising candidates for non- invasive biomarkers. This study aimed to analyze the correlation between serum COX-2 and VEGF concentrations and endometriosis severity to evaluate their potential utility as non-invasive biomarkers. A cross-sectional study was conducted among women with confirmed endometriosis at Dr. Zainoel Abidin General Hospital in Banda Aceh, Indonesia, in 2025. Peripheral blood samples were collected preoperatively, and serum COX-2 and VEGF concentrations were quantified using ELISA. Endometriosis severity was classified according to the American Society for Reproductive Medicine staging system. Correlation analyses were performed to assess associations between biomarker levels and disease stage, and diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis to determine the area under the curve (AUC) values, optimal cut-off points, sensitivity, and specificity. Twenty-eight patients were included, with the mean COX-2 and VEGF levels being 1.16 ± 1.28 ng/mL and 266.50 ± 72.91 pg/mL, respectively. VEGF demonstrated a strong and statistically significant correlation with endometriosis staging (r = 0.744, p < 0.001), while COX-2 showed a limited correlation that did not reach statistical significance (r = 0.367, p = 0.055). The ROC analysis further highlighted VEGF's superior diagnostic performance, with an AUC of 0.975 (95%CI: 0.926-1.000, p < 0.001) compared with COX-2 (AUC 0.734; 95%CI: 0.518-0.950, p = 0.057). The optimal VEGF threshold of 221 pg/mL yielded 90% sensitivity and 100% specificity, whereas the COX-2 threshold of 0.675 ng/mL provided 80% sensitivity and 62.5% specificity. These findings indicate that VEGF is a highly promising non-invasive biomarker for assessing endometriosis severity and may support the development of improved diagnostic approaches for endometriosis management.
The article published in this issue of the journal titled "Examining implementation of health exception laws in six countries"1 arrives at a critical juncture in global reproductive health discourse. Across much of the developing world, abortion law - often framed around narrow "health exceptions" - exist in statute but fail in practice. This disjuncture between legal permission and lived access is not merely a technical gap; it is a profound social justice failure with implications for women's health, autonomy, and dignity. Health exception laws typically allow abortion where a woman's physical or mental health is at risk. In theory, they represent a compromise between restrictive legal regimes and broader reproductive rights and social justice. However, evidence consistently shows that legal allowances alone do not guarantee access. Comparative research demonstrates that in many countries, even where abortion is technically legal under health grounds, women are denied services due to poor implementation, lack of guidelines, and restrictive interpretations.2This important article in this issue of the journal extends this insight through a six-country comparative lens, echoing earlier multi-country analyses such as the study by Wendy Chavkin and colleagues3, which examined reforms and implementation strategies across diverse settings including Ethiopia, Ghana, and South Africa. Together, these studies reinforce a crucial point: the effectiveness of abortion law lies not in its wording, but in its operationalization. L’article publié dans ce numéro de la revue, intitulé « Examen de la mise en œuvre des lois d’exception pour raisons de santé dans six pays »¹, arrive à un moment critique du débat mondial sur la santé reproductive. Dans une grande partie des pays en développement, le droit à l’avortement – souvent fondé sur des « exceptions pour raisons de santé » restrictives – existe dans la loi, mais reste inapplicable dans la pratique. Ce décalage entre l’autorisation légale et l’accès réel à l’avortement n’est pas qu’une simple lacune technique ; il s’agit d’une profonde injustice sociale qui a des conséquences sur la santé, l’autonomie et la dignité des femmes. Les lois d’exception pour raisons de santé autorisent généralement l’avortement lorsque la santé physique ou mentale de la femme est en danger. En théorie, elles représentent un compromis entre les régimes juridiques restrictifs et les droits reproductifs plus larges, ainsi que la justice sociale. Cependant, les faits montrent systématiquement que les autorisations légales, à elles seules, ne garantissent pas l’accès à l’avortement. Des recherches comparatives démontrent que dans de nombreux pays, même lorsque l'avortement est techniquement légal pour des raisons de santé, des femmes se voient refuser l'accès à ce service en raison d'une mauvaise mise en œuvre, d'un manque de directives et d'interprétations restrictives.² Cet article important, publié dans ce numéro de la revue, approfondit cette analyse à travers une étude comparative menée dans six pays, faisant écho à des analyses multinationales antérieures telles que l'étude de Wendy Chavkin et ses collègues³, qui ont examiné les réformes et les stratégies de mise en œuvre dans divers contextes, notamment en Éthiopie, au Ghana et en Afrique du Sud. Ensemble, ces études renforcent un point crucial : l'efficacité de la loi sur l'avortement ne réside pas dans sa formulation, mais dans son application concrète.