Differences in Incidence and Risk Factors of Infertility Between Couples Who Desire a First and Second Child: A Prospective Cohort Study

Background: With the implementation of the two-child policy in China, more couples expressed their desire to have a child. We conducted this study to evaluate the incidence and risk factors of infertility in couples intending to have a first child and second child.Methods: Couples who presented to the pre-pregnancy clinical centers were enrolled from 2013 to 2017. Participants were categorized into “first child intention” and “second child intention” groups based on the number of children they already had. Couples were followed up every three months until pregnancy or 12 months. Data regarding the sociodemographic characteristics, history of reproduction and gynecology, history of male disease, and laboratory and imaging examination results were collected. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors.Results: The overall infertility incidence was 16.95% (369/2177). The infertility incidence of “first child intention” and “second child intention” was 19.30% (355/1839) and 4.14% (14/338). The study showed great differences in infertility risk factors between two groups. Risk factors for “first child intention” infertility included advanced age (>35 years), abnormal body mass index (BMI), longer menstrual durations, endometrial polyps, polycystic ovarian syndrome (PCOS), salpingostomy, and history of mycoplasma. However, in “second child intention” group, clinical risk factor was slightly different, such as leiomyoma, higher age (>40 years).Conclusion: The incidence and risk factors of infertility are significantly different between “first child intention” group and “second child intention” group. Early and targeted intervention for couples in different groups at high risk can help reduce infertility and social burden.

Clinical and laboratory features of the course of the urinary tract infection among children in the first three years of life at the current stage

Objective: To study main clinical and laboratory peculiarities of the course of urinary tract disease among children aged from newborns to 3 years old.Methods: Research design is a prospective controlled clinical research. 102 (60.71±3.77 %) children having urinary tract infection without accompanying abnormalities of the urinary system development were included in the first group. 66 (39.29±3.77 %) children having infection of the urinary tract amid congenital kidney defect.Results: Comparative evaluation of the results of complex examination of both groups showed that urinary tract infection is characterized by intoxication, pain and dysuric syndroms. The presence of accompanying kidneys and urinary tract abnormality development defined the latent course of the disease in every second child (59.09%) and supports the early development of renal infection (during first six months after birth).Conclusions: It’s necessary to conduct the search of diagnostics markers and predictors of the infection of the urinary tract among children of the first years of life, especially if there is an abnormality of the organs of urinary system.

THE TABOO OF PRECEDING SISTER IN MARRY: A MINANGKABAU SOCIO CULTURE ANALYSIS

Ideally in the family, the order of marriage starts from the eldest child. Then followed by the second child, the third child and so on. But the reality is different. There are many cases that the youngest child preceded the older brother or sister in marry. In many areas, stepping over older siblings in marriage is commonplace. It doesn't matter whether the one who gets married is a man or woman. However, in Tabu Baraie Nagari Paninjauan Tanah Datar, stepping over an older siblings in marriage is taboo, in particular an older sister. It is forbidden for a sister or brother to step over her/his older sister in marriage. Generally, the older sister who is stepped on by her sister's marriage, her life is single. The aims of this study was to determine the origin of the taboo to step over the marriage of older sisters in a sociological study.Keywords: marriage, stepping over the marriage, older sister.

CPEB3 deficiency in mice affect ovarian follicle development and causes premature ovarian insufficiency

Premature ovarian insufficiency (POI) is a heterogeneous and multifactorial disorder. In recent years, there has been an increasing interest in research on the pathogenesis and treatment of POI, owing to the implementation of the second-child policy in China. Cytoplasmic polyadenylation element-binding protein 3 (CPEB3) is an RNA-binding protein that can bind to specific RNA sequences. CPEB3 can bind to and affect the expression, cellular location, and stability of target RNAs. Cpeb3 is highly expressed in the ovary; however, its functions remain unknown. In this study, Cpeb3-mutant mice were used to characterize the physiological functions of CPEB3. Cpeb3-mutant female mice manifested signs of gradual loss of ovarian follicles, ovarian follicle development arrest, increased follicle atresia, and subfertility with a phenotype analogous to POI in women. Further analysis showed that granulosa cell proliferation was inhibited and apoptosis was markedly increased in Cpeb3-mutant ovaries. In addition, the expression of Gdf9, a potential target of CPEB3, was decreased in Cpeb3-mutant ovaries and oocytes. Altogether, these results reveal that CPEB3 is essential for ovarian follicle development and female fertility as it regulates the expression of Gdf9 in oocytes, disruption of which leads to impaired ovarian follicle development and POI.

An Appraisal of Husband’s Support for Contraceptive Use in Low Resource Setting of Chattogram City, Bangladesh

This study aimed to explore the current status concerning the roles of husbands in family planning and to identify the associated factors in the slum areas of Chattogram city in Bangladesh. A community-based cross-sectional study was conducted among the women living in different slums (N = 400) of Chattogram city. Data were collected using a structured and facilitator-administered questionnaire. Cross tabulation with chi-square tests and multivariate logistic regression analyses were performed using IBM SPSS version 24.0. This study revealed that 70.5% of the husbands supported wives’ contraceptive use. This study explored that husbands’ having education (OR = 2.45, 95% CI: 1.42-4.22), having two children (OR = 0.37, 95% CI: 0.18-0.76) and more than two children (OR = 0.21, 95% CI: 0.09-0.50), more utility facility in the slum areas (OR = 2.32, 95% CI: 1.15-4.68), a good relationship between husband and wife (OR = 1.97, 95% CI: 1.13-3.44), commencing reproductive health communication after the birth of the second child (OR = 0.43, 95% CI: 0.19-0.99), respondents’ having moderate knowledge on RH (OR =4.46, 95% CI: 2.10-9.46) and husbands’ visiting any health center to take wives’ reproductive health care (OR = 2.08, 95% CI: 1.06-4.09) were the predictors for supporting their wives in terms of contraceptive use.

Laterotrusion (Side to Side) and Protrusion/Retraction Difficulty of Tongue in Two Children with Wilson's Disease

Involvement of tongue is uncommon in Wilson's disease (WD) in early stages. This is usually seen late when the patient has an established neurological WD associated with dyskinesia, dystonia, and tremors. In this article, we presented two children with tongue involvement in which there were slow laterotrusion (side to side) and protrusion and retraction movements. In the first child this was the early and only manifestation without any other neurological features while in the second child this was seen in a previously diagnosed WD. Slow tongue movements in any child with or without extrapyramidal features should be investigated to rule out a treatable condition like WD. Tongue involvement is common in children with different neurological/neuromuscular diseases, drugs, and other unknown conditions.

Fatal Neonatal DOLK-CDG as a Rare Form of Syndromic Ichthyosis

Neonatal collodion baby or ichthyosis can pose a diagnostic challenge, and in many cases, only additional organ involvement or the course of the disease will help differentiate between non-syndromic and syndromic forms. Skin abnormalities are described in about 20% of the congenital disorders of glycosylation (CDG). Among those, some rare CDG forms constitute a special group among the syndromic ichthyoses and can initially misdirect the diagnosis towards non-syndromic genodermatosis. DOLK-CDG is such a rare subtype, resulting from a defect in dolichol kinase, in which the congenital skin phenotype (often ichthyosis) is later associated with variable extracutaneous features such as dilatative cardiomyopathy, epilepsy, microcephaly, visual impairment, and hypoglycemia and may lead to a fatal course. We report two neonatal cases of lethal ichthyosis from the same family, with distal digital constrictions and a progressive course leading to multi-organ failure and death. Postmortem trio whole-exome sequencing revealed the compound heterozygous variants NM_014908.3: c.1342G>A, p.(Gly448Arg) and NM_014908.3: c.1558A>G, p.(Thr520Ala) in the DOLK gene in the first affected child, which were confirmed in the affected sibling. Reduced staining with anti-α-Dystroglycan antibody was observed in frozen heart tissue of the second child as an expression of reduced O-mannosylation due to the dolichol kinase deficiency. In addition to the detailed dermatopathological changes, both cases presented hepatic and extrahepatic hemosiderosis on histological examination. Our patients represent an early and fatal form of DOLK-CDG with a striking presentation at birth resembling severe collodion baby. Both cases emphasize the phenotypic variability of glycosylation disorders and the importance to broaden the differential diagnosis of ichthyosis and to actively search for organ involvement in neonates with ichthyosis.

Clinical and imaging interrelationships in the diagnosis of foreign body aspiration in children

Background: Foreign body aspiration (FBA) is a typical occurrence in children. The clinical signs are influenced by various causes, and the differential diagnosis is important, especially when the suffocation crisis is not recognized. The aim of this study was to evaluate the clinical and imaging symptoms in children with FBA. Material and methods: A retrospective study is provided of 156 children who were hospitalized and examined (clinical and paraclinical tests) in the Pneumology Clinic between 2011 and 2020 after having a foreign body removed from their airways, using rigid tube bronchoscopy or fibrobronchoscopy. Results: The most affected age group was 1-3 years, which constituted 77.6% (95% CI 70.2% -83.8%). The most common symptoms were: cough – 98.7% (95% CI 95.4%-99.8%), dyspnoea – 94.2% (95% CI 89.3%-97.3%), wheezing – 61.5% (95% CI 53.4%-69.2%). Chest radiography was relevant for foreign body aspirations in 55.8% of cases (95% CI 47.6%-63.7%). The foreign body was extracted from the right bronchus in 32.1%, from the left bronchus in 21.8% of cases, from the lobar / segmental bronchi – 22.5%, and in 21.2% – multiple locations. The etiological structure of the endobronchial foreign body was dominated by the organic ones – 96.8%. Conclusions: Cough, dyspnoea, and wheezing are suggestive of this pediatric emergency. Chest radiography provides diagnostic information only for every second child.