Combined PGT for Breast Cancer and Other Inherited Conditions

Inherited cancer predisposition is presently one of the major indications for preimplantation genetic testing (PGT), providing an option for couplers at risk to avoid the birth of an offspring with predisposition to cancer. We present here our experience of 35 of 874 PGT cycles for cancer, in which in addition to BRCA1/2 the couples were at risk to another genetic conditions as well, for which PGT was performed together with PGT for breast cancer. This resulted in in birth of 20 mutation free children with not only unaffected for the tested genetic condition, but also without risk of developing cancer. This is a part of our overall PGT series of 6,204 PGT cases for monogenic disorders (PGT-M), with 2,517 resulting births, free of genetic disorder. The accumulated experience, demonstrates considerable progress in using PGT for avoiding the birth of affected children together with avoiding predisposition to cancer.

Study Inhibitory Effect of Alhagi Extract on Oral Microorganisms

Many studies determined effect of plant extract on plant pathogens and human pathogens. Alhagi maurorum is considered as one of the important medicinal plants in Iraq. It is used for urinary tract infection, rheumatic pains and liver disorders. Study the Inhibition Effect of Alhagi extract on oral microorganisms as Streptococci, Actinobacillus and Staphylococci, with (0, 10, 50 and 100 percentages). The concentrations of 0% has not any inhibition effect, 10%, has a slight inhibition effect against oral Streptococci and Actinobacillus, but has not effect on Staphylococci. 50%, has an inhibition effect against oral Streptococci more than E-coli, but has not effect on Staphylococci, but 100%, has a wide inhibition effect a against oral Streptococci more than Actinobacillus except Staphylococci has not effect. The lack of inhibition effect at the concentration of 0% and 10% of Alhagi maurorum aqueous extract may be returned to the limits or decline of active components in these low concentrations of aqueous extract. In addition, studies indicate that there are many factors have an effect in the minimizing the impact of plant extracts.

Correlation of Bladder Wall Endometriosis Histological Location, To Infertility Patients’ Clinical Characteristics and Severity of Peritoneal Endometriosis

Study question: What is the correlation of bladder wall endometriosis histological location, to the severity of peritoneal endometriosis in infertility patients? Summary answer: Secondary infertility, back pain, micturition problems, history of ectopic pregnancy and number of abortions can probably be considered as high-risk factors for bladder wall endometriosis for infertility patients. What is known already: Bladder and/or ureter endometriosis occur in 70–85% among patients with deep infiltrating endometriosis. The knowledge regarding the bladder wall involvement with endometriosis in association to peritoneal endometriosis and infertility patients’ clinical characteristics is limited. Study design, size, duration: Retrospective, longitudinal cohort, Sixty-six, primary and secondary infertility patients, collection of surgical and clinical data between 2010 to 2018. Participants/materials, setting, and methods: An experienced histopathologist on endometriosis was asked to review all the patients’ histopathological results. The histopathological reported findings were reviewed prior to the study to reassure the bladder wall depth of endometriosis involvement. The operation and tissue macroscopic description reports before processing were also reviewed. Attention was paid for possible discrepancies or missed important data that could influence the histopathological results. In cases where results were equivocal, the paraffin blocks were available for additional sections for reassuring the diagnosis. An extra effort was made to meticulously observe and identify the involvement of the bladder serosa, muscularis and mucosa with endometriotic cells and glands. Main results and the role of chance: Primary infertility was the indication for the current laparoscopic surgeries in 32 out of 66 (48.5%) patients and secondary infertility for the rest of the group. The highest incidence of bladder endometriosis (BE) was detected on the serosa of 12 patients and in the detrusor muscle (DM) of 11 cases. Bladder serosa endometriosis (BSE) was significantly more prominent among patients with history of ectopic pregnancy (p=0.004) and among patients with secondary infertility (p=0.029). Destrusor muscle endometriosis (DME) was significantly more frequent (p=0.012) in patients with increasing number of abortions. DME highest rates of 37.7% were observed among the severe spread of abdominal endometriosis as compared to 19% of the cases with bladder serosa endometriosis. No statistically significant difference found between serosa and detrusor muscle endometriosis involvement, when compared to severity and spread of endometriosis within the abdominal cavity. Back pain was most prominent with statistical significant difference (p=0.007) in 8 patients with BSE + DME as compared with other groups of patients (4 BSE, 3 DME and 3 BME+DME patients). Among 30 cases with an ovarian endometrioma detected by TVU, DME was diagnosed in 13 patients, in serosa of 10, and in serosa and DM of 6 patients. Statistical analysis was performed using Pearson chi-square, Fisher’s exact tests and the Kruskal-Wallis test by STATA version 15 SE (StataCorp. 2017). Limitations, reasons for caution: This is a cohort retrospective study. There is a possibility that other areas with endometriosis were also involved in the BW other than those diagnosed and treated. The mixture of patients with primary and secondary infertility could also affect the results, although statistical analysis did not show any significance in BWE, clinical symptoms and surgical findings. BE is rarely an isolated condition, and other forms of endometriosis are frequently concomitant Wider implications of the findings: Detrusor muscle endometriosis involvement was in 68% and bladder serosa in 32% of all cases with bladder endometriosis and infertility investigated. The severity of the peritoneal endometriosis can probably direct to meticulous intraoperative investigation for bladder endometriosis.

Role of MRI in Pre-Operative Assessment of Patients with Advanced Ovarian Cancer Candidate for Cytoreductive Surgery, A Brief Review

When it comes to gynecologic cancer, ovarian cancer with no doubt is the deadliest and most challenging. The reason often falls into the late presentation, in fact the clinical symptoms are not prominent until the disease is disseminated In patients with advanced ovarian cancer cytoreductive surgery procedure is the key element in treatment plan. One of the best tools to predict successful and complete cytoreductive surgery is using prior imaging. Magnetic resonance imaging is one of the newly described imaging modality for advanced ovarian cancer patients selected for cytoreductive surgery. Here we discussed the application of MRI in advanced ovarian cancer underwent cytoreductive surgery.

Lipid profile an important risk factor in patients with ovarian tumors: a meta-analysis

Introduction: In the literature ovarian tumors are knowed to be one of the most deadliest gynecological malignancies [1-4]. In US this type of malignancy represents 2.3 % of all cancer-related death and about 4 % of all new cancer cases among women. There are several studies that have reported the role of lipid profiles and it’s role in ovarian tumorigenesis. Fatty acids are essential for cancer cells progression[4-8]. In our study we investigated the true differance in circulating lipid profiles (total cholesterol TC, triglyceride TG, high-density lipoprotein cholesterol HDL, low density lipoprotein cholesterol LDL) among patients with and without ovarian tumors (OT) using a meta-analytical approach. Mehods: The meta-analysis was conducted using the MOOSE guidelines. PubMed, EMBASE and Cochrane Library were extensively searched ( with a period of publication restriction between 2007 and 2019) to indetify published studies using the following keywords: “ total cholesterol ”, “high-density lipoprotein”, “ triglycerides ”, “ low-density lipoprotein ”, “ ovarian cancer”, “ ovarian tumor ”, “ lipid profile ”. The search methodology is shown in Fig. 1 and all references of retrieved articles were searched manually. Results: Seven studies, involving 1542 OT cases and 2195 non-cases of OT were included in this meta-analysis and I² statistics ranged between 97 and 99%. Mean circulating TC and HDL were significantly lower among OT cases compared to non-OT cases (P<0.04 and P<0.005). Conclusion: There is a modest significant association between circulating HDL and risk of ovarian tumor but it is crucial to elucidate the implications of HDL in tumor manifestations and growth.

Women Health Awareness, Acquisitions, and Partnerships to Bring New Era for Contraceptive Drugs.

The spread of COVID-19 and the resulted lockdown imposed across the globe has negatively affected the contraceptive drugs market. Many women across the world found it hard to purchase the pills as contraceptive drug manufacturers were facing challenges due to inconsistent supply chains and the workforce.

Impact of Living in Different Altitudes on Intracytoplasmic Sperm Injection (ICSI) Outcomes for Infertile Couples in Southwestern Region of Saudi Arabia, a Retrospective Study

Objective: The aim of this study was to determine the effect of different altitudes in the Southwestern region of Saudi Arabia on ICSI outcomes, fertilization rate, embryo quality, pregnancy rate, and miscarriage rates for infertile couples. Materials and Methods: This is a retrospective study on 551 infertile couples carried out in the Assisted Reproductive Technology unit at the Maternity and Childern Hospital in Abha, Saudi Arabia between 2018 and 2019 to compare ICSI outcomes in different altitudes. Low altitude (205 patients), mild altitude (86 patients) and high altitude (260 patients). Main result measurements: fertilization rates, embryo quality, clinical pregnancy and miscarriage rates at different altitudes. Results: The data showed that there were no significant differences (P>0.67) in fertilization rates and the number of good-quality embryos between different altitudes. Importantly, clinical pregnancy rates were similar between groups and there was no significant difference in the miscarriage rates between high, mild and low altitudes. Conclusions: This study demonstrates that there is now increased risk of miscarriage or low pregnancy rates with different altitudes in Southwestern region of Saudi Arabia. This suggests that altitude changes has no obvious risk on pregnancy rate and pregnancy outcome.

Effects of Low Estrogens: Vaginal Atrophy

Estrogens are the group of hormones which makes a woman a woman. Girls at menarche start making it and under normal conditions sufficient levels are maintained in the women's body until menopause. During perimenopause, menopause and postmenopause the hormone levels start fluctuating and if maintained low for a longer period, it starts giving various problems. Fluctuating levels of estrogen causes, hot flashes, night sweats, vaginal dryness, depression, and mood swings. Sleep disturbances brain fog and may be heart disease, osteoporosis, obesity and the appearance of unwanted facial hair. These problems can be overcome by supplementing with phytoestrogens or hormone replacement therapy.

A Homeopathic Treatment İn a Female Patient with İnfertility

There is a physiological balance between our systems in our body. When this physiological balance is disturbed, diseases ocur. Infertility; It is defined as not having a pregnancy despite the couples having regular sexual intercourse. Homeopathy, a natural remedy that has been used widely all over the world for 200 years system. It has been recognized by the World Health Organization (WHO) as the second largest treatment method used worldwide. Although it is the most popular form of treatment in India and South America, it is also used by over 30 million people in Europe and millions of other people around the world. A female patient 33 years old who applied to Getat Polk for infertility had also divorsed from her first marriage for 8 years due to infertility. She continued her infertility treatment during her marriage. Tsh 1.93Uıu/ml, t3 3,05 pg/ml,t4 0.76ng/dl. Glukose 82mg/ml, d vitamine 8ng/ml, b12 270pg/ml, total cholesterol 176mg/ml, creatinine 0.63mg/dl tg 77 mg/dl fe 38ug/dl AST 19 U/L E stradiole 46ug/l LH 12,42IU/L Ferritine 8.51 ug/l hemoglobine 11.8g/dl .After a detailed anamnesis, the patient was started on Hyos c30 2*1, Ignatia c30 2*1, and folliculunum c200 2*1 (1st and 14th days of menstruation) in December 2020. The patient was 7 weeks pregnant in september 2021.β-Hcg 15000Mıu/ml Fe 171 ug/dl. Hormonal balance in women is very sensitive and easily effected, either by endogen or exogen disturbances. Pressure and suppression induced by dominant forces on an individual such as dominant parents, husband, harassment at work or religions dominance can be a cause to create a so called Folliculinum state, as well as results from immune system suffering after long lasting and profound infection, which is suppressed by medication.

Identifying the Roles of Medical Providers when Addressing Barriers to HPV Vaccination Rates in Rural NE Clinics

Background: Although many interventions to address vaccine hesitancy until now have operated on the presumption that misperceptions are due to a lack of knowledge about HPV and the vaccine, this may not always be the reason behind vaccine hesitancy. Nyhan et. al found [1] that correcting myths about vaccines- such as autism links or vaccine side effects- do not increase vaccine rates among adolescents. Medical providers play a crucial role on influencing parents’ decision to vaccinate. In a study exploring how vaccination coverage among children 19-35 months old is associated with health care providers' influence on the parents' decision to vaccinate, parents who report their providers as being influential in the study are twice as likely to respond that vaccines are safe for children [2]. In the 2016 Clinical Report on Countering Vaccine Hesitancy by the American Academy of Pediatrics, motivational interviewing is listed as a potential communication technique that may be useful as pediatricians discuss vaccines with vaccine-hesitant parents. Research Question: The research attempting to find the best approaches to reverse the increasing rates of unvaccinated minors is limited and inconclusive. This project addressed the impact of medical providers’ attitudes of HPV vaccination on their early adolescent patient populations. Methods: Our cohort prospective study first examined medical providers’ baseline attitudes and approaches of HPV vaccination in privately insured clinics in rural areas of Nebraska. A survey was sent to eleven Phase III patient centered medical home (PCMH) NE clinics. The survey assessed medical staffs’ attitudes and approaches to HPV vaccination, particularly among specific patient age groups. In addition to each clinic’s collective survey responses, baseline HPV vaccination data was collected at eleven Phase 3 PCMH rural clinics in Nebraska for pediatric patients 11-15-years-old. The follow-up intervention implemented educational interventions in the clinics to increase HPV vaccination rates for pediatric patients 9-15-years-old. Our educational outreach program at the selected 10-13 clinics will serve as these rural clinics’ first efforts to selectively work toward improving HPV vaccination rates. Results: America’s Health Rankings (2017) found 42.4% of adolescents living in rural areas compared to 52.4% in urban areas are up-to-date on their HPV immunizations. The eleven rural clinics selected for the study show only a 0.9% completion of the vaccine series for 9-11-year-old patients (n=855), and 25.0% completion of the series for 12-15-year-old patients (n=1268) as of 2019. This implies a pressing health disparity that needs addressing in rural Nebraskan communities. 92.6% of all respondents chose the 12-15 age range as the patient population the clinics would typically ask about the vaccine versus 59.6% who chose the 9-11 age range. The most chosen reason for not mentioning the HPV vaccine is “parents previously voiced vaccine hesitancy” (33.3%) followed by “not enough clinic time” (22.2%). The most popular reason contributing to parental hesitancy is “they have concerns the vaccine is not safe for their child” (70.4%). The greatest benefit of the HPV vaccine was listed as “prevention from multiple forms of cancer” (33.3%) and the greatest drawbacks were both “multiple dose series completion” (40.7%) and “difficulty in convincing parents to vaccinate minors” (40.7%). The 9-11 age range was chosen as the most difficult age group to vaccinate (33.3%). The most difficult scenarios when addressing HPV vaccination concerns were “lack of vaccine education” (55.6%), “religious reasons against the vaccine (44.4%), and “language/cultural barriers” (37%). Qualitative results were also analyzed separately and focused on each individual clinic’s strengths and weaknesses regarding vaccination encouragement. Discussion: The baseline patient data show that clinics selected for the study exhibit a large disparity of HPV vaccination rates among a vulnerable age group. Survey responses show both a clinical observation regarding parents’ low-level education levels about the HPV vaccine as well as a lack of comfort engaging in open dialogue between patients and healthcare personnel. Focusing on these two variables alone could help increase rates of vaccination significantly. Survey results ultimately illustrate the urgent need for empirically-supported educational resources that will enhance communication- both within individual clinics among staff as well as between medical staff and patients’ families- to sustainably increase HPV vaccination rates across rural clinics.