Recurrent pregnancy loss resulting in IVF (In Vitro Fertilization) series. Pathophysiologic mapping. A systematic review

Objective: Assiduous depiction of recurrent pregnancy loss (RPL) in patients after in vitro fertilisation (IVF). Material and Method: Women undergoing IVF treatment who had experienced two or more consecutive pregnancy losses before 20 weeks’ gestation with or without a history of implantation failure. Systematic review resulting in specific data bases such as Pub Med and Cochrane data base. Results: Factors associated with RPL after IVF consist mainly genetic origin (approx. 30%) due to aneuploid embryos, followed by thrombophilia and autoimmune factors. Mainly predisposition factors associated with high risk of recurrent miscarriages include obesity, advanced maternal age, anatomic defects of the uterus and endocrine disorders. On the contrary, 10-15% of cases of RPL represent idiopathic origin (Unexplained RPL). The evaluation of preimplantation genetic testing (PGT) remains a controversial entity. Conclusion: The aim of our study is focusing on the pathophysiologic mapping, presented in current literature, concerning RPL after IVF. Although IVF procedures, including assisted hatching, PGT and immunologic therapy have been suggested to improve live birth rates, their efficacy is controversial, since the factors related to RPL after spontaneous abortion or IVF do not reveal any statistic differences. Additionally, assisted reproductive technique (ART) cannot be supported as a treatment intervention for couples with unexplained RPL, due to the lack of adequate clinical studies.

A Systematic Review of the Aluminum Content of the Normal Human Prostate Gland

The prostate gland is subject to various disorders. The etiology and pathogenesis of these diseases remain not well understood. Moreover, despite technological advancements, the differential diagnosis of prostate disorders has become progressively more complex and controversial. It was suggested that the aluminum (Al) level in prostatic tissue plays an important role in prostatic carcinogenesis and its measurement may be useful as a cancer biomarker. These suggestions promoted more detailed studies of the Al content in the prostatic tissue of healthy subjects. The present study evaluated by systematic analysis the published data for Al content analyzed in prostatic tissue of “normal” glands. This evaluation reviewed 1981 studies, all of which were published in the years from 1921 to 2020 and were located by searching the databases Scopus, PubMed, MEDLINE, ELSEVIER-EMBASE, Cochrane Library, and the Web of Science. The articles were analyzed and “Median of Means” and “Range of Means” were used to examine heterogeneity of the measured Al content in prostates of apparently healthy men. The objective analysis was performed on data from the 25 studies, which included 1190 subjects. It was found that the range of means of prostatic Al content reported in the literature for “normal” gland varies widely from 0.89 mg/kg to mg/kg with median of means 29.0 mg/kg on a wet mass basis. Finally, because of small sample size and high data heterogeneity, we recommend other primary studies be performed.

Virologic Failure and its Determinant Factors among Children in First Line on Highly Active Anti Retroviral Therapy at Felegehiwot Referral Hospital, Bahir Dar, Northwest, Ethiopia: cross-sectional study

Introduction: Highly active antiretroviral therapy (HAART) played a critical role in the medical management of HIV infected individuals by restoring the immune function and minimizes HIV related outcomes. But treatment failure minimized these advantages and leads to an increment of morbidity and mortality with poor quality of life in all HIV patients. The aim at this study was to assess the prevalence of HIV-1 treatment failure and its determinants factors among children on first line HAART at Felegehiwot Referral Hospital. Methods: Cross sectional study was conducted on 238 children who had on first line HAART regimen using the inclusion criteria. Data were collected from patients’ chart starting from ART commencement (baseline data and other information) and interviewed using structured questionnaire. CD4 T-cells from whole blood and viral load from separated plasma were analyzed according to protocols. The collected data were analyzed using SPSS packages version 20. Descriptive statistics, odds ratio, bi-variate and multiple logistic regression analysis were used to show determinant factors association. Independent associations were considered with p<0.05. Result: Among the 238 participants enrolled, 137(57.6%) were females. The mean ages were 8.09 years and the median months on HAART from initiation were 51.93 months. A total of 25 (10.5%) participants were found to have virologic/treatment failure. The mean CD4 T-cells at base line were 342.33 cells/ml and 672.13 cells/ml respectively. Long duration on treatment, sub-optimal drug adherence, conducting faith healing, high medication dosage and ambulatory functional status at baseline were found to be significant predictors of treatment failure and showed positive odds ratio. Conclusion: This study demonstrates high virologic failure and the determinant factors of virologic failures among HAART first line children are still changing. Therefore, evidence-based intervention and early detection of treatment failure must be made to further identify the potential causes and set standardized protective mechanisms of virologic failures.

A Rare Case of Brunner’s Gland Adenoma causing Melena

Brunner’s gland adenoma is a rare benign, proliferative lesion arising from the Brunner’s gland of the duodenum and is known by various names as Brunneroma or polypoidal hamartoma. Brunner gland adenoma was first reported by Cruveilhier in 1835 [1]. We report Brunner’s gland adenoma in a 50-year-old female who presented with melena and review briefly Brunner’s gland adenoma’s clinical presentations, radiological, pathological features and therapy.

Surgical Resection with Boyd Technique for Metastatic Ewing Sarcoma of the Bone Plus Docetaxel/Gemcitabine, Associated with Improved Outcomes in Tumor Activity

Ewing sarcoma is a malignant bone tumor that mainly affects children, adolescents and young adults with more than 1.5 cases per million worldwide. Approximately 20-25% of patients present metastatic disease at the diagnosis, that is often resistant to intensive therapy.We present the case of a 19-year-old male with history of epilepsy who started his condition with weight loss, increased volume, pain, swelling after receiving surgical treatment due to a left distal femur fracture, showing tomographic evidence of a 50-cm tumor with multiple lung lesions, so disarticulation was performed with the Boyd technique, obtaining histopathological result of Ewing’s Sarcoma, and was subsequently sent to the medical oncology service for follow-up and adjuvant treatment with significant clinical and radiological improvement in pulmonary metastatic activity.

Evaluation of the use of Orasol Plus®, A Mouthwash Based on Plant Extracts, in Mucositis in Patients with Breast Cancer Receiving Chemotherapy

Breast cancer is the first and most common cancer in women and represents the leading cause of female cancer death. To treat cancer, the treatment that is giving more results is the conventional poly-chemotherapy with numerous other substances that have specific action, called target therapy. During the treatment of breast cancer, chemotherapy drugs lead to the frequent detection of side effects, first of all, the Oral Mucositis. Oral mucositis (OM) is a common in cancer therapy, found in a percentage of 15-40%, and cause severe sequelae and strong impact on a patient’s quality of life (QoL), health care costs, and ultimately outcome by influencing the treatment dose. There are some and limited therapeutic options to help reduce the severity of OM. Our study evaluated the action of a mix of natural supplements (swallowable solution, Orasol plus®, for reduction of mucositis during chemotherapy, with Lapacho (Tabebuia Avellanedae Lorentz ex Griseb.), Camellia Sinensis L. Kuntze, Calendula Officinalis L, Malva Sylvestris L, Sisymbrium Officinale (L) Scop, Plantago Major L e Propoli) in 15 breast cancer patients under treatment with chemotherapy and target therapy. No patients had stopped the treatment because of mucositis. From 11 patients that have mucositis during treatment, 5 had complete remission at the and of the first cycle in the 4 patients who took Orasol Plus®, as a preventive measure, none developed mucositis during antiblastic treatments. The data of our study depose for the effectiveness of Orasol Plus® in the treatment of oral mucositis, in patients undergoing chemotherapy for breast cancer. They need a larger study to insert Orasol Plus® in a standardized pathway in the treatment of oral mucositis during chemotherapy.

Merkel Cell Carcinoma: A Case-Report of Rare Presentation of Merkel Cell Carcinoma, Non-Indolent Proliferative Type, Polyomavirus-Negative: Hypothesis of MolecularPathogenesis

Introduction: Merkel cell carcinoma (MCC) is a rare cutaneous indolent neuroendocrine cancer, arising from the Merkel cells of the stratum basalis, of the epidermis. This type of tumor commonly arises in sun-exposed areas, such as head, neck, and lower extremities. Here, we describe a rare presentation of non-indolent proliferative type Merkel cell carcinoma. Case Report: This is a case-report of a 70-year-old Caucasian man with no pertinent past medical history, presenting as a large painless violaceous necrotic irregular bordered rapidly growing lesion, reaching to 8x10x15 cm3, within one-year period, on the lower back region with surface ulceration. Pelvic MRI showed a multilobulated enhancing soft tissue mass measuring 8.7x10.4x15.1 cm3 at the left gluteal region with exophytic extension to the left paraspinal muscles. The patient was admitted, tangential surgical excision and debridement of left flank wound was performed with partial primary closure. Pathology showed features of Merkel cell, show diffuse dot-like positivity with CK20 and are negative for CK7, there is diffuse positivity with NSE, synaptophysin and CD56 with strong diffuse Ki-67 positivity noted in >65% of tumor cells. CD99 shows diffuse small faint dot-like paranuclear positivity. Discussion: Merkel cell carcinoma (MCC) is a rare, aggressive tumor that generally arises in sun-exposed regions. After an initial course of slow growth, starting as a painless violaceous non-pruritic domed-shaped lesion, the tumor becomes more aggressive, rapidly growing, with metastasis with local lymph nodes and regional tissue invasion. Sixty percent of tumors can rapidly grow within a three-month period after initial diagnosis. MCC is also clonally associated with is polyomavirus. MCC Contributing molecular pathogenesis is imperative to determining the causation of rare non-indolent MCC tumors, and its association with prognosis and treatment. In polyomavirus negative patients, consideration for molecular pathogenesis as etiology is imperative.

The Potential of Plasminogen Activator Inhibitor-1 as Prognostic Factor of Advanced Breast Cancer

Background: Advanced breast cancer causes problems in morbidity, mortality, quality of life, and low survival rate. Hence, a biomarker to predict the progression of cancer is needed. Plasminogen activator inhibitor-1 (PAI-1) has been known as one of the prognostic factors. However, in vivo studies indicated that PAI-1 has controversial roles. Whether PAI-1 suppresses or promotes the development of cancer, is still being the question. The study aims to examine the role of PAI-1 in predicting the survival rate and its association with clinicopathologic factors in advanced breast cancer. Materials and Methods: The historical cohort analytic method in advanced breast cancer patients was conducted at Dharmais National Cancer Center Hospital. Clinical data were obtained from patients’ medical records. The expression of PAI-1 was assessed through immunohistochemistry assay staining of breast cancer tissue using antibody PAI-1 Santa Cruz Biotechnology, Inc., PAI-1 C-9 sc5297. Survival analysis was done to obtain the prognostic data. Moreover, its association with clinicopathologic factors was analyzed. Results: Fifty-eight subjects were included in this study. There was a significant association between the expression of PAI-1 and survival rate (hazard ratio [HR] = 4.08, 95% confidence interval [CI] = 1.75 - 9.50, p = 0.001). The Kaplan-Meier method indicated significant differences in survival rate between subjects with high expression of PAI1 and those with low expression in advanced breast cancer (p = 0.001). PAI-1 expression had a sensitivity of 84.7% and specificity of 60% based on immunohistochemical score cut off of 90. Furthermore, the expression of PAI-1 showed no significant association with clinicopathological factors except for histopathology grade. (Relative risk [RR] = 1.5, 95%, CI = 1.2 - 1.8, p = 0.047). Conclusion: Advanced breast cancer patients with high expression of PAI-1 have better survival. PAI-1 expression is not associated with clinicopathological factors, except for the histopathological grade.

Subcutaneous Panniculitic T-Cell Lymphoma in an Adolescent: A Case Report

Rationale and Objectives: Subcutaneous panniculitic T-cell lymphoma (SPTCL) is a rare neoplasm accounting for less than 1% of pediatric Non-Hodgkin Lymphomas. It is most common in young adults with predominance of female cases at 0.5. Symptoms include multiple nodules involving the subcutaneous tissues of the extremities and trunk, neck and face. B symptoms such as fever, chills, night sweats and weight loss, have been reported. Rare extra-cutaneous manifestations include edema, involvement of the bone marrow, lymph nodes, liver, spleen, lungs and viscera. Laboratory abnormalities such as cytopenias and elevated lactate dehydrogenase have been recorded. Hemophagocytic syndrome (HPS) occurs in 33% of cases, which were correlated with fatal outcome. Case Report: We present a rare case of a 17 year-old male diagnosed with subcutaneous pannicultic T-cell lymphoma manifesting with prolonged fever, weight loss, and multiple subcutaneous nodules. He also presented with extra-cutaneous manifestations of facial edema, pleural effusion and ascites, lymph node enlargement, hepatosplenomegaly with jaundice and pancytopenia. Conclusion and Summary: Subcutaneous Panniculitic T-Cell Lymphoma may present with an unusual finding of facial edema, ascites and pleural effusion, lymph node enlargement, hepatosplenomegaly with jaundice and pancytopenia alongside skin manifestations of subcutaneous panniculitis. HPS may complicate the course, treatment decisions and outcome of the disease.

Factors Associated with Lymphovascular Invasion in Colorectal Adenocarcinoma at Dr. Cipto Mangunkusumo General Hospital, Jakarta: A Preliminary Report

Background: Lymph node metastasis is a prognostic factor in colorectal adenocarcinoma. Besides, lymphovascular invasion is one of the factors to indicate the lymph node metastasis. This study aimed to investigate factors associated with lymphovascular invasion in our hospital. Methods: This preliminary report was a cross−sectional study of patients with colorectal adenocarcinoma in Cipto Manungkusumo General Hospital, Jakarta, Indonesia between 2012 and 2016. Our focus of interest was the association between lymphovascular invasion and variables of patient’s characteristics, including age, gender, location of the tumor, tumor differentiation, pathological stage of tumor infiltration, and lymph node metastasis. Results: We found 70% of the 68 subjects had lymphovascular invasions. Among all the variables analyzed for association with lymphovascular invasion, there is no factor with significant association. However, lymph node metastasis was found to have significant association with lymphovascular invasion (odd ratio [OR] = 6.69, 95% confidence interval [CI] = 2.09–21.38, p−value =0.001). Conclusion: Although lymphovascular invasion was significantly associated with lymph node metastasis in colorectal adenocarcinoma, there is no factor significantly associated with lymphovascular invasion in this study.