Development and Assessment of a Patient-Reported Outcome Instrument for Gender-Affirming Care

Importance: There is an urgent need for a validated gender-affirming care-specific patient-reported outcome measure (PROM). Objective: To field test the GENDER-Q, a new PROM for gender-affirming care, in a large, international sample of transgender and gender diverse (TGD) adults and evaluate its psychometric properties. Design, Setting, and Participants: This international cross-sectional study was conducted among TGD adults aged 18 years and older who were seeking or had received gender-affirming care within the past 5 years at 21 clinical sites across Canada, the United States, the Netherlands, and Spain; participants were also recruited through community groups (eg, crowdsourcing platform, social media). The study was conducted between February 2022 and March 2024. Participants had to be capable of completing the instrument in English, Danish, Dutch, or French-Canadian. Eligible participants accessed an online REDCap survey to complete sociodemographic questions and questions about gender-affirming care they had received or sought (ie, to look, function, or feel masculine, feminine, gender fluid, or another way). Main Outcome and Measures: Branching logic was used to assign relevant instrument scales. Rasch measurement theory (RMT) analysis was used to examine the fit of the observed data to the Rasch model for each scale. Test-retest reliability and hypothesis-based construct validity of instrument scales were examined. The hypothesis was that instrument scale scores would increase with better outcomes on corresponding categorical questions. Results: A total of 5497 participants (mean [SD] age, 32.8 [12.3] years; 1837 [33.4%] men; 1307 [23.8%] nonbinary individuals; and 2036 [37.0%] women) completed the field test survey. Participants sought or had the following types of gender-affirming care: 2674 (48.6%) masculinizing, 2271 (41.3%) femininizing, and 552 (10.0%) other. RMT analysis led to the development of 54 unidimensional scales and 2 checklists covering domains of health-related quality of life, sexual, urination, gender practices, voice, hair, face and neck, body, breasts, genital feminization, chest, genital masculinization, and experience of care. Test-retest reliability of the scales (intraclass correlation coefficient [average] &gt;0.70) was demonstrated. Only 1 item (phalloplasty donor flap) had an ICC less than 0.70. As hypothesized, scores increased incrementally with better associated self-reported categorical responses. For example, among 661 participants who reported poor psychological well-being, the mean (SD) scale score was 45 (18) points; for those who reported excellent psychological well-being, the mean (SD) scale score was 85 (16) points (P &lt;.001). Conclusions and Relevance: In this cross-sectional study of 5497 TGD adults, the instrument demonstrated reliability and validity. The instrument was validated in an international sample and is designed to collect and compare evidence-based outcome data for gender-affirming care from the patients' perspective.</p

Neonate with Rare Clinical Presentation of COVID-19: A Report of Two Clinically Distinct Cases

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread across the world. We describe two cases of neonate, presenting with features like multisystem inflammatory syndrome (MIS-C), who presented to our neonatal unit of Dr. M R Khan Shishu Hospital, Bangladesh on August, 2020.Case 1 was a 7-day-old male infant presented at 14 hours of life with fever, poor feeding, per rectal bleeding and shock. Detailed examination revealed Down’s fancies and pallor. Case 2 was 15-day old neonate presenting with fever, rash and convulsion and his laboratory values were remarkable for high levels of C-reactive protein, D-dimer, ferritin and his Cerebrospinal fluid (CSF) findings were consistent with aseptic meningitis. Both babies were tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). First case was very critical and referred to tertiary care hospital after stabilization. 2nd case recovered completely and was discharged to home in 15 days. Though till date COVID 19 in neonate is not very well-known to us, it is essential to disseminate information among the medical community regarding severe and atypical presentations of COVID-19 in neonate as prior knowledge can help to quickly identify and treat these patients as they present in the neonatal department.&#x0D; Bangladesh Journal of Infectious Diseases 2020;7(2):102-106</jats:p

Association of Hyperhomocysteinemia with Early Onset Atherosclerotic Peripheral Arterial Occlusive Diseases

Background: Homocysteine is increasingly recognized as an independent risk factor for vascular disease specially peripheral arterial occlusive diseases. In the present study, an attempt was made to find out the association between the raised fasting plasma total homocysteine level and early onset atherosclerotic peripheral arterial occlusive diseases (PAOD).&#x0D; Methods: In this prospective observational study a total of 50 study subjects were included. All patients were clinically and angiographically documented for atherosclerotic PAOD. All patients underwent surgical intervention as well as estimation of serum total homocysteine level. Arterial segment was sent for histopathological examination to find out whether atherosclerosis was present or not. Patients were divided into two groups- Group-1 included patients of 20-40 years of age and group-II included those of 41-60 years of age. The groups were compared to see association between elevated level of plasma homocysteine and atherosclerotic peripheral arterial occlusive diseases in elderly as well as in early age.&#x0D; Results: 41 (82%) patients were male and 9 (18%) patients were female. Serum homocysteine level was higher in group I than group II (71.4% vs. 40.9%). Besides, the level of mean serum homocysteine level was significantly (p=0.02) higher in group I than group II (21.18±9.53 vs. 17.24±8.92 μmol/L).&#x0D; Conclusion: In conclusion, this study suggests that serum homocysteine has an association with early onset atherosclerotic PAOD. Therefore, a raised serum homocysteine level can be used as an independent biochemical predictor of early onset atherosclerotic PAOD.&#x0D; Cardiovasc. j. 2021; 13(2): 120-127</jats:p

Surgical Management of Vascular Complications in Intravenous Drug Abusers: Experience at the National Institute of Cardiovascular Diseases (NICVD), Bangladesh

Background: Intravenous drug abuse (IVDA) is a global health care problem that has tremendous socio-economic implications. Vascular complications following IVDA are not uncommon and may have serious consequences. At the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, there has been a steady increase in the number of cases with vascular complications of IVDA in the recent years. Objectives: The present study was undertaken to evaluate our surgical strategy for the management of various vascular complications following IVDA. Materials and Methods: Over the last 5 years, a total of 45 patients presented at the NICVD with various complications of IVDA. Thirty seven patients presented at the emergency department with bleeding from ruptured aneurysm or with impending aneurysm rupture. The remaining 8 patients presented at the vascular outpatient with deep venous thrombosis, superficial thrombophlebitis and chronic venous insufficiency. After resuscitation when necessary, excision of aneurysm was done either with simple ligation of the artery (Group A) or with restoration of arterial continuity (Group B). Outcome in the two groups were compared against the following parameters; acute limb ischemia, chronic limb ischemia, wound infection and lymphorrhoea. Results: There was no in-hospital mortality in this series. Both ligation and restoration of arterial continuity following aneurysmectomy were effective in treating the bleeding aneurysm. However, statistically significant differences were seen between the two groups in terms of acute and chronic limb ischemia. Restoration of arterial continuity was more effective in preventing acute and chronic limb ischemia. Conclusions: In Bangladesh, the incidence of IVDA with vascular complications is increasing at an alarming rate. In patients presenting with arterial pseudoaneurysms, surgical management should be aimed at restoration of arterial continuity whenever feasible. Key words: Intravenous drug abuse, Vascular complication, Aneurysm. DOI: 10.3329/cardio.v3i1.6426Cardiovasc. j. 2010; 3(1): 45-49</jats:p

Thoracic Endovascular Aortic Repair (TEVAR): A Case Report

Thoracic aortic aneurysm (TAA) is generally a disease of the elderly which remains mostly asymptomatic. It is often detected incidentally with imaging studies of the chest done for other reasons. We present a 55year-old smoker, normotensive and non-diabetic male patient who was diagnosed as a case of TAA and treated by endovascular means with thoracic endovascular aortic repair (TEVAR) technique. Due to small caliber femoral artery, thoracic endograft was deployed through a Dacron graft conduit of 10 mm diameter which was anastomosed to the common iliac artery. It was a hybrid procedure done in cardiac catheterization laboratory under general anesthesia. Completion angiogram revealed good technical success with no endoleak or neurological deficit. Patient improved symptomatically after TEVAR.&#x0D; Bangladesh Heart Journal 2019; 34(2) : 146-150</jats:p