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Cureus May 2024Background Infertility remains a significant challenge affecting millions of couples worldwide, with ovulation abnormalities being a common underlying cause....
A Comparative Analysis of Follicular Diameter Assessment Versus Doppler Ultrasound in Predicting Ovulation Timing for the Infertility Treatment: Insights From a Prospective Study.
Background Infertility remains a significant challenge affecting millions of couples worldwide, with ovulation abnormalities being a common underlying cause. Pharmacological methods, such as clomiphene citrate, are often used to stimulate ovulation. However, the optimal timing for sexual intercourse during ovulation induction remains contentious. Objectives This study aimed to compare the efficacy of transvaginal ultrasonography (TVS) for measuring follicle size with Doppler ultrasound for assessing changes in blood flow to predict the timing of ovulation. Methods We conducted a comparative analysis involving 64 women undergoing infertility therapy. Participants were evaluated using both TVS to measure follicle diameter and Doppler ultrasound to assess perifollicular blood flow dynamics. The primary outcomes measured included ovulation rates, resistive index (RI) values, peak systolic velocity (PSV) values, and conception rates. Results The analysis showed comparable age distributions between the TVS and Doppler groups. There was no significant correlation between follicle diameter and ovulation when assessed by TVS. However, Doppler ultrasound revealed a substantial association between perifollicular blood flow dynamics and ovulation. Higher ovulation rates were linked to lower RI values and higher PSV values, indicating their potential as predictors of ovulation. Additionally, higher conception rates were positively correlated with increased vascularity in Zone 4 of the endometrium. Conclusion Doppler ultrasonography indices, particularly RI and PSV values, provide critical insights into perifollicular blood flow dynamics and endometrial vascularity, which can enhance the effectiveness of fertility treatments. While these findings highlight the potential of Doppler ultrasound in predicting ovulation and improving treatment outcomes, further research is required to understand the underlying mechanisms and validate these results for personalised treatment strategies.
PubMed: 38953072
DOI: 10.7759/cureus.61466 -
Cureus May 2024Acute appendicitis is the most common non-obstetric reason for exploratory laparotomy during pregnancy. This case report involves a primigravida patient who presented to...
Early Diagnosis of Acute Appendicitis in the Second Trimester of Pregnancy Based on Non-typical Clinical Findings: Report of a Rare Case and a Mini-Review of the Literature.
Acute appendicitis is the most common non-obstetric reason for exploratory laparotomy during pregnancy. This case report involves a primigravida patient who presented to the emergency department of the General Hospital of Trikala at 15 weeks of gestation due to diffuse abdominal pain, primarily in the epigastric region. She also reported watery bowel movements. The ongoing atypical clinical symptoms, along with elevated inflammatory markers, strongly indicated a diagnosis of acute appendicitis. An immediate exploratory laparotomy was performed, during which acute localized inflammation of the appendix was found, leading to an appendectomy. Histological examination confirmed the diagnosis of acute appendicitis. The patient reported pain relief immediately after the surgery. On the fourth postoperative day, she was discharged without any signs of a threatened second-trimester miscarriage. At 39 gestational weeks, she delivered by elective cesarean section due to breech presentation. This paper discusses the case and highlights the significant challenges in the early diagnosis and management of acute appendicitis during pregnancy, emphasizing the importance of preventing potentially life-threatening complications for both the mother and the fetus.
PubMed: 38953065
DOI: 10.7759/cureus.61463 -
Research and Practice in Thrombosis and... May 2024
PubMed: 38953049
DOI: 10.1016/j.rpth.2024.102448 -
Patient Preference and Adherence 2024To compare three methods for identifying patient preferences (MIPPs) at the point of decision-making: analysis of video-recorded patient-clinician encounters,...
Comparing Methods for Identifying Post-Market Patient Preferences at the Point of Decision-Making: Insights from Patients with Chronic Pain Considering a Spinal Cord Stimulator Device.
PURPOSE
To compare three methods for identifying patient preferences (MIPPs) at the point of decision-making: analysis of video-recorded patient-clinician encounters, post-encounter interviews, and post-encounter surveys.
PATIENTS AND METHODS
For the decision of whether to use a spinal cord stimulator device (SCS), a video coding scheme, interview guide, and patient survey were iteratively developed with 30 SCS decision-making encounters in a tertiary academic medical center pain clinic. Burke's grammar of motives was used to classify the attributed source or justification for a potential preference for each preference block. To compare the MIPPs, 13 patients' encounters with their clinician were video recorded and subsequently analyzed by 4 coders using the final video coding scheme. Six of these patients were interviewed, and 7 surveyed, immediately following their encounters.
RESULTS
For videos, an average of 66 (range 33-106) sets of utterances potentially indicating a patient preference (a preference block), surveys 33 (range 32-34), and interviews 25 (range 18-30) were identified. Thirty-eight unique themes (75 subthemes), each a preference topic, were identified from videos, surveys 19 themes (12 subthemes), and interviews 39 themes (54 subthemes). The proportion of preference blocks that were judged as expressing a preference that was clearly important to the patient or affected their decision was highest for interviews (72.8%), surveys (68.0%), and videos (27.0%). Videos mostly attributed preferences to the patient's situation (scene) (65%); interviews, the act of receiving or living with SCS (43%); surveys, the purpose of SCS (40%).
CONCLUSION
MIPPs vary in the type of preferences identified and the clarity of expressed preferences in their data sets. The choice of which MIPP to use depends on projects' goals and resources, recognizing that the choice of MIPP may affect which preferences are found.
PubMed: 38953019
DOI: 10.2147/PPA.S431378 -
PeerJ 2024Ovarian cancer is an aggressive malignancy with high mortality known for its considerable metastatic potential. This study aimed to explore the expression and functional...
BACKGROUND
Ovarian cancer is an aggressive malignancy with high mortality known for its considerable metastatic potential. This study aimed to explore the expression and functional role of Unc-51 like autophagy activating kinase 2 (ULK2) in the progression of ovarian cancer.
METHODS
ULK2 expression patterns in ovarian cancer tissues as well as benign tumor control samples obtained from our institution were evaluated using immunohistochemistry. Cell counting kit 8 and Transwell assays were applied to assess the effects of ULK2 overexpression on cell proliferation, migration and invasion, respectively. RNA sequencing was performed to explore potential mechanisms of action of ULK2 beyond its classical autophagy modulation.
RESULTS
Our experiments showed significant downregulation of ULK2 in ovarian cancer tissues. Importantly, low expression of ULK2 was markedly correlated with decreased overall survival. functional studies further demonstrated that overexpression of ULK2 significantly suppressed tumor cell proliferation, migration, and invasion. RNA sequencing analysis revealed a potential regulatory role of ULK2 in the insulin signaling pathway through upregulation of insulin-like growth factor binding protein-3 (IGFBP3) in ovarian cancer cells.
CONCLUSIONS
In summary, the collective data indicated that ULK2 acted as a tumor suppressor in ovarian cancer by upregulating the expression of IGFBP3. Our study underscores the potential utility of ULK2 as a valuable prognostic marker for ovarian cancer.
Topics: Humans; Female; Cell Movement; Ovarian Neoplasms; Cell Line, Tumor; Neoplasm Invasiveness; Cell Proliferation; Insulin-Like Growth Factor Binding Protein 3; Autophagy-Related Protein-1 Homolog; Gene Expression Regulation, Neoplastic; Up-Regulation; Signal Transduction; Protein Serine-Threonine Kinases
PubMed: 38952983
DOI: 10.7717/peerj.17628 -
Nigerian Medical Journal : Journal of... 2023Ovarian cancer is the second most prevalent but most lethal gynaecologic malignancy in our institution. This study aimed at determining the rate of non-diagnosis in...
BACKGROUND
Ovarian cancer is the second most prevalent but most lethal gynaecologic malignancy in our institution. This study aimed at determining the rate of non-diagnosis in suspected lesions and reviewing the management challenges of ovarian tumours highly suspicious for malignancy in our hospital.
METHODOLOGY
A three-year retrospective review of patients' records from the ward, clinic, theatre, and histopathology laboratory was carried out. Cases with high indices of suspicion for ovarian cancer (ovarian tumour with malignant radiologic features with any of ascites, pleural effusion, as well as cachexia, anaemia, or evidence of metastasis) were included. In-depth interviews were carried out with a consultant from each specialty of Radiology, Radio-oncology, Pathology, and Gynaecologic oncology at the gynaecologic oncology multidisciplinary team meeting.
RESULTS
One hundred and twenty-two cases of highly suspicious ovarian malignancies were seen with a mean age of 40.6 years. Of these, 28 (23%) had surgery and 77% did not have any form of histological diagnosis. Of those that had surgery, 13 (46.4%) had upfront surgery and 15 (53.6%) neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Only two cases had documented complete (R) debulking. Among those that had upfront surgery, one case (7.7%) was an ovarian fibroid and one (7.7%) was a fibrosarcoma while two cases (15.4%) were borderline ovarian tumours. Chemotherapy was commenced based on malignant cells on ascitic or pleural fluid cytology in three cases. Of all the malignant cases, epithelial carcinomas were commonest accounting for 48%. Aside from the general late presentation of cases, insufficient funds for treatment, poor coverage of health insurance for cancer care, unavailability of routine immunohistochemistry, lack of germline and somatic testing, non-availability or prohibitive cost of some chemotherapeutic agents, unavailability of maintenance therapies, inadequate capacity to manage toxicities, inadequate skill across all specialties, unavailability / erratic function of computerized tomography scans and unavailable positron emission tomography, lack of interventional radiology facility amongst others were all identified as challenges to management.
CONCLUSION
Most patients with tumours highly suspicious for ovarian cancers did not get a histologic diagnosis and probably died undiagnosed. Management of ovarian cancer remains a challenge despite advances in surgical and chemotherapeutic options. Health insurance for all, infrastructure development, and training of all disciplines involved is recommended.
PubMed: 38952886
DOI: 10.60787/NMJ-64-4-217 -
Nigerian Medical Journal : Journal of... 2023The use of antenatal corticosteroids beyond 34 weeks of gestation to prevent certain neonatal complications remains a debate. This study sought to determine the effect...
BACKGROUND
The use of antenatal corticosteroids beyond 34 weeks of gestation to prevent certain neonatal complications remains a debate. This study sought to determine the effect of the use of antenatal corticosteroids in late preterm delivery on neonatal morbidity.
METHODOLOGY
It was a randomized double-blind placebo and active-controlled multi-arm trial. There were two study groups and one control group. It was conducted at the Department of Obstetrics and Gynaecology and the Department of Paediatrics of Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Pregnant women at 34 weeks to 36 weeks 6 days of gestation scheduled for elective delivery or who had emergency delivery were recruited for the study. The first study group had 2 doses of 12mg intramuscular dexamethasone and the second study group had 2 doses of 12mg betamethasone. The control group had 2 doses of a placebo. The primary outcome was the incidence of respiratory distress syndrome evidenced by tachypnoea with grunting, recession, or nasal flaring with diffuse reticulogranular infiltrate on X-ray or respiratory distress requiring the need for respiratory support by 72 hours of age. Secondary outcome measures included the need for neonatal resuscitation at birth, admission into the Special Care Baby Unit/Neonatal Intensive Care Unit, transient tachypnoea of the newborn, and apnoea.
RESULTS
A total of 138 mothers and 146 preterm neonates were included. A pairwise analysis was done to test for differences between the groups. There was no difference in the incidence of respiratory distress syndrome between the groups. However, the need for neonatal resuscitation was significantly higher (RR: 7.0; CI: 2.49-19.4; p = <0.001) in the placebo group when compared to the betamethasone group and also significantly higher (RR:4.0; CI: 1.86-26.03; p= 0.01) in the placebo group when compared to the dexamethasone group.
CONCLUSION
Antenatal corticosteroids may decrease the need for neonatal resuscitation at birth in late preterm neonates.
FUNDING
The research was funded by the Tertiary Education Trust Fund (TETFUND) of Nigeria. Trial registration: ClinicalTrial.gov, NCT03446937.
PubMed: 38952884
DOI: 10.60787/NMJ-64-4-297 -
Nigerian Medical Journal : Journal of... 2023Hepatitis B Virus Hepatitis B Virus (HBV) infection is a global public health problem. It is highly endemic in Nigeria and it is estimated that about 9-12% of the total...
BACKGROUND
Hepatitis B Virus Hepatitis B Virus (HBV) infection is a global public health problem. It is highly endemic in Nigeria and it is estimated that about 9-12% of the total population of Nigeria are chronic carriers of hepatitis B surface antigen. Epidemiological data on (HBV)infection among pregnant women in Nigeria are very scarce, especially in rural areas. The purpose of this study was to determine the prevalence and potential perinatal transmission among rural pregnant women in Abakaliki Nigeria.
METHODOLOGY
A cross-sectional study was conducted among pregnant women accessing antenatal care at the Federal Teaching Hospital, Abakaliki. We consecutively recruited 300 pregnant women attending antenatal consultations. A pretested questionnaire was used to collect socio-demographic data and factors associated with HBV infection. The presence of hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and human immunodeficiency virus (HIV) were determined using commercial test strips. A chi-square test was used for the analysis.
RESULTS
The mean age was 31.8 (SD6.2) years. All women were married and (23.4%) were farmers while (47.0%) had secondary education. Sixteen women (5.3%) were HBsAg-positive, of whom (6.3%) were positive for HBsAg. The prevalence of HIV infection was (0.3%). Overall, (6.3%) women were co-infected with HIV and HBV. Independent correlates of HBV infection included a history of Jaundice (p = 0.046) history of sexually transmitted infections (p=0.005) and concurrent infection by HIV (p < 0.0001).
CONCLUSION
The prevalence of HBV infection among pregnant women in Abakaliki was intermediate. The relatively high rate of women positive to both HBsAg and HBeAg suggests that perinatal transmission of HBV might be the prevailing mode of HBV transmission in this area.
PubMed: 38952881
DOI: 10.60787/NMJ-64-4-347 -
Nigerian Medical Journal : Journal of... 2023Oligohydramnios is defined as amniotic fluid index (AFI) less than or equal to 5cm. A borderline AFI has been defined as an AFI of 5.1cm to 8cm. The incidence of...
Comparison of the Effect of Injection Enoxaparin Versus Conventional Treatment on Amniotic Fluid Index in Borderline Oligohydramnios in Third Trimester of Pregnancy: A Randomized Control Trial in a Tertiary Care Hospital.
BACKGROUND
Oligohydramnios is defined as amniotic fluid index (AFI) less than or equal to 5cm. A borderline AFI has been defined as an AFI of 5.1cm to 8cm. The incidence of borderline AFI compared with a normal AFI (8.1cm to 18cm) is 6% to 44% in different studies. A decrease in amniotic fluid leads to serious complications for the mother and fetus. The study objective was to evaluate if an injection of Enoxaparin improves the amount of liquor in oligohydramnios in the third trimester of pregnancy.
METHODOLOGY
A randomized controlled trial was conducted at a tertiary care obstetric center, involving a total of 130 participants. Inclusion criteria include participant in 3 trimester of pregnancy, singleton pregnancy, intact amniotic membranes, and no known medical disorder. Patients with multiple pregnancies, ruptured amniotic membranes, anomalous fetuses, and known medical disorders were excluded. These participants were divided into two groups, each consisting of 65 participants. Group A received conventional treatment (intravenous fluid, tablet Aspirin, and rest in lateral position), while Group B received an injection of enoxaparin in addition to conventional treatment. AFI measurements were performed in the radiology department by radiologists using standard 4 quadrant measurements, twice weekly after the initiation of the treatment. The weight of the baby noted at birth and admission to neonatal intensive care was noted to assess the health of the neonate. Data was analyzed on SPSS (statistical package for social sciences) version 23.
RESULTS
In group A, the AFI increased after treatment in 47(72.3%) patients, remained static in 6(9.2%) patients, and decreased in 12(18.4%) patients. Whereas in group B, AFI increased in 31(68.8%) patients and decreased in 14(31.3%) patients, p= 0.334.
CONCLUSION
The findings in the current study did not demonstrate any significant effect of the use of injection enoxaparin in improving borderline oligohydramnios. Further research is needed to apply this research to the general population.
PubMed: 38952876
DOI: 10.60787/NMJ-64-4-319 -
Cureus Jun 2024The pandemic due to severe respiratory syndrome coronavirus 2 (SARS-Cov-2) was one of the most damaging healthcare emergencies the world has ever seen. Co-infection with...
The pandemic due to severe respiratory syndrome coronavirus 2 (SARS-Cov-2) was one of the most damaging healthcare emergencies the world has ever seen. Co-infection with dengue virus in COVID-19-positive patients is an additional challenge especially in dengue-endemic areas. Both dengue and COVID-19 infection cause increased morbidity and adverse outcomes in pregnant women, and simultaneous infection of these two illnesses can be further detrimental and sometimes fatal in pregnant women. Here, we present a case of a pregnant woman in her early second trimester with co-infection of dengue and moderate COVID-19 disease who was managed successfully and had a favorable outcome.
PubMed: 38952612
DOI: 10.7759/cureus.61501