Absorbable Hemostatic Particles to Reduce the Damage on the Follicular Reserve After Ovarian Endometriomas Stripping

Objective: to reduce the surgical damage to the ovarian reserve, after stripping of ovarian endometrioma, of the necrotic type given by the electrohaemostasis or ischemic type given by the suture. Design: perform haemostasis on ovarian parenchyma with topical haemostatic agents. Materials and methods: we used Arista AH which is a powder made up of microporous polysaccharide hemospheres that act by osmotic action and accelerate the natural coagulation process. We used Arista AH in 27 women with mono- or bilateral ovarian endometriosis. Results: in all treated cases we obtained a rapid and optimal haemostasis. There were no post-surgical complications related to haemostatic defects. Three months after the surgery, we checked the Antral Follicle Count (AFC) with a trans-vaginal ultrasound probe. AFC in 24 women with full follow-up gave the following results: unilateral endometrioma – AFC between 5 and 8 (MV: 6.3), bilateral endometriomas – the AFC between 5 and 7 (MV: 5.8). Conclusions: The use of Arista AH powder allows highly effective hemostasis and is easy to use, fully respecting the residual ovarian parenchyma after stripping.

Functional Hypothalamic Amenorrhoea in Adolescent girls as a Result of Stress-Related Conditions in Covid-19 Pandemic Situation

Functional hypothalamic amenorrhoea (FHA) is a form of anovulation due to the suppression of HypothalamicPituitary-Ovarian (HPO) axis, not related to identifiable organic cause. FHA is a state of hormonal imbalance related to stress, exercising too much or consuming too few calories. In the unprecedented Covid-I9 Pandemic, there is an upsurge of FHA in adolescent girls. Being confined to ‘stay at home’, the phobia of gaining weight due to restricted movement is often triggering eating disorders like Anorexia Nervosa(AN);indulging in indoor overexercise, stress associated with routine change, exposure and preoccupations with social media in the changed scenario are causing a disruption of HPO axis manifesting as FHA. But FHA has serious short-term and longterm effects on the physical and mental health of the adolescent individuals. The present article aims at reviewing the causes, effects, evaluation and management of FHA in the present scenario. Adolescent girls with FHA should be carefully diagnosed and properly managed to prevent both short-term and long-term deleterious effects with appropriate and timely intervention.

Statistics on Epidural Analgesia Made on Admitted Patients for Normal Vaginal Delivery, Outcome Results and Benefits

Introduction: Childbirth can be extremely painful. Labor pain is multifactorial and very complex, as it is a combination of visceral pain and somatic pain, in addition to psychological factors. Thus, the provision of effective pain relief during labor is an important element for a positive maternal experience. Epidural anesthesia is the most frequently used method of pain control In normal vaginal delivery (NVD), labor epidurals provide effective analgesia for laboring parturient. Objective: of the present study was to review the maternal and fetal risks associated with epidural analgesia for pain relief during labor, and to investigate whether the use of epidural analgesia during labor was a risk factor for AVD and CS delivery. Methods: We performed a 1-year (2020) prospective cohort analysis of the patients presenting at four obstetricled maternity units part of major academic medical centers in Beirut, Lebanon from January 2020 until December 2020. All eligible patients were approached for the consenting process, and those who agreed to participate in the study were included in the analysis. Patients were stratified in two groups based on the type of pain control they opted for/received at the time of admission: epidural delivered anesthesia or intravenous infusion of pain medications. Results: A 100 eligible women consented to take part in the study, between January 1st, 2020 and December 31st, 2020. Maternal and fetal survival at the 30-days mark was 100.0% for both groups. Duration of labor was significantly 0.1h shorter in the epidural group with a mean of 6.7 ± 1.8 h as opposed to 6.8 ± 2.6 h in the nonepidural group. Use of forceps and/or vacuum was significantly higher in the epidural group 9 (17.3%) and 2 (3.8%) as opposed to 1 (2.1%) and 0 (0.0%) in the epidural group. A higher rate of severe perineal tears (grade 3 or more) was observed in women who received epidural anesthesia. Conclusion: Epidural anesthesia is a safe option for pain control during vaginal delivery, both for the mother and the infant no effect on the duration of labor, and thus does not increase the risk of maternal or fetal infection or conversion to CS is also safe for neonates and is not associated with increased short term neonatal morbidity such as admission to the NICU. Epidural anesthesia however remains a risk factor for AVD and thus the use of instruments Its role as for severe perineal lacerations remains unclear according to our data, as we did not account for confounding factors. This last point remains to be investigated in large population-based studies.

A Summary Note of Gestational Diabetes Control Centred on Several Evidence-Based Type 2 Diabetes Research Results Using GH-Method: Math-Physical Medicine (No. 399)

The author, who has type 2 diabetes (T2D) for 26 years, conducted his diabetes research over the past 11 years. Since 2020, he has published 400+ medical research papers in various medical journals. Recently, he received invitations to submit his medical research notes to a gynecology journal but he hesitated because he was not a gynecologist. However, the editor convinced him that his research results may be beneficial to some patients with gestational diabetes mellitus (GDM) since diabetes conditions are quite similar, if not the same. Therefore, he started to review some medical papers online on the subject of gestational diabetes. Finally, he uncovered that his research results could indeed benefit some GDM patients to some degree and decided to write this summary note. Although his research specialties are in the areas of endocrinology, diabetes, and lifestyle, after 11 years of dedicated medical research with additional self-studying on GDM, he discovered that approximately 90% of his diabetes research findings are applicable to this special group. In summary, three areas with special emphasis are highlighted for GDM patients. The first and major area is food nutrition in a lifestyle management program. Due to the concerns of hyperglycemia, the author eats high-quality protein, a lot of fish and vegetables, particularly green leafy vegetables, portioncontrolled shellfish and fruits, along with avoidance of red meat and sweetened food. However, for a GDM patient, he highly recommends them to follow a “nutritional balanced” meal plan, avoiding high-carbs, sugar-based, and processed food in general to prevent unhealthy chemical additives. The fetus in utero needs good nutrition supplied by its mother; therefore, the mother must eat nutritional balanced meals that meet nutritional requirements and glucose concerns. The second area is specific weight-gain management. The author focuses on the food portion percentage with a strong willpower to resist his food cravings plus persistence each day, so that he can achieve his weight reduction target. However, for a GDM patient, she must constantly monitor the amount of weight gained according to the Mayo Clinic’s “weight-gain guidelines”. Maintenance in this area is important for the benefit of the baby’s development and mother’s health during pregnancy. However, both of his food portion percentage and persistent weight control are good examples to follow and useful for a GDM patient. The third area is medication treatment for gestational diabetes. Although the author ceased taking medications in controlling his diabetes symptoms, he decided to implement a rather stringent lifestyle management program in order to control or even reverse his diabetes conditions at the root-cause level. Nevertheless, it is a difficult route that takes a longer time span to be able to see significant improvements. Since the pregnancy period is relatively shorter, less than 10 months, a gestational diabetes patient must follow her physician’s advice to pursue all the necessary medication treatments or insulin injections. The information in particular the high correlation coefficients between any two variables, from Figures 2 through 5, provide useful knowledge for a GDM patient to learn in order to control her glucose levels during pregnancy. The most important goal is the safe delivery of a healthy new born

Cystitis in Women: Focus

Urinary tract infections are one of the most common conditions in medical practice, especially in general medicine. Whether it is uncomplicated adolescent cystitis after first sexual intercourse, postmenopausal infection or recurrent cystitis at any age, lower urinary tract infection disrupts the quality of life for many women. Despite the often multifactorial origin, each woman has a very specific reason for developing cystitis and it is necessary to look for the trigger (s) [1]. The reason for consultation is most often simple dysuria (difficulty voiding), but can also present in 2 to 5% of cases in the form of urgency voiding or pollakiuria [2]. The prevalence figures for acute uncomplicated urinary tract infection range from 30 to 50 per thousand in adult women [3]. As the risk of urinary tract infection increases with age, half of women develop symptomatic infection at least once [4], but only half of them will see them [5]. However, apart from the significant physical and psychological disturbances that can cause a urinary tract infection, especially recurrent, it should be known that there is no medical condition which requires so many consultations, bacteriological examinations and antibiotic prescriptions than cystitis [6].

The Pro-Life Paradox of Pregnancy Termination and Disability Exclusion

The debate over the use of genetic testing to inform expectant mothers regarding fetal anomalies, with the intention of enabling her to decide whether or not to terminate pregnancy based on testing outcomes, is arguably deemed by many physicians and scientists to be major medical advancement. Proponents of testing believe that this information prevents the potentiality of lifelong suffering for of the unborn child, as well as encourages a healthier population. There are, however, scientists, geneticists, theorists, and disability advocates, who disagree with this theory. Furthermore, pro-life allies appear to take very differing stances on this topic, from opposing any termination of pregnancy, even in cases of severe disability or a likelihood of infant or maternal mortality, while some may believe abortion is acceptable under these unique circumstances, even if they oppose others. It is difficult to understand how the criteria is evaluated, particularly in cases of the former, when support and resources for disabled persons are greatly lacking, which can lead to a more challenging life, and when the stigma of bearing and raising a defective child is widespread. Thus, it is a crucial topic in women’s studies to understand when there is a pro-life paradox of disability exclusion is and how it may inform decision-making and advocacy regarding selective termination of pregnancy

Urethral Bulking for Stress Urinary Incontinence or Mixed Incontinence in Women Not Suitable for Treatment With a Midurethral Sling: 5-Year Follow-Up

Aim: To compare outcome of injection with the bulking agent polyacrylamide hydrogel (PAHG) with no treatment in women with urinary incontinence who were not candidates for treatment with a midurethral sling. Methods: Women were randomized to treatment with PAHG or no treatment. After 2 months follow-up the women in the non-treatment group were also given PAHG treatment. All patients were then followed for 12 months. Patients were assessed with a patient satisfaction questionnaire, the UDI-6 (lower urinary tract symptoms) and IIQ-7 (quality of life). A new questioner was sent after 5 years. Results: At 2 months, IIQ-7 scores decreased by 55% and the UID-6 by 38% in women in the treated group compared with -4% and 2%, respectively in the non-treatment group. A total of 63% of patient were much satisfied/ satisfied in the treatment group compared with 19% in the non-treatment group. The 12-month follow-up showed a subjective satisfaction rate of 62%. The objective results show that women who were satisfied (n = 18) had a decrease in IIQ-7 of 61% and UID-6 of 41% compared with 20% and 10% in patients who were not satisfied (n = 11). At a mean (range) follow-up of 5 years (3–7), 44% of patients were still satisfied with treatment results. Conclusion: Bulking treatment with PAHG can be offered to patients not suited to treatment

Should “Transformed Alpha-fetoprotein” be considered a Potential Biomarker for Adverse Term Pregnancy Risk: An Opinion Letter

Human alpha-fetoprotein (HAFP), classified as a tumor-associated fetal protein, has been reported in the biomedical literature to display multiple molecular forms and complexes. Such forms have been demonstrated to include the following: 1) circulating serum full length HAFP; 2) non-secreted cell-bound cytoplasmic HAFP forms; 3) truncated mRNA expressed/translated forms largely found in cell culture supernatants; and 4) serum circulating inter-molecular complexed forms [1, 2]. Moreover, the native 70 kD circulating serum AFP form has long been employed in the clinic as a “gold standard” biomarker for hepatocellular carcinomas and germ cell tumors in addition to being a biomarker for fetal birth defects.

Evaluation of the Discrepancy in Bone Mineral Density Between the Lumbar Spine and Femoral Neck Among Japanese Women According to Age

This study aimed to examine the age-specific individual discrepancy between lumbar spine (LS) bone mineral density (BMD) and femoral neck (FN) BMD in Japanese women and to compare the significantly different characteristics between the two bone sites. We found a higher prevalence rate of discordance between the two BMD T-score sites, and many patients had a lower LS BMD T-score than FN BMD T-score. We believe that our study makes a significant contribution to the literature because our findings suggest that physicians should assess BMD more carefully in women who have a low body weight or body mass index and parental hip fracture history. For these patients, it is necessary to measure both the LS and FN BMD T-scores for calculating the fracture risk.

Clinical Management of Corona Virus Disease 2019 (COVID-19) in Pregnancy and Outcome- Case Reports

Bangladesh is a South East Asian country; the first case of COVID-19 was detected in early March 2020. In a land where 2.11% of the total world population resides; a devastating surge of the Pandemic of COVID-19 was anticipated to overwhelm the health sectors [1]. Specific high risk groups were identified and possible efforts to minimize both morbidity and mortality have been ensured. Pilot health projects launched with mass campaigns on preventive measures from COVID-19 and to educate people about mode of transmission, home treatment and isolations in mild cases. Apart from general cases, the obstetric cases became a delicate challenge for health professionals. Here both mother and babies requires standard treatment protocol, care along with unprecedented psychological support system for the mothers in all three antepartam, intrapartam and postpartam periods. A well designed care protocol introduced for neonatal care. A national guideline on clinical management of corona virus disease 2019 (COVID-19) has been developed on 30th March 2020 by Disease Control Division in combination with Director General of Health Services, Ministry of Health and Family Welfare of Government of the People’s Republic of Bangladesh [2]. The guidelines have been updated time to time to incorporate latest evidence and recommendations of WHO. New COVID-19 units reconstructed both in Government and Private sectors with adequate logistics, ICU support and trained stuffs with proper mother and baby isolation centers. A comprehensive infection prevention and control (IPC) is strictly maintained in every aspects of case management from community to hospital ICU. Severe and critical cases are treated in designated COVID-19 hospitals or units. Laboratory for patient screening tests and triage became a huge challenge for health facilities required constant supervision. Proper early diagnosis and case detection became the success tool of the disease. Two obstetric cases COVID-19 (SARS CoV2 virus) treatment and outcome have been discussed in this topic to highlight the management issue and to adopting national protocol.