Genetic and imaging study of a case with multiple malformations: limb body wall complex

The Limb-Wall Complex is a rare and sporadic congenital anomaly characterized by multiple craniofacial and thoracoabdominal malformations as well as involvement of the spine and lower extremities. The etiology is unknown and the chromosomal study is normal, however, it is related to an alteration in the formation of the umbilical cord (short umbilical cord), abdominal placental insertion and persistence of the extraembryonic coelom. This condition causes intracavitary organs to be exposed and adhered to the placenta and consequently also attached to the mother’s uterus. The diagnosis can be made from the first trimester of gestation with a nuchal translucency ultrasound in order to detect this pathology in time and to be able to offer good genetic counseling to the parents, since the prognosis is not favorable

Appendicitis in pregnancy: case report in a navy medical center of Mexico City

Acute appendicitis represents the most common non-obstetric surgical emergency during pregnancy, the most important clinical feature is abdominal pain in the right lower quadrant. Imaging studies can be used for diagnosis, where ultrasound and magnetic resonance imaging are mostly recommended. Timely diagnosis can prevent complications including fetal loss and preterm delivery. The case report orients the surgeon and obstetrician to make decisions in patients with this pathology

Spontaneous isolated intraperitoneal rupture of urinary bladder after normal vaginal delivery presenting as puerperal sepsis

Spontaneous isolated intraperitoneal rupture of urinary bladder is a rare urological complication of normal delivery. This complication is usually related to prolonged labour, failure to empty bladder in second stage of labour, use of forceps/ ventouse, postpartum urinary retention, vaginal birth after caesarean section and usually presents immediately after delivery. We report the case of a patient with spontaneous isolated intraperitoneal rupture of urinary bladder after normal vaginal delivery in the absence of any risk factor. She presented on day 5 postpartum with features suggestive of puerperal sepsis with pyoperitoneum with acute kidney injury. Absence of unhealthy lochia and later, normal-looking uterus and adnexa during laparotomy led to the suspicion of alternate cause for seropurulent ascites. Further exploration revealed rent in the urinary bladder with necrosed margins. High index of suspicion of alternate diagnosis should be maintained if some of the clinical findings are not supportive of provisional initial diagnosis

An unusual case of a neonate with left sided type 3 poland syndrome with dextrocardia

Poland syndrome (PS) is right sided in 75 percent of cases. Only 10 percent are associated with dextrocardia. It is usually detected late for the milder nature of the condition. Only in severe cases it comes to attention during neonatal period. Left sided Poland syndrome with dextrocardia is extremely rare. To the best of our knowledge this is the first case of left sided type 3 Poland syndrome with dextrocardia diagnosed at birth with chest wall getting sucked in and bulging out during inspiration and expiration respectively

Model of transfection in human endometrial epithelium cells with hsa-miR-191-5p Model of transfection in human endometrial epithelium cells with hsa-miR-191-5p

Background: Human endometrial cells are important in blastocyst recognition and implantation. We have recently shown that miR-191-5p secreted into culture medium by human embryos cultured and transferred to woman on the fifth day of development was associated with the percentage of pregnant vs. non-pregnant patients. Little is known about the regulation and expression of endometrial miRNAs induced by embryonic miRNAs in endometrial tissue. Therefore, in the present work we explored the viability and transfection of RL95-2 endometrial cell line with agomiR-191. Results: The main results obtained in this study were: First, transfection of RL95-2 cell line with 100nM of lipofectamine in combination with 15, 30, and 60 nM of agomiR-191 for 3, 6 and 24 hours does not affect the viability of RL95-2 cells. Second, we observed expression of miR-191 with 60 pmol of agomiR-191 in a time dependent transfection. Conclusion:: Stimulation of RL95-2 endometrial cell line with lipofectamine does not modify their viability. The transfected RL95-2 endometrial cells showed increased the expression of miR-191.

Improving the effectiveness of the referral process in a tertiary NICU using lean methodology concepts

Aim: To reduce the administrative time trainees spent when completing a patient referral to specialist teams in a tertiary Neonatal Intensive care setting. Methods: We designed a pre intervention and post intervention questionnaire completed prospectively by trainees describing the tasks they needed to undertake to complete a referral, the time perceived as ‘wasted’ and suggest potential solutions over a 2 month period between 1st June 2020 and 1st August 2020. We used Lean methodology to identify waste as steps that did not add value to quality patient care. We designed a NICU referral directory containing the standard operating steps, the appropriate proformas and contact details of receiving unit, a process algorithm and a collective consultant email address. Results: Our project achieved a reduction in the median time to complete a referral from 27.5 minutes to 6 minutes (p = 0.0087). The time perceived ‘wasted’ by trainees was reduced from 20 minutes to 0 minutes (p=0.006). Conclusion: Our project is a simple intervention and supports using Lean methodologies to identify waste and bring about quick improvements without significant capital investments. We demonstrate how front line staff can be engaged in identifying inefficiencies, suggest solutions which help in the successful adoption and sustainability of quality improvements.

Validation of the existence of genuine Empty follicle syndrome, versus false empty follicle syndrome to make definitive decisions in cases where recurrent IVF failure encountered secondary to absence of oocytes on ovum pick up-a short communication

Aim: Worldwide a big altercation exists with regards to the actual existence of the term “ Empty follicle syndrome’’(EFS), so much so that certain big authorities in the field have been believing that true EFS does not exist. Basically EFS is a syndrome when no functionally intact oocyte get retrieved when attempting an oocyte pick up (OPU) for a successful in vitro fertilization (IVF), however such patients encounter recurrent IVF failures. Since it is has become a big problem for the treating reproductive endocrinologist, besides the patient encountering recurrent IVF failures, it has become essential to differentiate the true EFS alias genuine Empty follicle syndrome (gEFS) from what is labeled today as the false empty follicle syndrome (fEFS). In view of the recently documented presence of mutations, gEFS got verified and appears to silence this biggest conflict that arose secondary to the existence of a false empty follicle syndrome(fEFS), where one could manage to get successful IVF outcomes subsequent to repeated hCG injections/ gonadotropin releasing hormone (GnRH) agonist in addition to pregnancy, with lot of clinicians believing there is no true term like EFS. Methods: Recently Yang et al., performed a study In tertiary a university based reproductive center in China that was comprised of a big cohort of patients that presented with gEFS. Genetic evaluation was conducted on 35 non correlated infertile patients who went through 16 failed IVF cycles in addition to oocyte degeneration, besides the subjects got a diagnosis of possessing a particular kind of EFS- cumulus oocytes complexes (COC’s) but possessed oocytes that were undergoing degeneration, with the utilization of whole –exome sequencing along with targeted Sanger sequencing. Results: Yang et al., found 22 innovative genetic variant of zona pellucida (ZP), genes in 18 subjects, that were inclusive of 20 variants in ZP 1 gene, 2 in ZP 2 gene in addition to 1 recurring variant in ZP3 gene that had been earlier documented. The homogenous /compound heterogenous ZP 1 mutations were inherited in an autosomal recessive manner, while the heterogenous variants of ZP 2 as well as ZP3 genes possessed an autosomal dominant manner of inheritance. Conclusions: These mutations were anticipated to be harmful in silico along with got further experimentally corroborated to be functionally null dependent on their ectopic expression in vitro. Thus with this further evidence that has been recently provided with regards to the existence of genuine Empty follicle syndrome (gEFS), it is significant for the youngsters to realize if they encounter similar cases after trial of rescue hCG injections / GnRH) agonist, not to further keep waiting, but evaluate further with regards to the existence of mutations for Zona Pellucida (ZP), ZP 1, ZP2 as well as ZP3 genes mutations, or LH/ chorionic gonadotropins receptor (LHCGR) gene mutation without subjecting the patient to repeated IVF, with her psychological as well as financial health in mind

Challenges for 2030 in maternal care, newborn and under 5 years old

The objective is to emphasize the importance on the subject of maternal morbidity and mortality, newborns, children under 5 years old, to meet the goal of transformation in the 2030 agenda towards sustainable development. One of the objective is health and well-being in order to guarantee universal access to sexual and reproductive health services, including family planning, information and education, with the integration of cross-cutting public policies and legal norms that allow the attention of the health service for women (before pregnancy, during pregnancy and after), as well as newborns and before the age of five