Practical Activities for Cognitive Stimulation of Turner Girls, Teenagers and Women: A Guide for Themselves and their Families

Objective To provide at no cost to parents or guardians of girls or teenagers and to women, all with Turner syndrome: A. Simple and effective activities (for frequent performance) and without any contraindication, directed towards specific cognitive stimulation. B. Other useful recommendations.

Heterotopic Pregnancy in Natural Conception – A Case Report

Heterotopic gestation is very rare in natural conception but can be common with assisted reproductive techniques; a high index of suspicion can help in timely diagnosis and appropriate intervention. We report a case of heterotopic pregnancy in a 32-year-old woman presented with hemoperitoneum from ruptured right sided tubal pregnancy with live intrauterine gestation at 12 weeks of amenorrhea, diagnosed on clinical and ultrasound examination.

The Diagnostic Dilemma of Ascites in Women

Introduction: Ascites is the pathological accumulation of fluid within the peritoneal cavity. The most common causes of ascites are liver disease, vascular occlusion, congestive heart failure, pericarditis or nephrotic syndrome. We present to you case series of ascites as a common presentation in women, but each case with a different etio-pathogenesis related to gynecological benign disease. This case series highlights the importance, to consider gynecological problems among the potential differential diagnoses in women with ascites for early diagnosis and timely intervention. Methods: We identified 5 female patients older than 18 years who presented with ascites as a common clinical presentation and we reviewed their medical records to assess demographic data, clinical presentation, imaging findings, co-morbid conditions, histo-pathologic features, pharmacologic therapies and surgical intervention. Results: In all the five female patients, ascites was clinically diagnosed and confirmed with ultrasound of pelvis and abdomen. One of them noted to have pelvic tuberculosis, which was confirmed with endometrial biopsy and treated with antitubercular medication. One patient was diagnosed with adenomyosis and one other patient was diagnosed with leiomyoma, both patients were treated with total abdominal hysterectomy. One of the patients was diagnosed with endometriosis on laparotomy who was treated with gonadotrophin releasing hormone analogues. One of them was diagnosed with right sided ovarian fibroma, treated with right oophorectomy. All these patients had ascites as a common clinical presentation but with different underlying gynecological etiopathogeneses. The appropriate diagnosis and timely intervention in the above 5 cases resulted in complete resolution of symptoms. Conclusion: As a healthcare worker, initial evaluation of a female patient with ascites, should rely on a detailed history and physical examination. In women with ascites, gynecologic problems should be considered among the potential differential diagnosis for appropriate management and timely intervention.

Accuracy of Preoperative Pelvic Ultrasound in Predicting Uterine Weight Across Varying Pathologies

Objectives: The purpose of this study is to evaluate the accuracy of preoperative pelvic sonography in predicting the weight of a non-gravid uterus at the time of hysterectomy. Additionally, the study seeks to examine the effect of varying uterine pathologies on the accuracy of these predictions. Methods: This was a retrospective comparative study in a tertiary care hospital with a total of 318 patients who underwent pelvic ultrasound, with reported uterine volumes, prior to undergoing hysterectomy in 2018. Estimated uterine weights from preoperative pelvic ultrasounds were compared to actual uterine weights from post-hysterectomy pathology reports. A Bland-Altman plot was constructed to determine intermethod agreement with 95% limits of agreement. Simple linear regression analysis was used to correlate estimated and actual uterine weights. Multivariable linear regression was performed, allowing for subgrouping by uterine pathology. Results: While a strong positive correlation was identified between the two measurements (r = .93, p <.01), the Bland-Altman analysis showed that actual uterine weight ranged from 0.51 to 1.99 times the magnitude predicted by preoperative ultrasound. These wide deviations in intermethod agreement were similar amongst the various uterine pathologies. Multivariable linear regression analysis demonstrated the difference in estimated and actual uterine weight was 2 to 3.5 times larger for patients with endometrial pathology, adenomyosis, and leiomyomata as compared to normal uteri (p < .03). Conclusion: This study shows that in 95% of cases, actual uterine weight ranged from half to twice as large as estimated by preoperative pelvic ultrasound. Uterine pathology had a significant impact on the reliability of ultrasound for estimation of uterine weight. In gynecologic practices where preoperative estimations of uterine weight are instrumental in choosing a surgical approach for hysterectomy, reliance on pelvic ultrasound as a means of predicting uterine weight should be carefully considered.

Hematological Characteristics During the Third Trimester of Pregnancy in a Population of Low and High Socio-Economic Levels in Lubumbashi

Background: During pregnancy, many hematologic changes occur to meet the demands of the developing fetus. The objective of this study was to describe the hematological characteristics in the third trimester in a population of low and high socioeconomic levels in Lubumbashi, in relation to the WHO and China reference values. Methodology: A descriptive cross-sectional observational study was carried out in Lubumbashi, among pregnant women received during the third trimester antenatal consultations in apparent good health. A total of 128 pregnant women with a monofetal pregnancy of at least 27 weeks of amenorrhea in apparent good health were selected and divided into two groups of low and high socioeconomic levels. Blood was drawn and analyzed on the CYANHEMATO machine. Results: Hemoglobin (HB) averages were 9.63 ± 1.52 and 11.19 ± 1.07 g / dl respectively in the low and high socioeconomic levels population. The majority of patients in the two populations were in the reference range for red blood cell (RBC) count from 2.75 to 4.64 1012 / l. The average values of hematocrit (HCT), mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) in Lubumbashi were lower than in the China population : 28.39 ± 4.21 versus 32.47 ± 3.46% ; 67.34 ± 9.50 versus 74.38 ± 8.15 fl and 22.96 ± 3.56 versus 25.71 ± 3.23 pg for reference values of 36% ; 90.8 fl and 30.5 pg, respectively. As for the red blood cell distribution width (RDW), it was higher in the low socio-economic level population (16.86 ± 3.40%) than in the high socio-economic level population (14.90 ± 2.25%) with a difference highly significant (p <0.0001). Conclusion: The RBC and RDW were significantly increased in Lubumbashi, while HB. HCT, MCV and MCH were decreased. The mean corpuscular hemoglobin concentration (MCHC) did not present any particularity

Thematic Dynamics of Internet of Things (IoT): Impact on Digital Personalized Healthcare (PHC)

Information technology has continued to shape contemporary thematic trends. Advances in communication have impacted almost all themes ranging from education, engineering, healthcare, and many other aspects of our daily lives. This paper attempts to review the different dynamics of the thematic IoT platforms. A select number of themes are extensively analyzed with emphasis on data mining (DM), personalized healthcare (PHC), and thematic trends of a select number of subjectively identified IoT-related publications over three years. In this paper, the number of IoT-related-publications is used as a proxy representing the number of apps. DM remains the trailblazer, serving as a theme with crosscutting qualities that drive artificial intelligence (AI), machine learning (ML), and data transformation. A case study in PHC illustrates the importance, complexity, productivity optimization, and nuances contributing to a successful IoT platform. Among the initial 99 IoT themes, 18 are extensively analyzed using the number of IoT publications to demonstrate a combination of different thematic dynamics, including subtleties that influence escalating IoT publication themes. Based on findings amongst the 99 themes, the annual median IoT-related publications for all the themes over the four years were increasingly 5510, 8930, 11700, and 14800 for 2016, 2017, 2018, and 2019 respectively; indicating an upbeat prognosis of IoT dynamics. And finally, the vulnerabilities that come with the successful implementation of IoT systems are highlighted as part of the research. Security continues to be an issue of significant importance.

Is there an association of bone mineral density and risk of breast cancer in postmenopausal Saudi women?

Several studies revealed an association between high bone mineral density (BMD) and the increased risk for developing breast cancer (BC). Aim: Explore if there is an association between BMD and BC risk in postmenopausal Saudi (PMS) women. Material and Method: In a retrospective cohort study of 1145 PMS women age range from 46 – 85 year (mean = 55 year). The average time period of menopause 4 years.We reviewed BMD of all patients performed between October 2012 and November 2018. All patients had BMD measurements of lumbar spine L2-L4 and right femoral neck in gm/cm². Results: The T-score was used for analysis of the results. Among the total patient studied 195 (17%) were found to have BC group 1 (G1) while 950 (93%) without BC group 2(G2). Analysis of lumbar spine T-score in G1 showed that: 29 % had osteoporosis, 37% osteopenia and 34% had normal BMD and in G2 40% had osteoporosis, 31% osteopenia and 29 had normal values. Results showed prevalence of osteoporosis in G1 was significantly lower than in G2 (p =0.002) while there was no significant difference between the two groups with osteopenia and normal BMD results (p = 0.06 and 0.205 respectively). Conclusion: PMS women with BC had higher BMD at time of diagnosis compared to their counterpart without BC.

Nerve Sparing Reduction Clitoroplasty in a Case of Congenital Adrenal Hyperplasia

Adrenogenital syndrome, or Congenital Adrenal Hyperplasia, is caused by a congenital insufficiency of the enzyme 21-hydroxylase, which is responsible for converting cortisol into cholesterol. Because of virilizing effect of androgens and its over- production, girls develop clitoral hypertrophy or Clitoromegaly. Clitoromegaly is an embarrassing condition, causing psychological stress to young girls and, hence requiring intervention. The goals of clitoroplasty are to achieve normal genital anatomy and to preserve tactile sensation with a satisfactory sexual response. We present a case of Adrenogenital syndrome with Clitoromegaly managed by reduction Clitoroplasty, preserving the dorsal neurovascular bundle and extensive network of nerves around the corpora to the glans and there by preserving the tactile sensation of the clitoris.

The Association Between Serum Estradiol and Progesterone On the Same Day of FET and The Pregnancy Outcome; A Cross Sectional Study

Research Question Precise timed synchronization between endometrium and the embryo is essential for high implantation and pregnancy rate, it is worthy to mention that endometrial thickness is not the only factor, E2 and P levels are also regularly monitored for endometrial receptivity. So, we decided to go for this study, to investigate the impact of serum E2 and P levels on the same day of embryo transfer on pregnancy outcomes for FET cycles. Design This was a retrospective cross sectional study for 402 FET cycles which conducted between April 2018 and May 2019. All participants started endometrial preparation for FET with 6 mg/day oral estradiol for 13 days. When endometrium reached 8 mm or greater, patients were initiated on both micronized vaginal and oral P treatment. On FET day, serum level of E2 and P were assessed. Then, transfer of PGT euploid embryos was performed. 12 days’ later pregnancy test was assessed, and then 4 weeks after FET date ultrasound was scheduled to check the viability and the clinical pregnancy. Results The mean E2 value was 931.41 ± 438.65 pg/ml, while mean P value was 8.47 ± 9.4 ng/ml. 240 out of 402 cases got pregnant (59.7%) while the clinical pregnancy rate was 53.9% with no correlation between serum (E2, P & E/P ratio) and the outcome. Conclusion Our results revealed that the association between E2 and P on FET day and the pregnancy outcome is still not proven and those markers can’t serve as predictors for the outcome.

Egocentric Networks and HIV in Pregnant and Breastfeeding Women Attending Antenatal Care in Lusaka, Zambia

Human immunodeficiency virus (HIV) has a disproportionate effect on pregnant and breastfeeding women in sub-Saharan Africa. This study used egocentric social network analysis (SNA) to compare the social and sexual networks of HIV-negative and HIV-positive women attending an antenatal care (ANC) clinic in Lusaka, Zambia. In order to assess risk and protective factors for HIV acquisition and transmission, variables included self (ego) sociodemographic characteristics, main partner characteristics, features of the relationship between ego and her main partner, alter attributes, alter-ego ties, and alter-alter ties. Associations between the independent variables and ego HIV status were identified using bivariate tests. Logistic regression analyses were performed to assess the relationship between predictors and ego HIV status when multiple variables were included in the same model. Overall, 219 participating women (69 HIV-positive, 150 HIV-negative) nominated 1095 alters. Compared to HIV-negative egos, HIV-positive egos were older, had main partners who were more likely to consume alcohol before sex, disclosed their HIV status to fewer alters, had fewer alters with whom they had daily interactions, and had more alters who were HIV-positive or HIV-unknown. Number of alters who were HIV-positive or HIV-unknown and non-disclosure of HIV status were the greatest risks (with the effect of HIV-positive or HIV-unknown being of a slightly greater magnitude than non-disclosure of HIV status), which places breastfeeding women, their partners and their infants at risk of preventable HIV infection.