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  • ISSN: 2333-6439
    Sex Hormone Binding Globulin in Gestational Diabetes Mellitus
    Authors: Saviour S. Anderson* and Zheng Zhiqun
    Abstract: Aims: The aim of this study was to measure and compare maternal plasma SHBG concentrations in normal pregnancy and in GDM patients, and thereafter determine the association between SHBG and GDM.
    Achalasia during Pregnancy Treated with Botulinum Toxin A Injection at the Lower Esophageal Sphincter
    Authors: Teresa A. Orth*
    Abstract: A 30-year-old African American woman, gravida 8 para 6016, was admitted at 34 weeks of gestation because of shortness of air, dysphagia for solids and liquids, ...
    Latest Articles
    Malcolm Wells Mackenzie*
    In 2006 Merck Pharmaceuticals announced the release of Gardasil, a first of its kind vaccination against a cancer, specifically cervical cancer. Attendant upon the release of this new vaccine was the usual blitz of advertising but more interestingly, Merck’s advertising campaign for Gardasil earned for the pharmaceutical company in 2008, “brand of the year award” for having created “a market out of thin air”[1].
    Review Article
    Varkha Agrawal1*, Mukesh Kumar Jaiswal2 and Yogesh Kumar Jaiswal3
    Abstract: A fundamental feature of implantation is synchronized development of the embryo to the blastocyst stage and differentiation of the uterus to the receptive state. Lipopolysaccharide (LPS), a bacterial endotoxin, is a component of the outer membrane of Gram-negative bacteria and its detection in biologic fluids is an evidence of microbial invasion of a sterile compartment, such as the amniotic cavity. A gram-negative bacterial infection model has been established in the mice. LPS alters the expression of tumor necrosis factor-a, interleukin-1, and colony-stimulating factor. LPS treatment disturbs serum P4, E2 and their receptors. Expression of Hsp90, Hsp70, Hsp60, and Hsp25 also altered due to LPS treatment. LPS disturbs the level of FSH and LH and, FSHR in embryos and ovaries, LHR in embryos and uterus. Disturbance in the embryonic and uterine expression of cytokines, growth factors, steroid hormones and its receptors, gonadotropins and its receptors and heat shock proteins in response to LPS probably trigger the multiple factors in the embryonic and uterine cells, which are responsible for implantation failure. The present review will contribute to our understanding of the mechanism of early pregnancy loss during gram-negative bacterial infection in pregnant mother.
    Mohammad Nasir Uddin1,2, Madhava R. Beeram2 and Thomas J. Kuehl1,2,3
    Abstract: Preeclampsia (preE) is a pregnancy disorder characterized by the de novo development of hypertension and proteinuria after 20 weeks of gestation and is the leading cause of maternal and fetal morbidity and mortality. The specific etiologies of this syndrome remain unknown. However, it seems clear that preE is not a single disorder, but a syndrome with multiple pathophysiologic triggers and mechanisms. Approximately 20% of the diabetic women who become pregnant develop preE. The mechanisms contributing to this effect is not well characterized. There is considerable evidence to suggest that dysfunction of cytotrophoblast cells, which are critical for formation of the fetal-maternal interface, may play a central role in the pathogenesis of preE. Excessive circulating glucose, caused by diabetes or other conditions, is one well-characterized precursor of preE. This review evaluates the potential linkage between the risk of developing preE and the presence of diabetes early in pregnancy. The concept is that high levels of glucose may stimulate one or more mechanisms of vascular remodeling during implantation and placental development. Elevated glucose levels in pregnancy may impair a cascade of vascular development that will predispose to development of placental vascular compromise. Cytotrophoblasts organize placental remodeling during pregnancy, and excess glucose in diabetic pregnancy may triggers intracellular changes in several stress signaling pathways resulting in cytotrophoblast cell dysfunction and abnormal placentation, thus development of preE.
    Research Article
    Pierre Marie Tebeu1,2*, Jeanine Abena Nnomo2, Calvin Tiyou2, MarieTherese Abena Obama3, Gisele Kengne Fosso1 and Joseph Nelson Fomulu2
    Abstract: Abruption Placenta (AP) is a premature partial or total separation of a normally implanted placenta from the uterine wall before the fetal delivery resulting in hemorrhage. This study aimed at evaluating the risk factors, maternal and perinatal outcome associated with abruption placenta at the Yaounde university teaching hospital in Cameroon.
    The overall 67 files of patients with AP were identified for a period of 10 years including January 2000 to December 2009. After each case of AP the files of the 3 women who delivered after her, without AP constituted the control group. We excluded 4 files in the AP group and 12 files in the control group because of missing or alteration making them useless. Finally 63 files for case and 189 for controls were analyzed. The level of significance was 0.05.
    During our period of study, a total of 20788 deliveries were registered among which 67 with AP (0.32 % of deliveries). The patient’s age varied from 16 to 45 years with the mean of 27.58 years old. Compared to the controls, the risk of AP was insignificantly increased in teenagers mothers (11.1% vs. 6.9%; OR: 1.66; 95% CI: 0.6 – 4.3; P = 0.298) and housewives (47.6 vs. 37.6%; OR: 1.40; 95%CI: 0.7 – 2.5; P=0.266). Women with AP were more likely to deliver a stillbirth (46% vs. 4.2%). No maternal death was recorded.
    Our findings justify the need for large quantitative and qualitative studies to understand more about the epidemiology of AP in Cameroon.
    Kai Wang1#*, Ying Chen1#, Susan D. Ferguson1 and Richard E. Leach1,2*
    Abstract: Hypoxia plays an important role in placental trophoblast differentiation and function during early pregnancy. Hypoxia-inducible factor 1 alpha (HIF1a) is known to regulate cellular adaption to hypoxic conditions. However, our current understanding of the role of HIF1a in trophoblast physiology is far from complete. Metastasis Associated Protein 1 and 3 (MTA1 and MTA3) are components of the Nucleosome Remodeling and Deacetylase (NuRD) complex, a chromatin remodeling complex, and are highly expressed in term placental trophoblasts. However, the role of MTA1 and MTA3 in the hypoxic placental environment of early pregnancy is unknown. In the present study, we examined the association among MTA1, MTA3 and HIF1a expression under hypoxic conditions in trophoblasts both in vivo and in vitro. We first investigated the localization of MTA1 and MTA3 with HIF1a expression in the placental trophoblast of 1st trimester placenta via immunohistochemistry. Our data reveals that under physiologically hypoxic environment, MTA1 and MTA3 along with HIF1a are highly expressed by villous trophoblasts. Next, we investigated the effect of hypoxia on these genes in vitro using the first trimester-derived HTR8/SVneo cell line and observed up-regulation of MTA1 and MTA3 as well as HIF1a protein following hypoxia treatment. To investigate the direct effect of MTA1 and MTA3 upon HIF1a, we over-expressed MTA1 and MTA3 genes in HTR8/SVneo cells respectively and examined protein levels of HIF1a via Western blot as well as HIF1a target gene expression using a luciferase assay driven by a hypoxia-response element promoter (HRE-luciferase). We found that over-expressions of MTA1 and MTA3 up-regulate both HIF1a protein level and HRE-luciferase activity under hypoxic condition. In summary, both MTA1 and MTA3 are induced by hypoxia and up-regulate HIF1a expression and HIF1a target gene expression in trophoblasts. These data suggest that MTA1 and MTA3 play critical roles in trophoblast function and differentiation during early pregnancy.
    Research Article
    Sarah K. Dotters-Katz1*, Andra H. James2 and Tracey A. Jaffe3
    Objective: The purpose of this study was to investigate the natural history of paratubal and paraovarian masses, and to identify indications for surgical intervention.
    Study design: Women who underwent transvaginal ultrasound at Duke University Hospital between 2002 and 2012 for the indication of pelvic mass, fullness, or pelvic pain were identified through a radiology database. Individuals noted to have a paratubal or paraovarian mass on ultrasound, or were found to have a paratubal/paraovarian mass on pathology, were included.
    Results: Of the 229 patients who underwent transvaginal ultrasound with the indication pelvic/abdominal mass, fullness or pelvic pain, 12 were identified with paraovarian cystic structures. Eight women were asymptomatic, while four women presented with pain. Ultrasound was the initial imaging modality in ten. All women were ultimately imaged with ultrasound. Five were recommended to have Magnetic Resonance Imaging (MRI) after initial ultrasound, (4of 5 of these patients had complex features to their cysts). 6 of 12 patients ultimately underwent surgery. The average diameter of the cyst in these women was 9.3cm (4-19.7cm range). Four of six patients underwent laparoscopy; three had concomitant removal of tubes and ovaries. The other six women were managed expectantly. The average cyst diameter of this group was 4.8cm (1.9-8.6cm). All had interval decrease in cyst size at follow up ultrasound; two patients had complete cyst resolution by a third follow up ultrasound.
    Conclusion: Large or complex paratubal/paraovarian cysts are best managed surgically. Simple cysts can be expected to regress and may be managed expectantly.
    Erin M. Wahle1, Abbey J. Hardy-Fairbanks2*, Jean M. Hansen2, Whitney L. Cowman2 and Colleen K. Stockdale2
    Background: Typically removal of an IUC involves mild traction on the string and yields few complications. However, there are situations in which IUC strings are not visible to the provider and removal of the device proves to be difficult.
    Study design: Retrospective cohort study of all patients presenting for IUC removal in the Procedure Clinic from January 1, 2009 through December 31, 2011 (N=29).
    Results: While there was no statically significant effect on whether strings were visible at the time of removal (p=0.06), patients who received misoprostol pre-procedure required significantly less ultrasound guidance (p=0.04) and significantly fewer instruments for IUC removal (p< 0.01).
    Conclusion: Use of vaginal misoprostol was associated with increased ease of IUC removal as demonstrated by lack of need for ultrasound guidance and fewer instruments required to successfully remove the device. Misoprostol appears to be effective in reducing the effort required in difficult IUC removal.
    Review Article
    Raymond Shamberger*
    Objective: The cause of SIDS is unknown. The American Academy of Pediatrics as a result of case-control studies has recommended that mother’s breast feed their children as a new step in SIDS prevention. The objective of this study is to apply nutritional epidemiology to SIDS, infant mortality, and breast feeding in the States of America and the counties of Florida to further confirm this observation.
    Study design: The rates of SIDS and infant mortality, and the 3 month exclusive breastfeeding are known for 2007. These rates, as well as several ecological factors, were compared using Excel statistics. Patterns between diseases were also observed. Similar statistics for infant mortality deaths were also done for the State of Florida using results from women who initiated breast feeding their babies after birth.
    Results: Rates of SIDS, and infant mortality were inversely significantly associated with 3 month exclusive breast feeding in the United States. Similar results were also seen for infant mortality in the counties of Florida. Patterns of relationships between SIDS, infant mortality and other factors may indicate a similarity in the 3origins of the diseases.
    Conclusion: Nutritional epidemiology of SIDS, and infant mortality in the United States and the counties of Florida in regard to infant mortality show that breast feedings may prevent these diseases as previously found in case-control studies.
    Comparison to other ecological factors suggests that the SIDS and infant mortality diseases may be similar in origin except for the severity of the diseases.
    Case Report
    Haritha Sagili1*, Papa Dasari1 and Bhawana Bhade2
    A 30 year old G5P2L2A2 presented with 2 months amenorrhoea and spotting per vaginum for 2 days. Urine test for hCG was positive and ultrasound revealed a normal uterus and a left complex adnexal mass measuring 8×6 cms. A provisional diagnosis of ectopic pregnancy or hormone secreting ovarian tumour was made. On laparotomy, the left ovary was replaced by a solid vascular mass densely adherent to the sigmoid colon. (Figure1) Left salpingoovariotomy was carried out with difficulty after releasing the adhesions. On the second postoperative day, she developed headache and vomiting. Fundus examination showed papilloedema and CT scan revealed 2 metastatic deposits in the parietal and temporal lobes (Figure 2). Choriocarcinoma was suspected, serum βhCG was 72,000 IU/ml, CXR showed a 2cm lesion in the right lower lobe (Figure 3) and histopathology revealed ovarian choriocarcinoma (Figure 4). She was being managed with anticerebral oedema measures and chemoradiation but her condition deteriorated and she was taken home against medical advice.
    Min Kyung Kim1, Kye Hyun Kim1, Jin-Sung Yuk2 and Jung Hun Lee2*
    Background: To report a rare case of primary adrenal tuberculosis mimicking metastasis in a patient with endometrial stromal sarcoma.
    Case presentation: A 50-year-old woman with advanced high grade endometrial stromal sarcoma (International Federation of Gynecology and Obstetrics stage IIIc) underwent staging operation and six courses of chemotherapy (cyclophosphamide, vincristine, doxorubicin, and dacarbazine). A whole-body Positron Emission Tomography-Computed Tomography suggested solitary right adrenal metastasis at 37 months after surgery. Laparoscopic right adrenalectomy was done and histopathological result showed primary adrenal tuberculosis.
    Conclusion: In endemic areas for tuberculosis, a diagnosis of adrenal tuberculosis should be considered for adrenal nodule in women with gynecologic malignancies.
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